Form Ccf-Pf - Surcharge For Parking Facilities In Boston, Springfield And Worcester

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Rev. 8/00

Form CCF-PF

Massachusetts

Surcharge for Parking Facilities in

Department of

Boston, Springfield and Worcester

Revenue

This return is due on or before the 20th day of the month following the close of each calendar quarter. For the quarter ending

Registration Section

Name

Federal Identification number

❿

Address

City/Town

State

Zip

Parking Facilities Surcharge in Boston, Springfield and Worcester

A separate form must be filed for each city listed below. Check applicable city where facility is located:

Boston

Springfield

Worcester

Total number of vehicle days in calendar quarter. Note: “Vehicle days” shall mean each 24-hour period

(or fraction thereof) that a vehicle is parked

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿ 1

2a Total number of vehicle days in calendar quarter for vehicles owned, rented or leased by the U.S. government and/or

its instrumentalities. Note: “Vehicle days” shall mean each 24-hour period (or fraction thereof) that a vehicle is parked

❿

2b Total number of vehicle days in calendar quarter for vehicles owned, rented or leased by foreign diplomats and/or

consular personnel. Note: “Vehicle days” shall mean each 24-hour period (or fraction thereof) that a vehicle is parked

❿

2c Total number of exempt vehicle days. Add lines 2a and 2b

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿

Total number of vehicle days subject to surcharge. Subtract line 2c from line 1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿

2.00

Surcharge rate ($2.00)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿

Surcharge amount due. Multiply line 3 by line 4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿

Penalties

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿

Interest

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿

Total amount due. Add lines 5, 6 and 7

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❿

Declaration

The undersigned certifies under the penalties of perjury that all items and statements herein contained are true and accurate in every particular.

Signature of authorized officer

Date

Phone number

Preparer’s signature and Social Security number

Date

Check if self-employed

Employer Identification number

Firm name (or yours, if self-employed) and address