Form Ga-8453s - Georgia S Corporate Income Tax Declaration For Electronic Filing - Summary Of Agreement Between Taxpayer And Ero Or Paid Prepayer - 2016

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CLEAR
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-8453S
2016
GEORGIA S CORPORATE INCOME TAX DECLARATION FOR ELECTRONIC FILING
SUMMARY OF AGREEMENT BETWEEN TAXPAYER AND ERO OR PAID PREPARER
UET Annualization Exception attached
2016
2017
Initial Net Worth
Income Tax Return
Net Worth Return
C Corp Last Year
Extension
Composite Return Filed
Name Change
Beginning ____________________
Beginning ____________________
PL 86-272
Original Return
Address Change
QSSS Exempt
Ending
_____________________
Ending
_____________________
Amended Return
Final
Federal Employer ID Number
Name (Corporate title)
Date admitted into GA
Location of Books (City & State)
Business Address
Incorporated under laws of
what state
Telephone Number
City or Town
State
Zip Code
NAICS Code
P
I
TAX RETURN INFORMATION
ART
1. Federal ordinary income
1.
(Form 600S, Line S) ..............................................................................................
2. Total Income for Georgia purposes
2.
(Form 600S, Sch 6, Line 11) ................................................................
3. Net Worth
3.
(Form 600S, Sch 3, Line 4) ...........................................................................................................
4. Net Worth Taxable by Georgia
4.
(Form 600S, Sch 3, Line 6) .........................................................................
5. Tax Amounts
Income
..... Net Worth
(Form 600S, Sch 4, Line 1) ...........
6. Balance of Tax due with return
6.
(Form 600S, Sch 4, Line 10).......................................................................
7. Refund
Credited to 2017
...... Refunded
(Form 600S, Sch 4, Line 11) ...
P
II
DECLARATION OF CORPORATE OFFICER
ART
Under penalties of perjury, I declare that the information I have provided to the corporation’s Electronic Return Originator (ERO) and/or Online Service Provider and/or
Transmitter andthe amountsshowninPart Iagree withthe amountsshownonthe corresponding lines of the electronic portion of the corporation’s 2016 Georgia S
Corporate Income Tax Return. I declare that I have examined the corporation’s tax return including, accompanying schedules and statements, and to the best
of my knowledge and belief, the corporation’s return is true, correct and complete. I consent that the electronic portion of the corporation’s return may be sent
by my ERO/Online Service Provider/Transmitter.
S
IGN
H
SIGNATURE OF OFFICER
DATE
ERE
TITLE
PRINT NAME
E-MAIL
P
III
DECLARATION OF ELECTRONIC RETURNS ORIGINATOR AND PAID PREPARER
ART
I DECLARE THAT I HAVE REVIEWED THEABOVE CORPORATION’S RETURNAND THATTHE ENTRIES ON THE GA-8453S ARE COMPLETE
AND CORRECTTO THE BEST OF MYKNOWLEDGE.
ERO’s Signature _________________________________________________________________
Date _______________________
ERO’s
Firm’s Name
__________________________________________________________________
Check also if paid preparer
Use
Address
__________________________________________________________________
Only
City, State & Zip Code ________________________________________________________________
IF PREPARED BYA 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
Firm’s Name
__________________________________________________________________
FEIN/PTIN _________________
Preparer’s
Address
__________________________________________________________________
SSN/TIN ___________________
Use Only
City, State & Zip Code ________________________________________________________________
KEEP A COPY WITH YOUR RECORDS
GA-8453S (REV. 09/23/16)

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