0819 Form 8453-X (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f8453x.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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(Rev. August 2019)

Department of the Treasury Internal Revenue Service

• Go to www.irs.gov/Form8453X for instructions and the latest information.

OMB No. 1545-0047

Part I Notice Information

1 Name of organization Employer identification number

2 Mailing address (P.O. box or number, street, and room or suite number)

City or town, state, and ZIP code

3 Confirmation number

4a Date Form 8871 filed 4b Time Form 8871 filed

Part II Declaration

Sign Here

Under penalties of perjury, I declare that the organization named in Part I is to be treated as a tax-exempt organization described in section 527 of the Internal Revenue Code, that it has filed the electronic Form 8871 referenced above, and that I have examined that notice, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.

Signature of authorized official Date

Signature of authorized official

After electronically submitting Form 8871, an authorized official must sign, date, and send Form 8453-X to: Department of the Treasury Internal Revenue Service Ogden, UT 84201

Upon receipt of this form, the Internal Revenue Service will send the organization a username and password that must be used to file an amended or final Form 8871 or to electronically file Form 8872, Political Organization Report of Contributions and Expenditures.

For Paperwork Reduction Act Notice, see separate Instructions for Form 8871. Cat. No. 36512T Form 8453-X (Rev. 8-2019)