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2
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Date Preparer’s SSN or PTIN
Date Preparer’s SSN or PTIN
Paid Preparer’s Use Only
▼
▼
▼
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete.
Preparer’s
signature
Check if
self-employed
អ
Firm’s name (or yours
if self-employed)
and address
E.I. No.
ZIP Code
▼
ERO’s Use Only
▼
ERO’s
signature
Check if also
paid preparer
អ
Firm’s name (or yours
if self-employed)
and address
E.I. No.
ZIP Code
▼
Label
Use Alabama
label.
Otherwise,
please type
or print.
Part I
Tax Return
Information
(Whole dollars only.)
Part III
Declaration
of Taxpayer
(Sign only after Part I
is completed.)
Sign
Here
Part IV
Declaration
of
Electronic
Return
Originator
(ERO) and
Paid
Preparer
(See instructions.)
Your first name and initial Last name
If a joint return, spouse’s first name and initial Last name
Home address (number and street). If a P. O. Box, see instructions. Apt. no.
City, town or post office, state, and ZIP code
L
A
B
E
L
H
E
R
E
ALABAMA DEPARTMENT OF REVENUE
Individual Income Tax Declaration for Electronic Filing
For the year January 1 – December 31, 2004
FORM
AL8453
2004
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()
1 Alabama taxable income (Form 40, line 17) .....................................................
2 Total tax liability (Form 40, line 22) ............................................................
3 Total payments (Form 40, line 26).............................................................
4 Refund (Form 40, line 33) ...................................................................
5 Amount you owe (Form 40, line 27)............................................................
Declaration Control Number (DCN)
អអ - អអអអអអ - អអអអអ - អ
00 5
Part II
Direct
Deposit
1 Routing number:
អអអអអអអអអ
2 Account number:
អអអអអអអអអអអអអអអអអ
3 Type of account:
អ
Checking
អ
Savings
Under penalties of perjury, I declare that I have compared the information contained on my return with the information I have provided to my electronic
return originator and that the amounts described in Part 1 above agree with the amounts shown on the corresponding lines of my 2004 Alabama individ-
ual income tax return. To the best of my knowledge and belief this return, including any accompanying schedules and statements, is true, correct, and
complete. Also, I hereby authorize the Alabama Department of Revenue to disclose to my ERO described below, any information concerning the dis-
bursement of the refund requested or any problems encountered in the processing of my return.
អ
I authorize a representative of the Department of Revenue to discuss my return and attachments with my preparer.
I declare that I have reviewed the above taxpayer’s Alabama individual income tax return and that the entries on this form are complete and correctly
represented based on all information of which I have any knowledge. I also declare that I have followed all other requirements described in IRS PUB.
1345, Revenue Procedures for Electronic Filing of Individual Income Tax Returns (Tax Year 2004), and the Alabama Handbook for Electronic Filers of
Individual Income Tax Returns (Tax Year 2004). If I am also the paid preparer, under penalties of perjury, I declare that I have examined this
return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete.
Your signature Date Spouse’s signature. If a joint return, BOTH must sign. Date
Form AL8453 2004
Your social security number
Spouse's soc. sec. no. if joint return
Telephone number (optional)
FN (For official use only)
DO NOT MAIL TO ALABAMA DEPT. OF REVENUE
2004 ALABAMA HANDBOOK FOR ELECTRONIC FILERS PAGE 19A