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Form Indiana Income Tax Do Not Mail
IT-8879C DECLARATION OF ELECTRONIC FILING This Form
State Form 55685
(R9 / 12-22) For calendar year 2022, or other tax year beginning To DOR
____________, 2022 and ending ____________, ______
Submission ID — —
Corporation/Partnership/Fiduciary Name Federal Employer Identification Number
Street Address City State ZIP Code Daytime Telephone Number
Part I. Tax Return Information (See instructions on next page)
1. Total net income (loss) from Form IT-20S/IT-65/IT-20/IT-41, line 1 ......................................................... 1.
2. Total income as adjusted (Form IT-20S/IT-65, line 3; Form IT-20, line 21;Form IT-41, line 9) ............... 2.
3. IT-20S ONLY: Total income tax from Schedule B (IT-20S, line 13) ......................................................... 3.
4. Total tax (Form IT-20S, line 16; Form IT-65, line 7; Form IT-20, line 23; Form IT-41, line 12) ................ 4.
5. Subtotal (Form IT-20S, line 23; Form IT-65, line 14; Form IT-20, line 41; Form IT-41, line 15) .............. 5.
6. Total amount due (Form IT-20S, line 27; Form IT-65, line 18; Form IT-20, line 45; Form IT-41, line 19) .... 6.
7. Overpayment/Refund (Form IT-20S, line 28; Form IT-65, line 19; Form IT-20, line 46; Form IT-41, line 20) . 7.
Part II. Electronic Settlement
8. Type of settlement: Direct Deposit of Refund
Direct Debit of Amount Owed Amount Date of Withdrawal
9. Routing number: Do NotNote: The first two digits of the routing number must be 01 - 12 or 21 - 32.
Mail
10. Account number:
Do Not Mail
11. Type of account: Checking Savings
This Form
12. Place an “X” in the box if refund will go to an account outside the United States.
To DOR
My request for direct deposit of my refund, or direct debit of the amountThisI owe, includesFormmy authorization for the Indiana Department of
Revenue to furnish my financial institution with my routing number, accountTonumber, accountDORtype, and Federal Employer Identification
Number to ensure my refund or payment is properly processed.
Part III. Declaration of Taxpayer
Under penalties of perjury, I declare that I am an officer of the corporation/partnership/fiduciary listed above and the amounts in Part I I
agree with the amounts on the corresponding lines of the electronic portion of the corporation’s/partnership’s/fiduciary’s 2022 Indiana
income tax returns. To the best of my knowledge and belief, this 2022 return is true, correct, and complete. I consent to my electronic N
return originator (ERO) sending my return, this declaration, and accompanying schedule and statements to the Indiana Department
of Revenue (DOR). I also consent to DOR sending my ERO and/or transmitter an acknowledgement of receipt of transmission and D
an indication of whether or not my return is accepted and, if rejected, the reason(s) for the rejection. If the processing of my return or
refund is delayed, I authorize DOR to disclose to my ERO and/or transmitter the reason(s) for the delay of when the refund was sent.
I
In addition, by using a computer system and software to prepare and transmit my return electronically, I consent to the disclosure
to DOR of all information pertaining to my use of the system and software and to the transmission of my tax return electronically. A
Officer’s signature ► ___________________________________ Title ______________________________ Date ______________________ N
Part IV. Declaration of ERO/Preparer/Transmitter A
I confirm that I am submitting this return in accordance with the IRS and Indiana Department of Revenue electronic filing programs.
ERO’s EFIN ________________________________ PTIN (if preparer) ______________________________ Phone _____________________
ERO’s Signature ► __________________________________________
ERO Must Retain This Form - See instructions. Do Not Submit this form to DOR unless requested to do so.
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