Fillable 727 FORM 1B-3 CLAUSE 3

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727 FORM 1B-3 CLAUSE 3

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MUST BE FILED WITH THE BOARD OF ASSESSORS NOT LATER THAN DUE DATE OF FIRST ACTUAL (NOT PRELIMINARY) TAX PAYMENT FOR FISCAL YEAR
FORM 1B-
3
CLAUSE 3
THE COMMONWEALTH OF MASSACHUSETTS
NAME OF CITY OR TOWN
20____
APPLICATION FOR STATUTORY EXEMPTION
LITERARY - BENEVOLENT - CHARITABLE - SCIENTIFIC OR TEMPERANCE
To the Board of Assessors:
NAME OF APPLICANT ....................... ........... ......... ........................................................ ...... ...... ................. ........ .........
POST OFFICE ADDRESS .......... .......... ............................... .... .. ...................................................... .....
Application for abatement is hereby made to put into effect the statutory- exemption authorized by General Laws,
Chapter
59, Section 5, Clause 3 from a 20 …
............ .................... .... …................TAX.
Real Estate - Personal Property
Location of Property .............. .............. ............... ........................... ......... .....………………………………………….... . …
Number Street City or Town Ward
STATEMENT OF FACTS
State in detail your claims as applicant, setting forth ALL THE FACTS relating thereto.
Has a return for the current year been filed on an "A B C" Form with the Board of Assessors?…………………
Yes or No
Is the applicant a
Massachusetts corporation? ............. .......... ......Incorporated . ............ .......... .... Under…………………………………………...
Yes or No Date Cite Chapter of General Laws or Special Act
What are the purposes of the corporation as specified in its charter • ............................. …………………………………………
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
Is the corporation the owner of record of the real estate for which exemption is claimed? ………………………………
Yes or No
When was the real estate acquired? ................................................................................................…….
Date
Was it acquired for the purpose of removal thereto? ........................…………………………………………..
Yes or No
Does the corporation occupy or use the whole of the real estate for which exemption is claimed?
If not, what proportion of the real estate is occupied or used by others?_______________________________
What part of the real estate, if any, is unoccupied or not in use?
____________________________________________________
State the circumstances fully ____________________________________________________
For what purpose is the real estate occupied or used (a) by the corporation?
(b) by other occupants?
State the extent to which the property is let for hire, both as to the proportion of space and the length of time during the year
What is the total amount of the revenue derived by the corporation from the property?._______________________
What is the total amount of the revenue derived by the corporation from the use of the property for purposes other than those specified in its
charter? $_________________
Is any of the income or profits divided among the shareholders or members?____________________
Yes or No
To what purpose is the income or profits used or appropriated by the corporation? _______________
______________________________________________________________________________________________________
____________________________________________________________
State any other facts which may bear on the right of this corporation to exemption of real estate or personal property
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
SUBSCRIBED THIS ................day of………………., 20 UNDER PENALTIES OF PERJURY.
SIGNED_____________________________________________________
Legal Name of Corporation
BY__________________________________________________________
Name of Officer or Representative
THE FILING OF THIS APPLICATION DOES NOT STAY THE COLLECTION OF THE TAX
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727 FORM 1B-3 CLAUSE 3

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Completed 11 July 2020

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