State Tax Form 126-Be - Boat Excise Abatement Application - Massachusetts

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The Commonwealth of Massachusetts
Assessors’ Use only
State Tax Form 126-BE
Date Received
Revised 12/2004
Application No.
Name of City or Town
BOAT EXCISE ABATEMENT APPLICATION
General Laws Chapter 60B
Return to:
Board of Assessors
Must be received by the assessors within three
years after the excise was due, or one year after
the excise was paid, whichever is later.
INSTRUCTIONS: Complete BOTH sides of application. Please print or type.
A. TAXPAYER INFORMATION.
Name(s) (as shown on bill)
Telephone No. (
)
Address (as shown on bill)
No.
Street
City/Town
Zip Code
Mailing address (if different)
No.
Street
City/Town
Zip Code
B. BILL INFORMATION. Complete using information as it appears on tax bill.
Fiscal year
Registration/documentation number
Issue date
Name of boat
Bill number
Model year
Length of boat
C. SIGNATURE.
Subscribed under the penalties of perjury
Signature of applicant
Date
YOU MUST ALSO COMPLETE SECTION D ON REVERSE SIDE
DISPOSITION OF APPLICATION (ASSESSORS’ USE ONLY)
Fiscal year _____________
Assessed excise $ _____________
Board of Assessors
Bill number _______________
Abatement
$ _____________
Adjusted excise $ _____________
Certificate number ____________
Date
FILING THIS APPLICATION DOES NOT STAY THE COLLECTION OF YOUR EXCISE.
TO AVOID INTEREST, CHARGES, PENALTY AND COLLECTION ACTION, YOU MUST PAY EXCISE AS BILLED BY THE DUE DATE.
THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE

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