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OMB No. 1545-0047
Form 8453-TE Tax Exempt Entity Declaration and Signature for E-file
For calendar year 2023, or tax year beginning , 2023, and ending , 20
Department of the Treasury For use with Forms 990, 990-EZ, 990-PF, 990-T, 1120-POL, 4720, 8868, 5227, 5330, and 8038-CP 2023
Internal Revenue Service Go to www.irs.gov/Form8453TE for the latest information.
Name of filer EIN or SSN
Part I Type of Return and Return Information
Check the box for the type of return being filed with Form 8453-TE and enter the applicable amount, if any, from the return. Form 8038-CP
and Form 5330 filers may enter dollars and cents. For all other forms, enter whole dollars only. If you check the box on line 1a ,2a ,3a ,4a ,5a ,
6a,7a ,8a ,9a , or10a below, and the amount on that line of the return being filed with this form was blank, then leave line 1b ,2b ,3b ,4b ,5b ,
6b ,7b ,8b ,9b , or10b , whichever is applicable, blank (do not enter -0-). If you entered -0- on the return, then enter -0- on the applicable line
below. Do not complete more than one line in Part I.
1a Form 990 check here . . b Total revenue , if any (Form 990, Part VIII, column (A), line 12) . . 1b
2a Form 990-EZ check here . b Total revenue , if any (Form 990-EZ, line 9) . . . . . . . . 2b
3a Form 1120-POL check here b Total tax (Form 1120-POL, line 22) . . . . . . . . . . 3b
4a Form 990-PF check here . b Tax based on investment income (Form 990-PF, Part V, line 5) . 4b
5a Form 8868 check here . . b Balance due (Form 8868, line 3c) . . . . . . . . . . . 5b
6a Form 990-T check here . b Total tax (Form 990-T, Part III, line 4) . . . . . . . . . . 6b
7a Form 4720 check here . . b Total tax (Form 4720, Part III, line 1) . . . . . . . . . . 7b
8a Form 5227 check here . . b FMV of assets at end of tax year (Form 5227, Item D) . . . . 8b
9a Form 5330 check here . . b Tax due (Form 5330, Part II, line 19) . . . . . . . . . . 9b
10a Form 8038-CP check here b Amount of credit payment requested (Form 8038-CP, Part III, line 22) 10b
Part II Declaration of Officer or Person Subject to Tax
11a I authorize the U.S. Treasury and its designated Financial Agent to initiate an Automated Clearing House (ACH) electronic funds
withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the
federal taxes owed on this return, and the financial institution to debit the entry to this account. To revoke a payment, I must
contact the U.S. Treasury Financial Agent at 1-888-353-4537 no later than 2 business days prior to the payment (settlement) date.
I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential
information necessary to answer inquiries and resolve issues related to the payment.
b If a copy of this return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I certify that I
executed the electronic disclosure consent contained within this return allowing disclosure by the IRS of this Form 990/990-EZ/
990-PF (as specifically identified in Part I above) to the selected state agency(ies).
Under penalties of perjury, I declare that I am an officer of the above named entity or I am the person subject to tax with respect to
(name of entity) , (EIN) ,
and that I have examined a copy of the 2023 electronic return and accompanying schedules and statements, and, to the best of my
knowledge and belief, they are true, correct, and complete. I further declare that the amount in Part I above is the amount shown on the copy
of the electronic return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send the return
to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any
delay in processing the return or refund, and (c) the date of any refund.
Sign
Here Signature of officer or person subject to tax Date Title, if applicable
Part III Declaration of Electronic Return Originator (ERO) and Paid Preparer (see instructions)
I declare that I have reviewed the above return and that the entries on Form 8453-TE are complete and correct to the best of my knowledge. If
I am only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on the return.
The entity officer or person subject to tax will have signed this form before I submit the return. I will give a copy of all forms and information to
be filed with the IRS to the officer or person subject to tax, and have followed all other requirements in Pub. 4163, Modernized e-File (MeF)
Information for Authorized IRS e-file Providers for Business Returns. If I am also the Paid Preparer, under penalties of perjury I declare that I
have examined the above return and accompanying schedules and statements, and, to the best of my knowledge and belief, they are true,
correct, and complete. This Paid Preparer declaration is based on all information of which I have any knowledge.
Date
ERO’s ERO’s Check if also Check if self- ERO’s SSN or PTIN
signature paid preparer employed
Use Firm’s name (or yours if EIN
Only self-employed),
address, and ZIP code Phone no.
Under penalties of perjury, I declare that I have examined the above return and accompanying schedules and statements, and, to the best of
my knowledge and belief, they are true, correct, and complete. Declaration of preparer is based on all information of which the preparer has
any knowledge.
Print/Type preparer’s name Preparer’s signature Date
Paid Check if self- PTIN
employed
Preparer Firm’s name Firm’s EIN
Use Only Firm’s address Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see back of form. Cat. No. 31574T Form 8453-TE (2023)
