Form GA-8453 — Individual Income Tax Declaration for E-filing

# preamble

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-8453

# GEORGI A INDIVIDU AL INC OME TA X DECLARATI ON FOR ELECTRONIC FILING

# SUMMARY OF AGREEMENT BETWEEN TAXPAYER AND ERO OR PAID PREPARER

Amended Return First Name and Initial Last Name Social Security Number I f J oint Retur n, Spouse' s Firs t N ame and Initial Spouse's Last Name Spouse's Social Security Number Home Address (number and street) Apt Number Daytime Telephone Number City, Town or Post Office State Zip Code PART I TAX RETURN INFORMATION , Line 8; Form 500EZ, Line 1) .................. 1. , Line 15c; Form 500EZ, Line 3) ......................... 2. , Line 23; Form 500EZ, Line 6) ........................................ 3. 4 .. Balance Due (Form 500, Line 45; Form 500X, Line 38; Form 500EZ, Line 23) ................................. 4. 5 .. Refund (Form 500, Line 46; Form 500X, Line 39; Form 500EZ, Line 24) ............................................ 5. PART II DECLARATION OF TAXPAYER(S) SIGN HERE TAXPAYER'SSIGNATURE Date SPOUSE'S SIGNATURE (if joint return, both must sig n)Date

# PRINT NAME EMAIL ADDRESS

# PART III DECLARATION OF ELECTRONIC RETURNS ORIGINATOR AND PAID PREPARER

I DECLARE THATIHA VE REVIEWED THE ABOVE TAXPAYER'S RETURN AND THAT THE ENTRIES ON THE GA-8453 ARE COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ERO's Signature _____________________________________________________________ Date ______________________ Firm's Name _______________________________________________________________ Check also if paid preparer Address _______________________________________________________________ FEIN/PTIN ERO's Use Only City, State, & Zip Code_________________________________________________________ SSN/TIN IF PREPARED BYANY PERSON OTHER THAN THE TAXPAYER, THIS DECLARATION IS BASED ONALL INFORMATION OF WHICH THE PREPARER HASANY KNOWLEDGE. Paid Preparer's Signature _____________________________________________________ Date ______________________ Paid Preparer's Firm's Name _______________________________________________________________ Address _______________________________________________________________ City, State, & Zip Code_________________________________________________________ FID/TIN Use Only SSN/TIN GA-8453 (REV 07/11/24)

# KEEP A COPY WITH YOUR RECORDS

1. Federal Adjusted Gross Income (Form 500 2. Georgia Taxable Income (Form 500 3. Net Georgia Tax (Form 500

# PLEASEDO NOTM

AIL! Under penalties of perjury, I declare that the information I have provided to my Electronic Return Originator (ERO) and/or Online Service Provider and/or Transmitter and the amounts shown in Part I agree with the amounts shown on the corresponding lines of the electronic portion of my 2024 Georgia Income 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 by my ERO/Online Service Provider/Transmitter.

# General Instructions

# PURPOSE OF FORM

The GA-8453 i s a signature form summarizing the agree ment between the taxpayer an d ERO or paid preparer. It may also be used b y the Georgia Department of Revenue (GADOR) to authenticate the electronic portion of Form 500, 500 EZ or 500X. This form is to be used when GA 500, 500EZ or 500X is filed electronically. This form should not be mailed, but should be kept for a period of 3 years from the end of the year of which the return is filed. Taxpayers filing from home computers must keep the signed GA-8453 and supporting documents for three (3) years after the due date of the return or the date the return was filed electronically, whichever is later.

# LINE INSTRUCTIONS

Enter either the DCN or Submission ID. IRS DCN - This is the IRS's Declaration Control Number. This is a 1 4 digit number assigned to each return b y the electronic returns originator (ERO). This numbe r will b e the same as on the Federal return. SUBMISSION ID - This is a distinct ID assigned to ever y electronic return that is submitted to Georgia. This 20 character ID can be used in trackin g the return.

# PART I - TA X INFORMATION

Enter the required data from the Georgia tax return. Line s 1- 3 must be completed. Eithe r Line 4 or Lin e 5 should als o be compl eted. These lines must reflect t he amounts transmitted on the return. Payment of Balance D ue - It is the responsibilit y of the taxpaye r who owes additional tax to make payment to the Georgia Department of Revenue using one of the following methods: Mail a check with the 525-TV. This voucher and other forms can be found online at dor.georgia.gov. ACH debit payment is available online at https://gtc.dor.ga.gov and through the payment option within tax software programs. Credit card payments can be made online. For more information, see https://dor.georgia.gov/taxes/how-do-i-make-tax-payment. PART II - DECLARATION OF TAXPAYER(S) fter the return has been prepared and before the return is transmitted, the taxpayer (and spouse, if j oint) must verify the nformatio n on the return, and sign and date the completed GA-8453. The ERO must provide the taxpayer(s) with a copy of this form. If an ERO makes changes to the electronic return after t he GA-8453 has been signed by the taxpayer, but before transmittal, the ERO must have th e taxpayer complete and sign a corrected GA-8453.

# PART III - DECLARATION OF ELECTRONIC RETURNS ORIGINATOR AND PA ID PREPARER

The Georgia DOR requires that the ERO sig n this form an d keep i t with the require d attachments for three (3 ) years. A preparer must sign the GA-8453 in the space provided for the preparer. If the preparer is also the ERO, do not complet e the Prepare r Section ; instead, chec k the box labele d "Check als o if paid preparer" i n the ERO section. TAXPAYER(S)' COPY:The ERO must provide a co py of the completed GA-8453 and all other relevant and required information to the taxpayer(s). TELEPHONE ASSISTANCE: Refunds Taxpayer Assistance INDIVIDUAL TAX QUESTIONS: Georgia Tax Center (GTC)

# REPORTING FRAUD

1-877-423-6711 1-877-423-6711 revenue.taxpayerservice@dor.ga.gov https://gtc.dor.ga.gov dor.georgia.gov/webform/fraud-referral-form A fraud hotline has been established for practitioners and taxpayers to report tax-related activities that they believe are illegal or incorrect. The hotline can be used to report suspected illegal activity for all tax types. Persons submitting reports may remain anonymous. For Rules an d Regulations, Frequently Asked Question s and forms, please visit our website at dor.georgia.gov

# KEEP THIS FORM FOR YOUR RECORDS

A i