City Of Springfield Motor Vehicle Excise Abatement Form
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1INSTRUCTIONS: To apply for an abatement
CITY OF SPRINGFIELD MOTOR VEHICLE EXCISE ABATEMENT FORM
(or refund if excise has been paid), complete
FAILURE TO PROVIDE THE REQUIRED DOCUMENTATION WILL RESULT IN THIS OFFICE RETURNING YOUR APPEAL AND NO ABATE-
ABATEMENT WILL BE PROCESSED.
YOU MUST INCLUDE A SASE FOR US TO INSURE PROPER RETURN TO YOU.
this form and provide all the specified
documentation.
.
TAX YEAR
ISSUE DATE
/
/
BILL NUMBER
Abatement application MUST be filed with
the Assessors on or before December 31 of
PLATE REGISTRATION NUMBER:
MAKE/MODEL
the calendar year following the excise year
(or 30 days after the bill is issued if that date
NAME (as shown on bill)
is later). By law the Assessors cannot act on
late applications.
ADDRESS (as shown on bill)
City/Town
State
Zip
Filing an application does not stay the
CORRECT MAILING ADDRESS:
collection of your excise bill. To avoid
City/Town
State
Zip
interest, charges and collection action,
TELEPHONE:
Home
(______) ______-___________
Work
(______) ______-_________
including non-renewal of your registration,
THE MOTOR VEHICLE WHICH THE ENCLOSED BILL REPRESENTS HAS BEEN:
you must pay the bill in full within 30 days
Check Applicable:
PROVIDE A COPY OF THE FOLLOWING DOCUMENTATION FOR THE BILL TO BE ABATED
of its issue date. You will receive a refund
Bill of Sale AND Plate Return Receipt from RMV OR Bill of Sale AND New
if an abatement is granted.
SOLD/TRADED
New Registration Form if transferred to another vehicle.
NOTE: You are NOT entitled to an abatement
Form C-19 (Affidavit of Lost or Stolen Plate) from RMV AND insurance company
if you (1) cancel your registration and retain
STOLEN OR
settlement letter OR police report.
ownership of the vehicle, or (2) move to
TOTAL LOSS
another Mass. Community during the
Notice from Lien Holder AND plate return receipt, C-19 Form OR New
calendar year. NO EXCISE MAY BE REDUCED
VEHICLE
TO LESS THAN $5.00. NO ABATEMENT OR
REPOSSESSED
Registration Form.
REFUND OF LESS THAN $5.00 MAY BE MADE.
--------DO NOT WRITE BELOW THIS LINE--------
MOVED FROM
Date of Move:
/
Proof of garaging before January 1 of the Billing Year AND a copy of your
Valuation
Months Assessed
SPFLD BEFORE
_______________
_____________
JANUARY 1
Insurance Policy (Coverage Section Page) BEFORE JANUARY 1 of the Tax Year.
Original Excise
$____________
NOTE:
You must notify the RMV within 30 days of moving before January 1 to be billed to your new city.
Abatement Allowed
$____________
Adjusted Excise
$____________
MOVED FROM
Before January 1, of the Tax Year (Registration Form from the New State or
Country of Registration AND Plate Return Receipt.
Certificate # ________ Date_____/______/____
MASSACHUSETTS
RETURN TO:
EXEMPT
Proof of statutory entitlement must be provided.
ASSESSORS OFFICE/EXCISE DIV.
Plate return from RMV or new registration AND a letter from donation
36 COURT ST. SPRINGFIELD, MA 01103
OTHER
ENCLOSE A SELF-ADDRESSED STAMPED
organization or junk yard.
ENVELOPE FOR CERTIFICATE RETURN
SUBSCRIBED THIS ________ DAY OF _______________, 2______ UNDER THE PENALTIES OF PERJURY.
SIGNATURE OF ASSESSED PERSON:_____________________________________________________________
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