W-4(SP) Forma W-4(SP)

Caution: DRAFT FORM
This is an advance proof copy of an IRS tax form.
It is subject to change and OMB approval before it
is officially released. You can check the scheduled
release date on our web site (www.irs.gov).
If you have any comments on this draft form, you can
submit them to us on our web site. Include the word
DRAFT in your response. You may make comments
anonymously, or you may include your name and
e-mail address or phone number. We will be unable
to respond to all comments due to the high volume
we receive. However, we will carefully consider
each suggestion. So that we can properly consider
your comments, please send them to us within 30
days from the date the draft was posted.

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 8453-OL, PAGE 1 of 2
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
FLAT SIZE: 203 mm (8") 3 279 mm (11")
PERFORATE: (NONE)

Date

PRINTS: HEAD to HEAD
INK: BLACK

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Action

Date

Signature

O.K. to print
Revised proofs
requested

Declaration Control Number (DCN)

Form

00–

–

8453-OL

Part I

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2006

If a joint return, spouse’s first name and initial

Last name

Your social security number

Last name

Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions.
H
E
R
E

OMB No. 1545-0074

For the year January 1–December 31, 2006
© See instructions on back.

Your first name and initial

Use the
IRS label.
Otherwise,
please
print or
type.

IRS Use Only—Do not write or staple in this space.

U.S. Individual Income Tax Declaration
for an IRS e-file Online Return

Department of the Treasury
Internal Revenue Service

L
A
B
E
L

–7

Apt. no.

City, town or post office, state, and ZIP code

¶

¶

Daytime phone number

(

)

Tax Return Information (Whole dollars only)

1 Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4)

1

2 Total tax (Form 1040, line 63; Form 1040A, line 38; Form 1040EZ, line 10)

2

3 Federal income tax withheld (Form 1040, line 64; Form 1040A, line 39; Form 1040EZ, line 7)

3

4 Refund (Form 1040, line 73a; Form 1040A, line 45a; Form 1040EZ, line 11a)

4

5 Amount you owe (Form 1040, line 75; Form 1040A, line 47; Form 1040EZ, line 12) (see instructions)

5

Part II

Important!

You must enter
your SSN(s) above.

Declaration of Taxpayer. Be sure to keep a copy of your tax return.
I consent that my refund be directly deposited as designated in the refund section of my 2006 federal income tax
return (or Form 8888, if applicable). If I have filed a joint return, this is an irrevocable appointment of the other spouse
as an agent to receive the refund.

6a

b

I do not want direct deposit of my refund or I am not receiving a refund.

c

I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal entry
to the financial institution account indicated in the tax preparation software for payment of my federal taxes owed
on this return and/or a payment of estimated tax. I further understand that this authorization may apply to future
federal tax payments that I direct to be debited through the Electronic Federal Tax Payment System (EFTPS). In
order for me to initiate future payments, I request that the IRS send me a personal identification number (PIN) to
access EFTPS. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent
to terminate the authorization. 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.

If I have filed a balance due return, I understand that if the IRS does not receive full and timely payment of my tax liability,
I will remain liable for the tax liability and all applicable interest and penalties. If I have filed a joint federal and state tax return
and there is an error on my state return, I understand my federal return will be rejected.
Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and
accompanying schedules and statements for the tax year ending December 31, 2006, and to the best of my knowledge and
belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts shown on the
copy of my electronic income tax return. I consent to allow my intermediate service provider and/or transmitter to send my
return to the IRS and to receive from the IRS (a) an acknowledgment of receipt or reason for rejection of the transmission,
(b) an indication of any refund offset, (c) the reason for any delay in processing the return or refund, and (d) the date of any
refund.

Sign
Here

©

Your signature

For Paperwork Reduction Act Notice, see back of form.

Date

©

Spouse’s signature. If a joint return, both must sign.
Cat. No. 15907C

Form

Date

8453-OL

(2006)