Virginia Form Va 8453 – Fill Out and Use This PDF

Virginia Individual Income Tax Declaration for Electronic Filing				2002
First Name and initial (if joint or combined return, enter both)		Last Name	B Your Social Security Number
Present home address			A Spouse's Social Security Number
City and state		ZIP Code	On-line filed return
Part I Tax Return Information			A Spouse	B Yourself
1.	Federal Adjusted Gross Income (Form 760CG, line 1; 760PY, line 6, columns B & A; line 4; Form 763, line 6)
2.	Virginia Adjusted Gross Income (Form 760CG, line 9; 760PY, line 10, columns B & A; Form 763, line 10)
3.	Taxable Income (Form 760CG, line 14; 760PY, line 15, columns B & A; Form 763, line 15)
4.	Virginia Income Tax (Form 760CG, line 17; 760PY, line 16, columns B & A; Form 763 line 18)
5.	Withholding (Form 760CG, line 18b and a; 760PY, lines 18b & 18a; Form 763, lines 19a)
6.	Amount you Owe (Form 760CG; Form 760PY, line 26; Form 763, line 27)
7. Refund (Form 760CG; 760PY, line 27; Form 763, line 28)
Part II Direct Deposit of Refund

8.Routing transit number (RTN) __________________________________________________

First two numbers of the RTN must be 01 through 12 or 21 through 32.

9.Depositor account number (DAN) _________________________________________________

Part III Declaration of Taxpayer

I declare under penalties of perjury that I have compared the information on my return with the information I have provided to my electronic return originator and that the amounts described in Part I above agree with the amounts shown on the corresponding lines of my 2002 Virginia individual income tax return. To the best of my knowledge and belief, my return is true, correct and complete. I consent that my return including this declaration and accompanying schedules and statements be sent to the Internal Revenue Service (IRS) by my electronic return originator and by the IRS to the Virginia Department of Taxation. This declaration is to be retained by the ERO or transmitter as validation of my electronically filed Virginia income tax return.

__________________________________________________________		__________________________________________________________________
Your Signature	Date	Spouse's Signature (If Filing Status 2 or 4, BOTH must sign)	Date

Part IV Declaration of Electronic Return Originator (ERO) and Paid Preparer

I declare that I have reviewed the above taxpayer's return and that the entries on this form are complete and correct to the best of my knowledge. I have obtained the taxpayer's signature on Form VA-8453 before submitting this return to the Internal Revenue Service (IRS) and the Virginia Department of Taxation. I have provided the taxpayer with a copy of all forms and information to be filed with the IRS and the Virginia Department of Taxation, and have followed all other requirements as described in Pub. 1345, Handbook for Electronic Filers of Individual Income Tax Returns (Tax Year 2002) and any requirements specified by the Virginia Department of Taxation. If I am also the Paid Preparer, under penalties of perjury, I declare that I have examined the above taxpayer's 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 preparer has any knowledge.

________________________________________________________________________________				_____________________________________________
ERO's Signature			Date	SSN
				Paid preparer? Self-employed?
________________________________________________________________________________
Firm's name (or yours if self-employed)
________________________________________________________________________________				_____________________________________________
Address	City	State	ZIP Code	EIN

________________________________________________________________________________				_____________________________________________
Paid Preparer's Signature			Date	SSN
________________________________________________________________________________				Self-employed?
Firm's name (or yours if self-employed)
________________________________________________________________________________				_____________________________________________
Address	City	State	ZIP Code	EIN

Form VA-8453 (REV. 11-02)