Form 8453 EO Exempt Organization Declaration and Signature for Electronic Filing 2012

Paid Use Only Print/Type preparer s name Preparer s signature PTIN Firm s EIN Firm s address For Privacy Act and Paperwork Reduction Act Notice see back of form. if Cat. No. 36606Q Form 8453-EO 2012 Page 2 TIP Instead of filing Form 8453-EO an organization officer filing an originator ERO can sign the return using a personal identification number PIN. For details see Form 8879-EO IRS e-file Signature Authorization for an Exempt Organization. IRS.gov Should any unforeseen developments arise with respect to this form or its instructions after they are published the IRS will create a page on IRS.gov at www.irs.gov/form8543eo to alert filers to the development and provide any necessary additional instructions. For details see Form 8879-EO IRS e-file Signature Authorization for an Exempt Organization. IRS.gov Should any unforeseen developments arise with respect to this form or its instructions after they are published the IRS will create a page on IRS.gov at www.irs.gov/form8543eo to alert filers to the development and provide any necessary additional instructions. Purpose of Form Use Form 8453-EO to Authenticate the electronic Form 990 Return of Organization Exempt From Income Tax Form 990-EZ Short Form Return of Organization Exempt From U.S. Income Tax Return for Certain Political Organizations or Form 8868 Application for Extension of Time To File an Exempt Organization Return Authorize the ERO if any to transmit via a third-party transmitter Authorize the intermediate service provider ISP to transmit via a thirdparty transmitter if you are filing online not using an ERO and Authorize an electronic funds withdrawal for payment of federal taxes owed Form 990-PF Form 1120-POL or Form 8868 with payment. Who Must File If you are filing a 2012 Form 990 Form 990-EZ Form 990-PF Form 1120POL or Form 8868 with payment through an ISP and/or transmitter and you are not using an ERO you must file Form 8453-EO with your electronically filed return. An ERO can use either Form 8453-EO or Form 8879-EO to obtain authorization to file an organization s Form 990 Form 990-EZ Form 990-PF or Form 1120-POL or to file a Form 8868 with payment. Who Must File If you are filing a 2012 Form 990 Form 990-EZ Form 990-PF Form 1120POL or Form 8868 with payment through an ISP and/or transmitter and you are not using an ERO you must file Form 8453-EO with your electronically filed return. An ERO can use either Form 8453-EO or Form 8879-EO to obtain authorization to file an organization s Form 990 Form 990-EZ Form 990-PF or Form 1120-POL or to file a Form 8868 with payment. When To File Form 990 Form 990-EZ and Form 990-PF. File Form 990 Form 990-EZ or Form 990-PF by the 15th day of the 5th month after the organization s accounting period ends. And belief they are true correct and complete. Declaration of preparer is based on all information of which the preparer has any knowledge. Paid Use Only Print/Type preparer s name Preparer s signature PTIN Firm s EIN Firm s address For Privacy Act and Paperwork Reduction Act Notice see back of form. if Cat. No. 36606Q Form 8453-EO 2012 Page 2 TIP Instead of filing Form 8453-EO an organization officer filing an originator ERO can sign the return using a personal identification number PIN. An ERO may sign the Form 8453-EO by rubber stamp mechanical device or computer software program. The alternative method of signing must include either a facsimile of the individual ERO s signature or of the ERO s printed name. Use of PTIN Paid preparers. Anyone who is paid to prepare the organization s return must enter their PTIN in Part III. The PTIN entered must have been issued after September 27 2010. For information on applying for and receiving a PTIN see Form W-12 IRS Paid Preparer Tax Identification Number PTIN Application and Renewal or visit www.irs.gov/ptin. EROs who are not paid preparers. When To File Form 990 Form 990-EZ and Form 990-PF. File Form 990 Form 990-EZ or Form 990-PF by the 15th day of the 5th month after the organization s accounting period ends. If the regular due date falls on a Saturday Sunday or legal holiday the organization may file on the next business day. The Form 8453-EO must be filed with the electronically filed Form 990 Form 990-EZ or Form 990-PF. Form 1120-POL. File Form 1120-POL by the 15th day of the 3rd month after the organization s accounting period ends. Form 8453-EO Exempt Organization Declaration and Signature for Electronic Filing For calendar year 2012 or tax year beginning 2012 and ending OMB No. 1545-1879 For use with Forms 990 990-EZ 990-PF 1120-POL and 8868 Department of the Treasury Internal Revenue Service Name of exempt organization Employer identification number Type of Return and Return Information Whole Dollars Only Part I Check the box for the type of return being filed with Form 8453-EO and enter the applicable amount if any from the return. If you check the box on line 1a 2a 3a 4a or 5a below and the amount on that line of the return being filed with this form was blank then leave line 1b 2b 3b 4b or 5b whichever is applicable blank do not enter -0-. If you entered -0- on the return then enter -0- on the applicable line below. Do not complete more than one line in Part I. 1a 2a 3a 4a 5a Form 990 check here b Total revenue if any Form 990 Part VIII column A line 12. Form 990-EZ check here Form 1120-POL check here b Total tax Form 1120-POL line 22. Under penalties of perjury I declare that I am an officer of the above named organization and that I have examined a copy of the correct and complete. I further declare that the amount in Part I above is the amount shown on the copy of the organization s electronic return. I consent to allow my intermediate service provider transmitter or electronic return originator ERO to send the organization s return to the IRS and to receive from the IRS a an acknowledgement of receipt or reason for rejection of the transmission b the reason for any delay in processing the return or refund and c the date of any refund. Date Signature of officer Sign Here Title I declare that I have reviewed the above organization s return and that the entries on Form 8453-EO are complete and correct to the best of my knowledge.