Instructions For Massachusetts Premium Excise Return For Insurance Companies Form 63-23p - 2016 Page 10

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Signature
When the form is complete, it must be signed by the treasurer or assis-
tant treasurer. If you are signing as an authorized delegate of the ap-
propriate corporate officer, check the box in the signature section and
attach a Massachusetts Form M-2848, Power of Attorney. Mail forms
to: Massachusetts Department of Revenue, PO Box 7052, Boston,
MA 02204.
10

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