General Laws Chapter 60A
RETURN APPLICATION FORM AND DOCUMENTATION TO: Board of Assessors ____________________________________________
INSTRUCTIONS. To apply for an abatement (or refund if
excise has been paid), complete this form and provide the
specified documentation.
Abatement applications must be received by the assessors
within three years after the excise was due, or one year after
the excise was paid, whichever is later. To preserve your right
to appeal, you must file on time. By law, assessors may only
act on late applications in limited circumstances where the
excise is still unpaid and their decision in those cases is final.
Filing an application does not stay the collection of your
excise bill. To avoid interest, charges and collection action,
including non-renewal of your registration, you must pay the
bill in full within 30 days of its issue date. You will receive a
refund if an abatement is granted.
Tax Year __________ Tax Date _____/______ Issue Date ______/______/______ Bill Number ___________
Plate/Registration Number ___________ VIN __________________ Vehicle Year ________ Make & Model ________________
Name (as shown on bill) _________________________________________________________________________________
Address (as shown on bill) _________________________________________________________________________________
City/Town State Zip
Mailing Address (if different) ________________________________________________________________________
City/Town State Zip
Check where applicable
Vehicle sold or traded
You must provide this documentation
Bill of sale and
plate return receipt from Registry of Motor Vehicles (RMV) or new
registration form if plate transferred to another vehicle
Vehicle stolen or total loss
Police report or insurance settlement letter and plate return receipt, C-19 Form (Affidavit of
Lost or Stolen Plate from RMV) or new registration form
Vehicle repossessed
Notice from lienholder and plate return receipt, C-19 Form or new registration form
Vehicle junked
Receipt from junk yard and plate return receipt, C-19 Form or new registration form
Vehicle returned (Lemon Law)
Letter from dealer certifying return and plate return receipt or new registration form
Moved from _________ before
January 1 of tax year
Date of move: ________/________/_________
Proof of residency before January 1 of tax year of bill (e.g., utility bill, voter registration,
lease) and
proof RMV was notified before January 1 of address change for registration
NOTE: You must notify the RMV within 30 days of moving and before January 1 to be
billed by your new city or town next year.
Moved out of state
Date of move: ________/________/_________
Registration from new state or country
Exemption Type: _______________________________ Documentation establishing qualifications
NOTE. You are not entitled to an abatement if you (1) cancel
your registration and retain ownership of the vehicle, or (2)
move to another Massachusetts city or town, during the
calendar year. No excise may be reduced to less than $5.00.
No abatement or refund of less than $5.00 may be made.
Return this completed form to:
Board of Assessors _____ of ________
____________ ________ MA ______
Board of Assessors at (____) __________
------------------ Do not write below this line ---------------------
Year ________________ Bill # ______________
Valuation ____________ Months Assessed _____
Excise Assessed $__________________
Abatement Allowed $__________________
Adjusted Excise $__________________
Cert. # ______________ Date: ___/____/______
Assessor _________________________________
Assessor _________________________________
Other Explain: ____________________________________________ Relevant documentation
Form Approved by Commissioner of Revenue
(STF 126-MVE)(12/2004)
Subscribed under the penalties of perjury
Signature: ____________________________________________________________ Date: ___________________________
Telephone: ________________________________