The Commonwealth of Massachusetts
Assessors’ Use only
State Tax Form 126-MVE
Date Received
Revised 12/2004
Application No.
Name of City or Town
MOTOR VEHICLE EXCISE ABATEMENT APPLICATION
General Laws Chapter 60A
Return to:
Board of Assessors
Must be received by the assessors within three
years after the excise is due, or one year after the
excise is 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.
Tax year
Plate/registration number
Tax date
Vehicle identification number
Issue date
Vehicle year
Bill number
Make & Model
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)
Calendar year _____________
Assessed excise $ _____________
Board of Assessors
Bill number _______________
Abatement
$ _____________
Valuation _________________
Adjusted excise $ _____________
Months assessed ___________
Certificate number ____________
Date
FILING THIS APPLICATION DOES NOT STAY THE COLLECTION OF YOUR EXCISE.
TO AVOID INTEREST, CHARGES AND COLLECTION ACTION, YOU MUST PAY EXCISE AS BILLED BY THE DUE DATE.
THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE