Form Indiana Individual Income Tax Do Not Mail This IT ...

form Indiana Individual Income Tax Do Not Mail This IT-8879 DECLARATION OF ELECTRONIC FILING. Income Tax for the Tax Year January 1 - December 31, 2019 form To DOR. State form 53399. (R15 / 9-19). Submission ID. First Name and Middle Initial Last Name Your Social Security Number Spouse's Social Security Number Spouse's First Name and Middle Spouse's Last Name Street Address i s Initial h City State Zip Code Daytime Telephone Number Part I. i l T Tax Return Information (See Instructions on Next Page). a R. 1. Federal Adjusted Gross 1. M DO. 2. Indiana Adjusted Gross 2. t 3. Total Indiana 3. o 4. Total State Tax 4. N o 5. Total County Tax 5. 6. T. Total Indiana Tax 6. Do orm 7. 7. 8. Amount You 8. Part II Direct Deposit F.. W-2 Forms Here 9. Routing number Note: The first two digits of the routing number must be 01 - 12 or 21 - 32. 10. Account number Do Not Mail 11. Type of account: Checking Savings Hoosier Works MC This form 12. Place an X in the box if refund will go to an account outside the United States.

7. Keep the submission ID on file. It is not necessary to fill in the submission ID unless the form is requested by the department. Before providing the form to the department, this field should be completed. NOTE: The ERO must receive the completed and signed Form IT-8879 from the taxpayer before the electronic return is transmitted.

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