Pennsylvania PA Individual Income Tax Declaration for Electronic Filing

PA Individual Income Tax Declaration for Electronic Filing
2023 Pennsylvania Individual Income Tax Declaration for Electronic Filing (PA-8453)
IMPORTANT: FILL IN FORM MUST BE DOWNLOADED ONTO YOUR COMPUTER PRIOR TO COMPLETING

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PENNSYLVANIA INDIVIDUAL INCOME TAX
DECLARATION FOR ELECTRONIC FILING

PA-8453 (EX) 03-23 (FI)

➜

For the year Jan. 1 – Dec. 31, 2023
Primary Taxpayer’s Social Security Number
Last Name

2023

Declaration Control Number/Submission ID
Secondary Taxpayer’s Social Security Number

Primary Taxpayer’s Name, Initial; Secondary Taxpayer’s First Name, Initial; Secondary Taxpayer’s Last Name (only if different)

Home Address (Number and Street including Rural Route or P.O. Box)
City

State

ZIP Code

Daytime Telephone Number

NO DASHES

The above information must match that on the electronic return exactly.
Mark Proper Filing Status

Á

SECTION I

S

Single

M

Married, Filing Separately

J

Married, Filing Jointly

D

Deceased

F

Final Return

TAX RETURN INFORMATION (whole dollars only)

1. Adjusted PA taxable income (Form PA-40, Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
2. PA tax liability (Form PA-40, Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Total PA tax withheld (Form PA-40, Line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
4. Amount to be refunded (Form PA-40, Line 30) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Total payment (tax due) (Form PA-40, Line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.

SECTION II

DIRECT DEPOSIT OF REFUND OR ELECTRONIC FUNDS WITHDRAWAL OF TAX DUE (optional - see instructions)

STAPLE COPY OF
STATE W-2(s), W-2G
and 1099(s) HERE

6. Routing transit number (RTN)

8. Type of account:
Checking

9. Debit date
Savings

MMDDYYYY

NOTE: The first two numbers of the RTN must be 01 through 12 or 21 through 32.

SECTION III
10.

7. Depositor account number (DAN)

DECLARATION OF TAXPAYERS (sign only after Section I is complete)

a. I consent for my refund to be directly deposited as designated in Section II and declare all information shown on Lines 6 through 8 is correct. I certify the ultimate
destination of the funds is within the U.S. or one of its territories. If I have filed a joint return, this is an irrevocable appointment of the other Taxpayer as an agent to
receive the refund.
b. I am not receiving a refund or I do not want direct deposit of my refund.
c. I authorize the Pennsylvania Department of Revenue and its designated financial agents to initiate an electronic funds withdrawal entry to my designated account
for Pennsylvania taxes owed. I also authorize my financial institution to debit the entry to my account and the financial institutions involved in the processing of my
electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to my payment. I certify the funds for this
withdraw are originating from an account within the U.S. or one of its territories. I may revoke this authorization by notifying the Pennsylvania Department of Revenue
no later than two business days prior to the payment (settlement) date. I understand notification must be made in writing by email to [email protected].

If I have filed a balance-due return, I understand that if the PA Department of Revenue does not receive full and timely payment of my tax liability, I will remain liable for the tax
and all applicable interest and penalties. If I have filed a joint federal and state tax return and there is an error on my state return, I understand my federal return will be rejected.
I declare under penalties of perjury that I have compared the information on my return with the information I provided to my electronic return originator and the amounts match
those on my 2023 PA Tax Return (PA-40). To the best of my knowledge, my return is true and complete. I authorize my electronic return originator to send my return and
accompanying schedules and statements to the Internal Revenue Service (IRS) and the IRS to subsequently send them to the PA Department of Revenue. In addition, by using
a computer system and software to prepare and transmit my return electronically, I consent to the disclosure of all information pertaining to my use of the system and software
and to the transmission of my tax return electronically to the PA Department of Revenue. If I am filing from a home computer, I understand that I am required to keep this form
and supporting documents for three years.
MMDDYYYY
MMDDYYYY

SIGN
HERE

Á

Primary Taxpayer

Secondary Taxpayer

Date

Signature of Primary Taxpayer – Please sign after printing

SECTION IV

Date

Signature of Secondary Taxpayer – Please sign after printing

DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER (see instructions)

I declare that I have received the above-named taxpayer’s return and that the entries on this form are complete and correct to the best of my knowledge. I obtained the taxpayer’s
signature on this form before submitting this return to the PA Department of Revenue. I provided the taxpayer with a copy of all forms and information to be filed with the IRS and
the PA Department of Revenue and followed all other requirements specified by the PA Department of Revenue and described in the IRS Publication 1345, Handbook for
Electronic Filers of Individual Tax Returns (Tax Year 2023). If I am the preparer, under penalty of perjury, I declare that I examined the above-named taxpayer’s return and
accompanying schedules and statements, and to the best of my knowledge, they are true and complete. I understand that I am required to keep this form and supporting
documents for three years.
MMDDYYYY

ERO’S
USE
ONLY

Á

ERO’s Signature

Á

Mark if also
paid preparer

Mark if
self-employed

EIN/SSN or PTIN

Firm’s Name (or yours if self-employed)
City

Address

PAID
PREPARER’S
USE
ONLY

Date

Signature of ERO – Sign after printing

Preparer’s Signature

State

Mark if
self-employed

Date

Signature of Preparer – Sign after printing

Phone Number
EIN/SSN or PTIN

MMDDYYYY

Firm’s Name (or yours if self-employed)
City

Address

ZIP Code

State

ZIP Code

Phone Number

Electronic Return Originators (EROs) and paid preparers must retain this form and supporting documents for three years.
DO NOT SUBMIT THIS FORM TO THE PA DEPARTMENT OF REVENUE UNLESS REQUESTED TO DO SO.

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2023
Instructions for PA-8453

PA-8453 IN (EX) 03-23

Individual Income Tax Declaration for Electronic Filing

FILING OF FORM PA-8453

SECTION I

If a taxpayer elects not to use the federal self-select PIN or
a return is filed without a federal return, electronic return
originators (EROs) and transmitters must retain completed
Forms PA-8453 and supporting documents for three years
after the due date of the return or the date the return was
filed electronically, whichever is later. EROs and transmitters
must make the documents available to the PA Department
of Revenue upon request. Do not mail Form PA-8453 and
attachments to the PA Department of Revenue unless
requested.

TAX RETURN INFORMATION

NOTE: If an ERO or transmitter closes its business, it
must mail all forms to the following address with a
letter of explanation.

Enter total PA tax withheld from Line 13, Form PA-40.

PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
ELECTRONIC FILING SECTION
PO BOX 280507
HARRISBURG PA 17128-0507
Any taxpayer filing electronically from a home computer
must keep the signed Form PA-8453 and supporting
documents for three years after the due date of the return
or the date the return was filed electronically, which-ever is
later. Taxpayers must make the documents available to the
PA Department of Revenue upon request. Do not mail Form
PA-8453 and attachments to the PA Department of Revenue
unless requested.

LINE INSTRUCTIONS
SUBMISSION ID
The Submission ID is a 20-digit number assigned by the
ERO to a taxpayer’s return.
NAME, ADDRESS AND SOCIAL SECURITY NUMBER
Print or type the taxpayer’s name (last name first) and
complete address including ZIP code. In the spaces
provided, enter the taxpayer’s Social Security number and
that of the spouse, if applicable. If a husband and wife use
different last names, please separate the names. For
example, Paul A. Smith and Joan A. Weston would be
Smith, Paul A. and Joan A. Weston.
The address on this form must match the address on the
electronically filed PA-40.
www.revenue.pa.gov
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LINE 1
Enter adjusted PA taxable income from Line 11, Form PA-40.

LINE 2
Enter PA tax liability from Line 12, Form PA-40.

LINE 3
LINE 4
Enter the amount to be refunded from Line 30, Form PA-40.

LINE 5
Enter total payment (tax due), from Line 28, Form PA-40.
Taxpayers are responsible for submitting payment due to
the PA Department of Revenue by April 15, 2024.
Payment may be sent along with Form PA-40 V. If Form
PA-40 V was not received, it may be completed online,
printed and mailed to the department with payment. Check
or money order should be made payable to the PA Dept. of
Revenue. The last four digits of the taxpayer’s Social
Security number, “2023 PA-40 V” and daytime telephone
number should be written on the payment.
PA DEPT. OF REVENUE
PAYMENT ENCLOSED
1 REVENUE PLACE
HARRISBURG PA 17129-0001

SECTION II
DIRECT DEPOSIT OF REFUND OR ELECTRONIC
FUNDS WITHDRAWAL
Taxpayers may elect to have refunds directly deposited or
payments made by electronic funds withdrawal by
completing Section II.

LINE 6
The routing transit number (RTN) must contain nine digits.
If the RTN does not begin with 01 through 12, or 21 through
32, the direct deposit or electronic funds withdrawal request
will be rejected.
PA-8453
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LINE 7
The depositor account number (DAN) may contain up to 17
alphanumeric characters. Include hyphens but omit spaces
and special symbols. If fewer than 17 characters, enter the
number from left to right and leave the unused boxes blank.

LINE 8
Mark the appropriate box.

LINE 9
Debit date – Enter the date the taxpayer wants the payment
electronically withdrawn, on or before April 15, 2024.
NOTE: The account cannot include the name of any
other person unless the taxpayer’s filing status on the
return is “married filing jointly” or “married filing separately,”
and the taxpayer’s spouse is the other name listed on the
account.
Some financial institutions do not permit the deposit of a joint
refund in an individual account. The PA Department of
Revenue is not responsible when a financial institution
refuses a direct deposit.
To be eligible for direct deposit or electronic funds
withdrawal, taxpayers must provide proof of account
ownership to the ERO. An acceptable proof of account
ownership is a check, form, report or other statement
generated by the financial institution that has the taxpayer’s
name, RTN and DAN preprinted on it.
For accounts payable through a financial institution other
than the one at which the account is located, the taxpayer
must provide a document, such as an account statement or
identification card, showing the RTN of the bank or institution
where the account is located. A deposit slip should not be
used to verify RTN or DAN because it can contain internal
routing numbers that are not part of the RTN.
If there is any doubt about the correct RTN, the taxpayer
should contact the financial institution for assistance.
NOTE: Some financial institutions may not accept
direct deposits into accounts payable through another
bank or financial institution, including credit unions.

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PA-8453
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SECTION III
DECLARATION OF TAXPAYER

LINE 10
All filers must mark one of the boxes.
NOTE: Taxpayers may revoke the electronic funds
withdrawal authorization by notifying the PA
Department of Revenue in writing no later than two
business days prior to the debit date. Written requests to
revoke the electronic funds withdrawal must include the
taxpayer’s name, address, Social Security number, RTN,
DAN and payment amount. Written requests can be emailed
to [email protected].
After a return has been prepared and before the return is
transmitted, the taxpayer (or both taxpayers, if filing jointly)
must verify the information on the return and sign and date
the completed Form PA-8453. If you are responsible for the
affairs of a minor, disabled person, or a decedent who could
not prepare his or her own PA tax return, you must sign to
file a valid tax return. The ERO must provide the taxpayer
with a copy of this form.
If the ERO makes changes to the electronic return after the
Form PA-8453 has been signed by the taxpayer, but before
it is transmitted, the ERO must have the taxpayer complete
and sign a corrected Form PA-8453.

SECTION IV
DECLARATION OF ELECTRONIC RETURN
ORIGINATOR (ERO) AND PREPARER
The ERO must sign this form and keep it with the required
attachments for three years.
A preparer must sign the Form PA-8453 in the space for
Preparer. If the preparer is also the ERO, do not complete
the Preparer Section; instead, mark the box labeled “Mark if
also paid preparer.”

www.revenue.pa.gov