Form 121a - Urban Redevelopment Excise Return - 2001
ADVERTISEMENT
1
22001
Form 121A
Massachusetts
Urban Redevelopment
Department of
Excise Return
Revenue
Massachusetts General Laws, Chapter 121A, section 10, as amended for the calendar year 2001.
Name of taxpayer
Federal Identification number
❿
Present address of principal office
DOR use only
Present location of principal office in Massachusetts
11 Check type:
Corporation
Individual
Trust
Partnership
Other (specify)_____________________________________________________
12 Date of charter or organization____________________________________ 3 Date of project approval ________________________________________
14 Location of project _____________________________________________________________________________________________________________
15 Has the Federal Government changed your taxable income for any prior year which has not yet been reported to Massachusetts?
Yes
No.
If “Yes,” report such change on Form CA-6, Application for Abatement/Amended Return, within three months after the final federal determination.
16 Has any governmental unit made any payments to or on behalf of any tenant of the taxable entity which are in addition to such payments actually made
by such tenant?
Yes
No. If “Yes,” state the total of these payments. $____________________________________ . Was this amount included in
line 1a of Computation of Excise of this return?
Yes
No.
17 Taxpayer’s books are in the care of __________________________________________ Title ________________________________________________
Computation of Excise
Use whole dollar method
a.
b.
11 Gross income from all sources* in 2001. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿ 1
@ 5% ❿1
$
$
12 Fair cash value of owned and leased real and tangible personal
❿ 2
property exempt from local taxation as of January 1, 2002
@ $10.00
as certified by assessors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿ 2
per $1,000 ❿ 2
13 Total of line 1b and line 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
14 Assessed valuation of line 2a property for last three years
January 1, _____
it was subject to local taxation (less abatements)
January 1, _____
January 1, _____
Three year total . . . 4
15 Three-year average assessed valuation (line 4 total, divided by three) . . . . . . . . . 5
16 Line 5 or line 2a, whichever is smaller. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
× line 6 . . . . . . . . . . . . . . . . . . . ❿
17 Minimum excise: 2001 fiscal local tax rate* $ _________________________ per $1,000
17
18 Excise due (line 3 or line 7, whichever is larger) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Voluntary contribution for Endangered Wildlife Conservation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿ 19
Add line 8 and line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿ 10
10 Excise due plus voluntary contribution.
11 Previous payments made . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿ 11
12 Excess payment to be refunded. Subtract line 10 from line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿ 12
13 Balance due. Subtract line 11 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿ 14
15 Interest on unpaid balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿ 15
16 Total payment due at time of filing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿ 16
*See instructions
Under the penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which he/she has
knowledge.
Signature of appropriate corporate officer
Social Security number
Telephone number
Date
Individual or firm signature of preparer
Employer Identification number
Address
Date
❿
If you are signing as an authorized delegate of the appropriate corporate officer, check here
and attach Mass. Form M-2848, Power of Attorney.
Authorized representative to whom contents may be disclosed in discussing questions which may arise in connection with this return:
Name of person authorized
Address
This return, together with payment in full, is due on or before March 15, 2002. Mail to: Massachusetts Department of Revenue, PO Box 7052, Boston,
MA 02204. Make check or money order payable to: the Commonwealth of Massachusetts.
Form Code 380 Tax Type 0169
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial