Georgia Declaration for Electronic Filing

Declaration for Electronic Filing
8453_2018_Individual_Income_Tax_Declaration_for_Electronic_Filing_4.11.18
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DO NOT

CLEAR

ERO MUST RETAIN THIS FORM.
DO NOT SUBMIT THIS FORM TO
GEORGIA DEPARTMENT OF REVENUE
UNLESS REQUESTED TO DO SO.

MA

IL!

PLEAS

PRINT

GA-8453
2023

IRS DCN OR SUBMISSION ID

GEORGIA INDIVIDUAL INCOME TAX DECLARATION FOR ELECTRONIC FILING
SUMMARY OF AGREEMENT BETWEEN TAXPAYER AND ERO OR PAID PREPARER
Amended Return

First Name and Initial

Last Name

Social Security Number

If Joint Return, Spouse’s First Name and Initial

Spouse’s Last Name

Spouse’s Social Security Number

Home Address (number and street)

Apt Number

Daytime Telephone Number

City, Town or Post Office

State

Zip Code

PART I

TAX RETURN INFORMATION

1. Federal Adjusted Gross Income (Form 500
2. Georgia Taxable Income (Form 500

, Line 8; Form 500EZ, Line 1) .................. 1.
, Line 15c; Form 500EZ, Line 3) .........................

2.

, Line 22; Form 500EZ, Line 6) ........................................

3.

4. Balance Due (Form 500, Line 44; Form 500X, Line 37; Form 500EZ, Line 23) .................................

4.

3. Net Georgia Tax (Form 500

5. Refund (Form 500, Line 45; Form 500X, Line 38; Form 500EZ, Line 24) ............................................ 5.

PART II

DECLARATION OF TAXPAYER(S)

Under penalties of perjury, I declare that the information I have provided to my Electronic Return Originator (ERO) and/or Online Service
Provider and/or Transmitter and the amounts shown in Part I agree with the amounts shown on the corresponding lines
of the electronic portion of my 2023 Georgia Income Tax Return. I declare that I have examined my tax return,
including accompanying schedules and statements, and to the best of my knowledge and belief, my return is true, correct and
complete. I consent that the electronic portion of my return may be sent by my ERO/Online Service Provider/Transmitter.

SIGN
HERE

TAXPAYER’S SIGNATURE

PRINT NAME

PART III

Date

SPOUSE’S SIGNATURE (if joint return, both must sign) Date

EMAIL ADDRESS

DECLARATION OF ELECTRONIC RETURNS ORIGINATOR AND PAID PREPARER

I DECLARE THAT I HAVE REVIEWED THE ABOVE TAXPAYER’S RETURN AND THAT THE ENTRIES ON THE GA-8453 ARE COMPLETE
AND CORRECT TO THE BEST OF MY KNOWLEDGE.

ERO’s
Use
Only

ERO’s Signature _____________________________________________________________

Date ______________________

Firm’s Name

_______________________________________________________________

Check also if paid preparer

Address

_______________________________________________________________

FEIN/PTIN

City, State, & Zip Code_________________________________________________________ SSN/TIN

IF PREPARED BYANY PERSON OTHER THAN THE TAXPAYER, THIS DECLARATION IS BASED ON ALL INFORMATION OF WHICH
THE PREPARER HAS ANY KNOWLEDGE.

Paid Preparer’s Signature _____________________________________________________

Paid
Firm’s Name
Preparer’s
Use Only Address

Date ______________________

_______________________________________________________________

FID/TIN

_______________________________________________________________

SSN/TIN

City, State, & Zip Code_________________________________________________________

GA-8453 (REV 05/05/23)

KEEP A COPY WITH YOUR RECORDS

PRINT

CLEAR

General Instructions
PURPOSE OF FORM
The GA-8453 is a signature form summarizing the agreement between the taxpayer and ERO or paid preparer. It may also be used by
the Georgia Department of Revenue (GADOR) to authenticate the electronic portion of Form 500, 500EZ or 500X. This form is to be
used when GA 500, 500EZ or 500X is filed electronically. This form should not be mailed, but should be kept for a period of 3 years
from the end of the year of which the return is filed. Taxpayers filing from home computers must keep the signed GA-8453 and supporting
documents for three (3) years after the due date of the return or the date the return was filed electronically, whichever is later.
LINE INSTRUCTIONS
Enter either the DCN or Submission ID.
IRS DCN – This is the IRS’s Declaration Control Number. This is a 14 digit number assigned to each return by the electronic returns
originator (ERO). This number will be the same as on the Federal return.
SUBMISSION ID – This is a distinct ID assigned to every electronic return that is submitted to Georgia. This 20 character ID can be
used in tracking the return.
PART I – TAX INFORMATION
Enter the required data from the Georgia tax return. Lines 1-3 must be completed. Either Line 4 or Line 5 should also be completed.
These lines must reflect the amounts transmitted on the return.
Payment of Balance Due – It is the responsibility of the taxpayer who owes additional tax to make payment to the Georgia Department
of Revenue using one of the following methods:
Mail a check with the 525-TV. This voucher and other forms can be found online at dor.georgia.gov.
ACH debit payment is available online at https://gtc.dor.ga.gov and through the payment option within tax software programs.
Credit card payments can be made online. For more information, see https://dor.georgia.gov/credit-card-payments.
PART II – DECLARATION OF TAXPAYER(S)
After the return has been prepared and before the return is transmitted, the taxpayer (and spouse, if joint) must verify the
information on the return, and sign and date the completed GA-8453. The ERO must provide the taxpayer(s) with a copy of
this form.
If an ERO makes changes to the electronic return after the GA-8453 has been signed by the taxpayer, but before transmittal, the ERO
must have the taxpayer complete and sign a corrected GA-8453.
PART III – DECLARATION OF ELECTRONIC RETURNS ORIGINATOR AND PAID PREPARER
The Georgia DOR requires that the ERO sign this form and keep it with the required attachments for three (3) years. A preparer must
sign the GA-8453 in the space provided for the preparer. If the preparer is also the ERO, do not complete the Preparer Section;
instead, check the box labeled “Check also if paid preparer” in the ERO section.
TAXPAYER(S)’ COPY: The ERO must provide a copy of the completed GA-8453 and all other relevant and required information to the
taxpayer(s).
TELEPHONE ASSISTANCE:
Refunds

1-877-423-6711

Taxpayer Assistance

1-877-423-6711

INDIVIDUAL TAX QUESTIONS:

[email protected]

Georgia Tax Center (GTC)

https://gtc.dor.ga.gov

REPORTING FRAUD

dor.georgia.gov/webform/fraud-referral-form

A fraud hotline has been established for practitioners and taxpayers to report tax-related activities that they believe are illegal or
incorrect. The hotline can be used to report suspected illegal activity for all tax types. Persons submitting reports may remain
anonymous.
For Rules and Regulations, Frequently Asked Questions and forms, please visit our website at dor.georgia.gov

KEEP THIS FORM FOR YOUR RECORDS