1210 Form 8879-EX (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f8879ex.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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(Rev. December 2010)

Department of the Treasury Internal Revenue Service

For the period beginning, 20, and ending, 20 .

- Do not send to the IRS. Keep for your records. - See instructions.

OMB No. 1545-2081

Name (as shown on Forms 720, 2290, or 8849) Taxpayer identification number

Part I Type of Return and Return Information (Whole dollars only)

Check the box for the return for which you are using this Form 8879-EX and enter the applicable amount from the return. If you check the box on lines 1a, 2a, or 3a, below, and the amount on that line for the return for which you are filing this form was blank, leave lines 1b, 1c, 2b, or 3b, whichever is applicable, blank (do not enter -0-). However, if you entered -0- on the return, enter -0- on the applicable line below. Do not complete more than one line in Part I.

Caution. For line 3b, Schedules 2, 3, 5, and 8 cannot be combined with any other schedules. File a separate Form 8879-EX for each schedule.

Part II Taxpayer Declaration and Signature Authorization

Under penalties of perjury, I declare that I have examined a copy of my electronic return and accompanying schedules and statements for the period shown above and to the best of my knowledge and belief, they are true, correct, and complete. I further declare that the amounts in Part I above are the amounts shown on the copy of my electronic return. I consent to allow my electronic return originator (ERO), transmitter, or intermediate service provider to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund, that are required for electronic returns processing. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the federal taxes owed on this return, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537 no later than two business days before 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. I have selected a personal identification number (PIN) as my signature for the electronic return and, if applicable, my consent to electronic funds withdrawal.

Taxpayer’s PIN: check one box only

I authorize

to enter my PIN

as my signature

ERO firm name

do not enter all zeros

on my electronically filed return and, if filing Form 2290, the Consent to Disclosure of Tax Information.

I will enter my PIN as my signature on my electronically filed tax return or request for refund. Check this box only if you are entering your own PIN and your return or request is filed using the Practitioner PIN method. The ERO must complete Part III below.

Taxpayer’s signature ^▶ Date ^▶

Part III Certification and Authentication

ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.

do not enter all zeros

I certify that the above numeric entry is my PIN, which is my signature on the electronically filed return for the taxpayer indicated above. I confirm that I am submitting this return in accordance with the requirements of Pub. 3112, IRS e-file Application and Participation, and Pub. 4163, Modernized e-File (MeF) Information for Authorized IRS e-file Providers for Business Returns.

ERO’s signature ^▶ Date ^▶

ERO Must Retain This Form — See Instructions Do Not Submit This Form to the IRS Unless Requested To Do So

For Paperwork Reduction Act Notice, see instructions. Cat. No. 49632M Form 8879-EX (Rev. 12-2010)

Form 8879-EX (Rev. 12-2010) Page 2

Purpose of Form

Use Form 8879-EX if you and the electronic return originator (ERO) want to use a personal identification number (PIN) to electronically sign an electronic excise tax return or request for refund.

If applicable, Form 8879-EX is also used to authorize an electronic funds withdrawal. If you do not use Form 8879-EX to sign your return, you must use Form 8453-EX, Excise Tax Declaration, for an IRS e-file Return. For more information, see the instructions for Form 8453-EX.

Do not send this form to the IRS. The ERO must retain Form 8879-EX. ERO Responsibilities

The ERO will:

• Enter the name and taxpayer identification number as shown on Forms 720, 2290, or 8849.

• Complete Part I by checking the box for the type of return being filed and using the amounts (zeros may be entered when appropriate) from the return being filed.

• Enter on the authorization line in Part II the ERO firm name (not the name of the individual preparing the return) if the ERO is authorized to enter the taxpayer’s PIN.

• Give the taxpayer Form 8879-EX for completion and review. This can be done by hand delivery, U.S. mail, private delivery service, email, or Internet website.

• Complete Part III, including a signature and date.

Form 8879-EX must be completed and signed before the electronic return is transmitted (or

CAUTION

Taxpayer’s Responsibilities

The taxpayer filing Forms 720, 2290, or 8849 has the following responsibilities.

• Verify the type of return being filed in Part I.

• Verify the accuracy of the prepared return.

• Check the appropriate box in Part II to either authorize the ERO to enter your PIN or to choose to enter it in person.

• Indicate or verify his or her PIN when authorizing the ERO to enter it (the PIN must be five numbers other than all zeros).

• Sign and date Part II.

• Return the completed Form 8879-EX to the ERO by hand delivery, U.S. mail, private delivery service, or fax.

Note. Your return will not be transmitted to the IRS until the ERO receives the signed Form 8879-EX. Important Notes for EROs

• Do not send Form 8879-EX to the IRS unless requested to do so. Retain the completed Form 8879-EX for 3 years from the return due date or IRS received date, whichever is later.

• Enter the taxpayer’s PIN on the input screen only if the taxpayer has authorized you to do so.

• Provide the taxpayer with a copy of the signed Form 8879-EX upon request.

• Provide the taxpayer with a corrected copy of Form 8879-EX if changes are made to the return (for example, based on the taxpayer’s review).

• See Pub. 4163, Modernized e-File (MeF) Information for Authorized IRS e-file Providers for Business Returns.

Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are required to give us the information. We need it to ensure that you are complying with these laws and to allow us to figure and collect the right amount of tax.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Internal Revenue Code section 6103.

The time needed to complete this form will vary depending on individual circumstances. The estimated average time is:

Recordkeeping . . . . . . . . . . . . 52 min.

Learning about the law or the form . . . . . . . . . . . . . . . 6 min.

Preparing, copying, assembling, and sending the form . . . . . . . . . . . 9 min.

If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send Form 8879-EX to this address. Instead, keep it for your records.