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Form Pit 8453 2019-2023
Address is new or changed, mark this box.
3a
Spouse's date of birth
3b
City
State
Postal/ZIP Code
3c
If foreign address, enter country
Foreign province and/or state
3d
5.
6a
EXEMPTIONS: Taxpayer, spouse, dependents, and other dependents
reported on federal Form 1040. If you are a dependent or other dependent of
another taxpayer, enter 00. (See instructions)
If taxpayer or spouse
died before this
4c
return is filed, enter
date of death.
be made payable to a person other
than the...
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