Form

8453-NR U.S. Nonresident Alien Income Tax Declaration

for Electronic Filing
OMB No. 1545-1274

Department of the Treasury

Internal Revenue Service
For the year January 1–December 31, 2000
䊳 See instructions on back. 2000
Taxpayer’s first name and initial Last name Identifying number

Part I Tax Return Information (Whole dollars only)

1 Adjusted gross income (Form 1040NR, line 33) 1

2 Total tax (Form 1040NR, line 54) 2

3 Total payments (Form 1040NR, line 64) 3

4 Refund (Form 1040NR, line 66a) 4

5 Amount you owe (Form 1040NR, line 68) 5

Part II Direct Deposit of Refund (Optional—See instructions.)

The routing number must be nine digits, and the first

6 Routing number two must be 01 through 12 or 21 through 32.

7 Account number

8 Type of account: Checking Savings

Part III Declaration of Taxpayer (Sign only if Part I is completed.)
9a I consent that my refund be directly deposited as designated in Part II, and declare that the information on lines 6 through 8 is correct.
b I do not want direct deposit of my refund or am not receiving a refund.
If I have filed a balance due return, I understand that if the IRS does not receive full and timely payment of my tax liability, I will remain liable for
the tax liability and all applicable interest and penalties.
Under penalties of perjury, I declare that the information I have given my electronic return originator (ERO) and the amounts in Part I above (or the
amounts on the attached listing) agree with the amounts on the corresponding lines of the electronic portion of my 2000 Federal income tax return.
To the best of my knowledge and belief, my return is true, correct, and complete. I consent to my ERO sending my return, this declaration, and
accompanying schedules and statements to the IRS. I also consent to the IRS sending my ERO and/or transmitter an acknowledgment of receipt
of transmission and an indication of whether or not my return is accepted, and, if rejected, the reason(s) for the rejection, and, if I am applying for
a refund anticipation loan or similar product, an indication of a refund offset. If the processing of my return or refund is delayed, I authorize the IRS
to disclose to my ERO and/or transmitter the reason(s) for the delay, or when the refund was sent.

Sign Here 䊳 Your signature Date

Part IV Declaration of Electronic Return Originator (ERO) and Paid Preparer (See instructions.)
I declare that I have reviewed the above taxpayer’s return and that the entries on Form 8453-NR are complete and correct to the best of my
knowledge. If I am only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on the
return. The taxpayer will have signed this form before I submit the return. I will give the taxpayer a copy of all forms and information to be filed with
the IRS, and have followed all other requirements in Procedures for Electronic Filing of U.S. Nonresident Alien Income Tax Returns, Form 1040NR,
for Tax Year 2000. If I am also the Paid Preparer, under penalties of perjury I declare that I have examined the above taxpayer’s return and
accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. This Paid Preparer
declaration is based on all information of which I have any knowledge.

䊳
Date Check if ERO’s SSN or PTIN
ERO’s also paid Check if self-
ERO’s signature preparer employed

Use Only Firm’s name (or

yours if self-employed),
address, and ZIP code
䊳 EIN
Phone no. ( )

Under penalties of perjury, I declare that I have examined the above taxpayer’s return and accompanying schedules and statements, and to the
best of my knowledge and belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.

䊳
Date Preparer’s SSN or PTIN
Paid Preparer’s
signature
Check if
self-employed
Preparer’s
䊳
Firm’s name (or EIN
yours if self-employed),
Use Only address, and ZIP code Phone no. ( )

For Paperwork Reduction Act Notice, see back of form. Cat. No. 13115A Form 8453-NR (2000)
Form 8453-NR (2000) Page 2

Purpose of Form Line 6. The routing number must be nine digits, and the first two
must be 01 through 12 or 21 through 32. Otherwise, the direct
Use Form 8453-NR to: deposit will be rejected and a check sent instead.
● Authenticate the electronic portion of Form 1040NR, U.S. Line 7. The account number can be up to 17 characters (both
Nonresident Alien Income Tax Return, numbers and letters). Include hyphens but omit spaces and
● Send any accompanying paper schedules or statements, special symbols. Enter the number from left to right and leave
● Authorize the electronic return originator (ERO) to transmit via any unused boxes blank.
a third-party transmitter, and
● Confirm the taxpayer’s consent to directly deposit any refund
Part III—Declaration of Taxpayer
into an account of a U.S. financial institution located in the Note: All taxpayers must check either the box on line 9a or the
United States. box on line 9b.
An electronically transmitted return will not be considered
Who Must File complete, and therefore filed, unless and until a Form 8453-NR
Every nonresident alien filing a 2000 Form 1040NR electronically signed by the taxpayer is received by the IRS.
must file a signed 2000 Form 8453-NR. The taxpayer’s signature allows the IRS to disclose to the
ERO and/or transmitter the reason(s) for a delay in processing
Signature for Multiple-Return Filing the return or refund. In the case of a taxpayer who is applying
A single signature may be used for a multiple-return filing by a for a refund anticipation loan or similar product, the taxpayer’s
person authorized to sign each return. If you are filing more than signature also allows the IRS to advise the ERO and/or
one return for which only one signature is provided, enter “See transmitter if a refund offset may occur.
attached Multiple-Return Information Listing” in the space If the ERO makes changes to the electronic return after
provided for the taxpayer’s name. You must also attach a Form 8453-NR has been signed by the taxpayer but before it is
Multiple-Return Information Listing according to the instructions transmitted and either 1 or 2 below applies, the ERO must have
given in the Procedures for Electronic Filing of U.S. Nonresident the taxpayer complete and sign a corrected Form 8453-NR.
Alien Income Tax Returns, Form 1040NR, for Tax Year 2000. 1. The adjusted gross income on line 1 differs from the
The information listing must include the name control for each amount on the electronic return by more than $50 or
taxpayer, identifying number, and the information requested on 2. The total tax on line 2, the total payments on line 3, the
lines 1 through 5 of Form 8453-NR for each return. refund on line 4, or the amount owed on line 5 differs from the
amount on the electronic return by more than $14.
When To File
This form must be filed when the electronic return is transmitted. Part IV—Declaration of Electronic Return
Originator (ERO) and Paid Preparer
Where To File
The IRS requires the ERO’s signature. A paid preparer must sign
Send Form 8453-NR to: Form 8453-NR in the space for Paid Preparer’s Use Only. Only
Internal Revenue Service handwritten signatures are acceptable. But if the paid preparer is
Philadelphia Submission Processing Center also the ERO, do not complete the paid preparer’s section.
ATTN: DP 2720, ELF Processing Support Section Instead, check the box labeled “Check if also paid preparer.”
11601 Roosevelt Blvd. Note: If the paid preparer’s signature cannot be obtained on
Philadelphia, PA 19154 Form 8453-NR, you may attach a copy of Form 1040NR instead.
Attach only pages 1 and 2, and write “COPY—DO NOT
PROCESS” on each page.
Part II—Direct Deposit of Refund
Refunds. After the IRS has accepted the return, the refund
Note: Taxpayers who want to have their refund directly should be issued within 3 weeks. However, some refunds may
deposited must complete Part II and check the box on line 9a. be delayed because of compliance reviews to ensure that
A check, form, report, or other statement generated by the returns are accurate.
financial institution should show the routing number and account
number. On checks, the check number usually follows the
account number at the bottom of the check. Be sure not to Paperwork Reduction Act Notice. We ask for the information
include the check number. on this form to carry out the Internal Revenue laws of the United
States. You are required to give us the information. We need it
For accounts payable through a financial institution other than
to ensure that you are complying with these laws and to allow
the one at which the account is located, the taxpayer should use
us to figure and collect the right amount of tax.
a document, such as an account statement or account
identification card, showing the routing number of the bank or You are not required to provide the information requested on
institution where the account is located. A deposit slip should a form that is subject to the Paperwork Reduction Act unless the
not be used because it can contain internal routing numbers. If form displays a valid OMB control number. Books or records
there is any doubt about the correct routing number, the relating to a form or its instructions must be retained as long as
taxpayer should contact the financial institution and ask for the their contents may become material in the administration of any
correct routing number for direct deposit (Electronic Funds Internal Revenue law. Generally, tax returns and return
Transfers). information are confidential, as required by Internal Revenue
Code section 6103.
Note: Some financial institutions may not accept direct deposits
into accounts that are payable through another bank or financial The time needed to complete and file this form will vary
institution, including credit unions. Also, the financial institution depending on individual circumstances. The estimated average
must be a U.S. financial institution located in the United States. time is 15 minutes. If you have comments concerning the
The IRS cannot make a direct deposit to a foreign bank or a accuracy of this time estimate or suggestions for making this
foreign branch of a U.S. bank. form simpler, we would be happy to hear from you. You can
write to the Tax Forms Committee, Western Area Distribution
Center, Rancho Cordova, CA 95743-0001. Do not send the form
to this address. Instead, see Where To File on this page.