8453 Form 2011

Form 8453-EO Exempt Organization Declaration and Signature for Electronic Filing For calendar year 2011 or tax year beginning 2011 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 See instructions on back. 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 2011 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. Who Must File If you are filing a 2011 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. 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. b Tax based on investment income Form 990-PF Part VI line 5 Form 8868 check here b Balance due Form 8868 Part I line 3c or Part II line 8c. Declaration of Officer 1b 2b 3b 4b 5b I authorize the U*S* Treasury and its designated Financial Agent to initiate an Automated Clearing House ACH electronic funds withdrawal direct debit entry to the financial institution account indicated in the tax preparation software for payment of the organization s federal taxes owed on this return and the financial institution to debit the entry to this account. To revoke a payment I must contact the U*S* Treasury Financial Agent at 1-888-353-4537 no later than 2 business days prior to the payment settlement date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. If a copy of this return is being filed with a state agency ies regulating charities as part of the IRS Fed/State program I certify that I executed the electronic disclosure consent contained within this return allowing disclosure by the IRS of this Form 990/990-EZ/990PF as specifically identified in Part I above to the selected state agency ies.