Rev. 2/10
Massachusetts
Form ST-BDR-Meals
Department of
Claim for Bad Debt Reimbursement
Revenue
Legal name of taxpayer
Federal Identification or Social Security number
Street address
City/Town
State
Zip
Fiscal year-end date of federal return
Due date of federal return, including valid extensions
Is the applicant a registered vendor in Massachusetts?
Yes
No. If No, the applicant cannot file a bad debt reimbursement claim.
Did the applicant make the retail sales for which tax was collected and remitted?
Yes
No. If No, the applicant cannot file a bad debt reimbursement
claim for such sales.
Did the applicant extend credit to the retail customer at the time of sale?
Yes
No. If No, the applicant cannot file a bad debt reimbursement claim
for such sales.
Did the applicant claim the amount listed on Line 5 as a bad debt expense deduction on its federal tax return?
Yes
No. If No, the applicant is not
entitled to a bad debt reimbursement for such amounts.
Did the applicant assign, sell or transfer the debt in question to any other entity?
Yes
No. If Yes, the applicant cannot file a bad debt reimbursement
claim, nor may the assignee, purchaser, transferee or factor of any such accounts.
1 Gross sales of meals (including non-Massachusetts sales) for previous fiscal year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Total gross Massachusetts sales of meals for previous fiscal year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Total taxable Massachusetts sales of meals for previous fiscal year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Total meals tax remitted for previous fiscal year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Bad debt expense per U.S. tax return (actual or pro forma; please attach) for previous fiscal year . . . . . . . . . . . . . . . . . . . . . 5
6a Amount of taxable meals occurring before August 1, 2009 (upon which 5% meals tax has been remitted) determined
to be worthless for previous fiscal year. (Attach an explanation for each worthless sale; see instructions) . . . . . . . . . 6a
6b Amount of taxable males occurring on or after August 1, 2009 (upon which 6.25% meals tax has been remitted) deter-
mined to be worthless for previous fiscal year. (Attach an explanation for each worthless sale; see instructions) . . . 6b
7a Reimbursement for bad debts at the 5% rate. Multiply line 6a by .05. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7a
7b Reimbursement for bad debts at the 6.25% rate. Multiply line 6b by .0625 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7b
8 Total reimbursements for bad debts. Add lines 7a and 7b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Under penalties of perjury, I declare that the taxpayer named above was the vendor in the sales that have become bad debts and is not an
assignee or factor of that vendor. I have examined this claim, including accompanying schedules and statements, and to the best of my
knowledge and belief it is true, correct and complete. (Attach Form M-2848, Power of Attorney, if representing taxpayer.)
Signature
Title
Date
Type or print name of signee
Daytime telephone number
If you wish to have a hearing in the event that this claim is denied in full or in part, you must indicate your request here.
Yes
No