Form 8879-Pe - Irs E-File Signature Authorization For Form 1065 (Page 2 of 2) in pdf

ERO MUST RETAIN THIS FORM.

DO NOT SUBMIT THIS FORM TO

GEORGIA DEPARTMENT OF REVENUE

UNLESS REQUESTED TO DO SO.

IRS DCN OR SUBMISSION ID

GA-8453P

2016

GEORGIA PARTNERSHIP TAX RETURN DECLARATION FOR ELECTRONIC FILING

SUMMARY OF AGREEMENT BETWEEN TAXPAYER AND ERO OR PAID PREPARER

Beginning

, and Ending

Original Return

Amended Return

Final Return

Name Change

Change of Address

Composite Return

FEI Number

Name

Number of Partners

Resident

Non-Resident

GA Withholding Tax Acct. Number

Business Address

Country

Telephone Number

Payroll WH Number Nonresident WH Number

GA Sales Tax Reg. Number

City or Town

State

Zip Code

NAICS Code

Kind of Business

Location of Books for Audit (City & State)

TAX RETURN INFORMATION

PART I

1. Total Income for Georgia purposes (Schedule 1, Line 1) ..................................................

2. Total Georgia net income (Schedule 1, Line 7) .................................................................

DECLARATION OF PARTNER

PART II

Under the penalty of perjury, I declare that I am a general partner or limited liability company member of the above partnership and the information

I have provided to my Electronic Return Originator (ERO) and/or Online Service Provider and/or Transmitter, the amounts shown in Part I agree with

the amounts shown on the corresponding lines of the electronic portion of my 2016 Georgia Partnership 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 to the IRS by my ERO/Online Service Provider/Transmitter.

SIGN

HERE

Signature of Partner

Date

E-mail Address

DECLARATION OF ELECTRONIC RETURNS ORIGINATOR AND PAID PREPARER

PART III

I DECLARE THAT I HAVE REVIEWED THE ABOVE TAXPAYER'S RETURN AND THAT THE ENTRIES ON THE GA-8453P ARE COMPLETE

AND CORRECT TO THE BEST OF MY KNOWLEDGE.

ERO's Signature

Date

ERO'S

Firm's Name

Check also if paid preparer

USE

ONLY

Address

FEIN/PTIN

City, State & Zip Code

SSN/TIN

IF PREPARED BY A PERSON OTHER THAN THE TAXPAYER, THIS DECLARATION IS BASED ON ALL THE INFORMATION OF WHICH

THE TAXPAYER HAS KNOWLEDGE.

Paid Preparer's Signature

Date

PAID

PREPARER'S

Firm's Name

FEIN/PTIN

USE ONLY

Address

SSN/TIN

City, State & Zip Code

KEEP A COPY WITH YOUR RECORDS

GA-8453P (Rev. 09/26/16)

013

Form 8879-Pe - Irs E-File Signature Authorization For Form 1065 Page 2

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