VA-8453                           Virginia Individual Income Tax Declaration for                                                                     Tax Year 
Virginia Department 
    of Taxation                                                       Electronic Filing                                                                     2022 

    DO NOT SEND THIS VA-8453 TO THE VIRGINIA DEPARTMENT OF TAXATION OR THE IRS. 
                                              IT MUST BE MAINTAINED IN YOUR FILES! 
Virginia Submission Identification Number (SID)

First Name & Middle 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, State and Zip Code                                                                                                                        Online Filed Return 

Part I     Tax Return Information                                                                                                A Spouse                   B Yourself 
1.     Federal Adjusted Gross Income (Form 760CG, Line 1;  760PY, Line 1, columns A & B; Form 763, Line 1)
2.     Virginia Adjusted Gross Income (Form 760CG, Line 9; 760PY, Line 10, columns A & B; Form 763, Line 9)
3.     Taxable Income (Form 760CG, Line 15; 760PY, Line 16, columns A & B; Form 763, Line 1 )7
4.     Virginia Income Tax (Form 760CG, Line 18; 760PY, Line 17, columns A & B; Form 763 Line 1 )8
5.     Withholding (Form 760CG, Line 19a & b;19760PY, Lines  a & 19b; Form19 763, Lines  a &  b)19    19
6.     Amount you Owe (Form 760CG, Line 35; Form 760PY, Line 35; Form 763, Line 3 )5
7.     Refund (Form 760CG, Line 36; 760PY, Line 36; Form 763, Line 3 )6
Part II    Declaration of Taxpayer 
8a.         I consent that my refund be directly deposited as designated on my 20 22Virginia income tax return.  If I have filed a joint return, this is an irrevocable 
            appointment of the other spouse as an agent to receive the refund.  I certify that the transaction does not directly involve a financial institution outside of 
            the territorial jurisdiction of the United States at any point in the process. 
8b.         I do not want direct deposit of my refund  orI am not receiving a refund.  I choose to have a check mailed to me. 
8c.         I authorize the Virginia Department of Taxation (Virginia Tax) and it’s designated Financial Agent to initiate an ACH electronic funds withdrawal entry to 
            the financial institution account indicated on my 20 22Virginia income tax return for payment of my state taxes owed on this return and/or a payment of 
            estimated tax.  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.  I certify that the transaction does not directly involve a financial institution 
            outside of the territorial jurisdiction of the United States at any point in the process. 
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 20 22Virginia 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 (ERO) and by the IRS to Virginia Tax.  This declaration is to be retained by the ERO or 
transmitter as validation of my electronically filed Virginia income tax return. Taxpayers may sign the form using a rubber stamp, mechanical device, such as a 
signature pen, or computer software program. 

                Your Signature                             Date               Spouse’s Signature (If Filing Status 2 or 4, BOTH must sign)                  Date 
Part III  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 Virginia Tax.  I have provided the taxpayer with a copy 
of all forms and information to be filed with the IRS and Virginia Tax and have followed all other requirements as described in Handbook for Electronic Filers of 
Individual Income Tax Returns (Tax Year 202)2and any requirements specified by Virginia Tax.  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.  EROs and paid preparer can sign the form using a rubber 
stamp, mechanical device, such as a signature pen, or computer software program. 

ERO’s Signature                                                                        Date                                               SSN/PTIN 

Firm’s name (or yours if self-employed)                                                                   Paid Preparer?      Y           N       Self-employed?   Y       N 

Address, City, State and Zip                                                                                                                    EIN 
Paid Preparer’s Signature                                                              Date                                               SSN/PTIN 

Firm’s name (or yours if self-employed)                                                                   Self-employed?                    Y N 

Address, City, State and Zip                                                                                                                    EIN 

                                                                                                                                                  Form VA-8453 (REV 9/2)2

Purpose of Form                                                       Taxpayers’ Responsibilities 
Note:  This form should be retained by the ERO.  Do not send          If there is an amount on Line 6 and the taxpayer checks Box 8c 
this form to the Virginia Department of Taxation (Virginia Tax) or    and is paying by check or money order, mail the payment by  
the IRS. ERO can store this form electronically.                      May 1, 2023 with Form 760-PMT to the applicable address 
                                                                      shown in the instruction booklet. 
Use Form VA-8453 to: 
                                                                      If the taxpayer checks Box 8a OR 8c, the taxpayer must ensure 
• Authenticate the electronic portion of Form 760CG, Form             that the following information relating to the financial institution 
  760PY or Form 763,                                                  account is provided in the tax preparation software: 
• Authorize the ERO to transmit via a third party transmitter
  or authorize the online filing company to transmit, and             •      Routing number
• Provide the taxpayer's consent to directly deposit any              •      Account number
  overpayment                                                         •      Type of account (checking or savings)
                                                                      •      Refund amount for overpayment returns
When and Where to File                                                       Note: Refunds will be deposited into a taxpayer’s
                                                                             account per the timeframe detailed in the Individual
This form must be retained by the preparer/ERO for three (3)                 Income Tax instructions.
years or for online filed returns, the taxpayer must retain for three •      Direct debit amount for tax due returns
(3) years once the Virginia acknowledgment is received.  For self-           Note: Direct debits from a taxpayer’s account will occur 5 
prepared returns, the taxpayer must retain the form.  Preparers,             to 7 business days from the requested direct debit date.
EROs, transmitters and or taxpayers must make the documents           •      Direct debit date must equal the date of transmission for 
available to Virginia Tax upon request.                                      returns filed on or after May 1, 2023.
ERO and Paid Preparers’ Responsibilities                              Federal banking regulations have imposed additional reporting 
                                                                      requirements on all electronic banking transactions that directly 
Virginia Tax requires the ERO’s signature. A paid preparer must       involve a financial institution outside of the territorial jurisdiction of 
sign Form VA-8453 in the space for Paid Preparers.                    the United States at any point in the process.   
EROs and Paid Preparers may sign Part III of the form using the       These are called International ACH Transactions (IAT) and 
alternative signature methods using a rubber stamp, mechanical        include both electronic debit (tax payments) and credit (direct 
device, such as a signature pen, or computer software program.        deposit of refunds) transactions.  At present, Virginia Tax does not 
The signature must include either a facsimile of the Individual       support IAT.  Taxpayers who instruct Virginia Tax to process 
ERO’s signature or of the ERO’s printed name.                         electronic banking transactions on their behalf are certifying that 
                                                                      the transactions do not directly involve a financial institution 
If the paid preparer is also the ERO, do not complete the paid        outside of the territorial jurisdiction of the United States at any 
preparer section.  Instead, check the box labeled "Y” next to “Paid   point in the process. 
Preparer?”. 
                                                                      If direct deposit is IAT, select Option 8b to receive a check by 
                                                                      mail. 
                                                                      If direct debit is IAT, payments should be made by check attached 
                                                                      to Form 760-PMT and mailed or by credit card. 

                                                                      Taxpayers may sign Part II of the form using the alternative 
                                                                      signature methods using a rubber stamp, mechanical device, such 
                                                                      as a signature pen, or computer software program. The signature 
                                                                      must include either a facsimile of the taxpayer’s signature or of the 
                                                                      taxpayer’s printed name.  

                                                                      Note.  Automated Refund information is available online at 
                                                                      www.tax.virginia.gov or by phone at (804) 367-2486. 

                                                                                                                Form VA-8453 (REV 9/2)2