State Tax Form 128
Revised 11/2016

The Commonwealth of Massachusetts

Assessors' Use only

Date Received ____________

Application No. ____________

Name of City or Town

APPLICATION FOR ABATEMENT OF

REAL PROPERTY TAX PERSONAL PROPERTY TAX

FISCAL YEAR

General Laws Chapter 59, § 59

THIS APPLICATION IS NOT OPEN TO PUBLIC INSPECTION (See General Laws Chapter 59, § 60)

Return to: Board of Assessors

Must be filed with assessors not later than due date of first actual (not preliminary) tax payment for fiscal year.

INSTRUCTIONS: Complete BOTH sides of application. Please print or type.

A. TAXPAYER INFORMATION.

Name(s) of assessed owner:

Name(s) and status of applicant (if other than assessed owner)

Subsequent owner (acquired title after January 1) on

Administrator/executor. Mortgagee.

Lessee. Other. Specify.

Mailing address

No.

Street

City/Town

Zip Code

Telephone No. ( )

Amounts and dates of tax payments

B. PROPERTY IDENTIFICATION. Complete using information as it appears on tax bill.

Tax bill no.

Assessed valuation $

Location

No.

Street

Description

Real: Parcel ID no. (map-block-lot) Land area Class

Personal: Property type(s)

C. REASON(S) ABATEMENT SOUGHT. Check reason(s) an abatement is warranted and briefly explain why it applies.

Continue explanation on attachment if necessary.

Overvaluation Incorrect usage classification

Disproportionate assessment Other. Specify.

Applicant's opinion of: Value $

Class

Explanation

Reminder: If your explanation requires more space, prepare a separate attachment to include with your printed form. If signing by agent, attach a copy of written authorization.

FILING THIS FORM DOES NOT STAY THE COLLECTION OF YOUR TAXES. TO AVOID LOSS OF APPEAL RIGHTS OR ADDITION OF INTEREST AND OTHER COLLECTION CHARGES, THE TAX SHOULD BE PAID AS ASSESSED.

THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE

D. SIGNATURES.

Subscribed this day of , Under penalties of perjury.

Digital Signature (Optional - select one or skip):

Skip digital signature (sign by hand after printing)

Type signature:

Draw signature:

Signature of applicant

If not an individual, signature of authorized officer

Title

( )

(print or type) Name Address Telephone

If signed by agent, attach copy of written authorization to sign on behalf of taxpayer.