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                            U.S. Individual Income Tax Transmittal for an IRS e-file Return                                                 OMB No. 1545-0074
Form   8453                                           For the year January 1–December 31, 2021
                                                      ▶
Department of the Treasury                              See instructions on back.                                                           2021
Internal Revenue Service                      ▶ Go to www.irs.gov/Form8453 for the latest information.
                         Your first name and initial                        Last name                                       Your social security number 
                P 
                R        If a joint return, spouse’s first name and initial Last name                                       Spouse’s social security number 
                I 
                N 
Please          T 
                         Home address (number and street). If you have a P.O. box, see instructions. Apt. no.                               Important! 
print or        C                                                                                                           ▲ You must enter            ▲
type.           L 
                E        City, town or post office, state, and ZIP code (If a foreign address, also complete spaces below.)   your SSN(s) above. 
                A 
                R 
                L 
                Y        Foreign country name         Foreign province/state/county   Foreign postal code

                            FILE THIS FORM ONLY IF YOU ARE ATTACHING ONE OR MORE 
                            OF THE FOLLOWING FORMS OR SUPPORTING DOCUMENTS.
Check the applicable box(es) to identify the attachments.

         Form  1098-C,  Contributions  of  Motor  Vehicles,  Boats,  and  Airplanes  (or  equivalent  contemporaneous  written
         acknowledgement)

         Form 2848, Power of Attorney and Declaration of Representative (or POA that states the agent is granted authority to sign the
         return)

         Form 3115, Application for Change in Accounting Method

         Form  3468  -  attach  a  copy  of  the  first  page  of  NPS  Form  10-168,  Historic  Preservation  Certification  Application  (Part  2—
         Description of Rehabilitation), with an indication that it was received by the Department of the Interior or the State Historic 
         Preservation  Officer,  together  with  proof  that  the  building  is  a  certified  historic  structure  (or  that  such  status  has  been 
         requested)

         Form 4136 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the
         provider identifying the product as renewable diesel and, if applicable, a statement from the reseller

         Form 5713, International Boycott Report

         Form 8283, Noncash Charitable Contributions, Section A (if any statement or qualified appraisal is required), or Section B, 
         Donated Property, and any related attachments (including any qualified appraisal or partnership Form 8283)

         Form  8332,  Release/Revocation  of  Release  of  Claim  to  Exemption  for  Child  by  Custodial  Parent  (or  certain  pages  from  a 
         divorce decree or separation agreement that went into effect after 1984 and before 2009) (see instructions)

         Form 8858, Information Return of U.S. Persons With Respect to Foreign Disregarded Entities (FDEs) and Foreign Branches (FBs)

         Form 8864 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the
         provider identifying the product as renewable diesel and, if applicable, a statement from the reseller

         Form 8885, Health Coverage Tax Credit, and all required attachments

         Form  8949,  Sales  and  Other  Dispositions  of  Capital  Assets  (or  a  statement  with  the  same  information),  if  you  elect  not  to 
         report your transactions electronically on Form 8949

                                                      DON’T SIGN THIS FORM.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see your tax return instructions.                          Cat. No. 62766T Form 8453 (2021)

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Form 8453 (2021) Page 2

General Instructions Social security number (SSN). Be sure to enter the
taxpayer’s SSN in the space provided on Form 8453. If a
Future Developments joint tax return, list the SSNs in the same order as the first
names.
For the latest information about developments related to
Form 8453 and its instructions, such as legislation Payments
enacted after they were published, go to
www.irs.gov/Form8453. Don’t attach a payment to Form 8453. Instead, mail it by
April 18, 2022 (April 19, 2022, if you live in Maine or
Purpose of Form Massachusetts), with Form 1040-V to the IRS at the
applicable address shown on that form. If a Form 1040-V
Use Form 8453 to send any required paper forms or
isn’t available, see the instructions for your tax return for
supporting documentation listed next to the checkboxes
other ways to get forms or you can go to
on Form 8453 (don’t send Form(s) W-2, W-2G, or
www.irs.gov/Forms.
1099-R).
To pay your taxes online or for more information, go to
Don’t attach any form or document that isn’t www.irs.gov/Payments.
shown on Form 8453 next to the checkboxes. If
▲! you are required to mail in any documentation Form 2848. An electronically transmitted return signed by
CAUTION
not listed on Form 8453, you can’t file the tax an agent must have a power of attorney attached to Form
return electronically. 8453 that specifically authorizes the agent to sign the
return.
Note: Don’t mail a copy of an electronically filed Form
1040, 1040-SR, 1040-NR, 1040-PR, or 1040-SS to the Divorce decree or separation agreement. If the divorce
Internal Revenue Service (IRS). decree or separation agreement went into effect after
1984 and before 2009, the noncustodial parent can
When and Where To File attach certain pages from the decree or agreement
If you are an ERO, you must mail Form 8453 to the IRS instead of Form 8332. To be able to do this, the decree or
within 3 business days after receiving acknowledgement agreement must state all three of the following.
that the IRS has accepted the electronically filed tax return. 1. The noncustodial parent can claim the child as a
If you are filing your tax return using an online provider, dependent without regard to any condition (such as
mail Form 8453 to the IRS within 3 business days after payment of support).
you have received acknowledgement from your 2. The other parent won’t claim the child as a
intermediate service provider and/or transmitter that the dependent.
IRS has accepted your electronically filed tax return. If 3. The years for which the claim is released.
you don’t receive an acknowledgement, you must contact
your intermediate service provider and/or transmitter. The noncustodial parent must attach all of the following
pages from the decree or agreement.
Mail Form 8453 to:
• Cover page (include the other parent’s SSN on that
Internal Revenue Service page).
Attn: Shipping and Receiving, 0254
Receipt and Control Branch • The pages that include all of the information identified in
Austin, TX 73344-0254 (1) through (3) above.
• Signature page with the other parent’s signature and
Specific Instructions date of agreement.
Name and address. Print or type the information in the Note: The noncustodial parent must attach the required
spaces provided. If using a foreign address, don’t information even if it was filed with a return in an earlier
abbreviate the country name. year.
P.O. box. Enter the box number only if the post office
doesn’t deliver mail to the home address.
Note: The address must match the address shown on
the electronically filed tax return.

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