Form 8453N 2012 Nebraska Individual Income Tax Transmittal for E-Filed Returns

All other persons attach proof of death Form 1099 BFC Certificate for Beginning Farmer Credit Form 1099 MISC Form 1099 OID Form 1099 INT (only if Nebraska withholding is shown) Form 1310N Nebraska Refund for Deceased Taxpayers Form 2210N Individual Underpayment of Estimated Tax when the annualizing income box is checked; or if claiming waiver of penalty attach explanation Form 33 Power of Attorney Form 4797N Special Capital Gains/Extraordinary Dividend Election and Computation (see instructions) Form NFC Statement of Nebraska Financial Institution Tax Credit Form RRB 1099 or RRB 1099R Tax Statement from Railroad Retirement Board If filing as personal representative attach proof of appointment Nebraska Department of Revenue PO Box 98911 Lincoln NE 68509 8911 8 523 2012 Check the applicable boxes to identify attachments City State Zip Code Current Mailing Address (Number and Street or PO Box) First Name and Initial Last Name for Tax Year Beginning January 1 and Ending December 31 2012 FORM 8453N If a Joint Return Spouse s First Name and Initial Last Name INSTRUCTIONS Mail Form 8453N and applicable documentation only when the e filed Nebraska Individual Income Tax Return requires this information to substantiate a claim or credit and your software does not support this form in e file Documentation must be received within 15 days of e filing your return or the claim or credit will be disallowed Nebraska Individual Income Tax Transmittal for E Filed Returns NEBRASKA TAX INCENTIVE CREDIT DOCUMENTATION All required information necessary to support Form 3800N must be filed with the tax return and cannot be mailed NOTE: The submission of a federal self selected personal identification number (PIN) with a taxpayer s e filed federal income tax return serves as the Nebraska signature on the Nebraska e filed return PLEASE DO NOT WRITE IN THIS SPACE Please Type or Print RETENTION OF RECORDS You must retain the state copies of Forms W 2 W 2G 1099 MISC and 1099 R and all other state documentation for a period of at least three years from the due date of the related return Social Security Number Spouse s Social Security Number Email Address SPECIAL CAPITAL GAINS/EXTRAORDINARY DIVIDEND ELECTION AND COMPUTATION Attach Federal Schedule D (Form 1040) and Federal Form 8949 If filed federally attach Federal Form 6252 WHEN TO FILE Form 8453N should be mailed with attachments as soon as the Nebraska Acknowledgement has been received indicating the state return has been accepted Form 8453N and attachments must be filed within 15 days of the Nebraska Department of Revenue s receipt of your e filed individual income tax return WHO MUST FILE Almost all Nebraska returns can be e filed However when you claim certain credits or claim a refund for a deceased taxpayer who is not your spouse additional documentation may be required The software you use should prompt you to print the Nebraska Individual Income Tax Transmittal for E filed Returns Form 8453N Attach the required documentation to Form 8453N and mail to: www revenue ne gov 800 742 7474 (NE and IA) 402 471 5729 You may also fax this form and the required attachments to 402 471 5927