EFTA01220954.pdf

Required Information For Electronic Filing - Complete All 3 Sections Below Per Delaware Division of Revenue Section 1: Information Needed for Delaware Return If you received a Form W-2, 1099-R that has Delaware Witholding on it, you are required to enter all information for eachof the forms received. You must enter the information exactly as it appears on the form. If you have multiple forms, use theAdd button to enter information from each form separately. Example: If you received two Forms W-2, click the Add button next to the Form W-2 and enter the information for your first Form W-2. After completing the first Form W-2, select the Add button again and enter the information for the second Form W-2. Repeat this for each of the types of forms listed below that you received. Form W-2 Wage & Tax Statement Form 1099-R Distributions from Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc s. Check the box if you do not have any of the above Section 2: Additional Information Needed to E-file Your Delaware Return A. Enter Email Address E-mail address (for confirmation e-mail) Re-enter e-mail address (must match) B. Disclosure Statement I agree Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and believe it is true correct and complete Section 3: Refund/Payment Options A. Refund- You will receive a check unless you entered direct deposit information directly on Form 200.01. B. Paying Tax Due by Check • If you are paying with a check, print Form DE 200-V and mail it with your check to the Delaware Division of Revenue. C. Electronic Funds Withdrawal of Tax Due If you would like to pay your tax balance due using electronic funds withdrawal, enter the required information below. By filling in the Information below I agree to pay my tax balance due by electronic funds withdrawal Routing number fr. Account number Type: p- Checking Savings Date to make withdrawal fr. Yes No Will the funds originate from an account outside the U.S.? Note: Do not enter direct deposit information here, enter it on Form 200.01. EFTA01220954