DO NOT IGNORE YOUR BILL, EVEN THOUGH YOU MAY HAVE MOVED FROM THE CITY, SOLD, TRADED OR OTHERWISE DISPOSED OF THE VEHICLE WHICH THIS BILL REPRESENTS.
If the bill remains unpaid and outstanding more than thirty (30) days after its issued date, it will accrue interest and other charges and fees for which you may be responsible. YOUR DRIVER'S LICENSE AND/OR REGISTRATION WILL ALSO BE SUBJECT TO NON-RENEWAL.
Return this completed form with a copy of your excise tax bill and ALL REQUIRED SUPPORTING DOCUMENTATION. All requested information must be supplied for the bill to be abated. DO NOT ENCLOSE PAYMENTS. SEE REVERSE SIDE OF EXCISE BILL.
The motor vehicle that the enclosed bill represents has been:
| 1. ( ) | Sold: | Bill of Sale AND MA Registration cancellation receipt. |
| 2. ( ) | Traded: | New Registration Form |
| 3. ( ) | Stolen or Total Loss: | Police Report or Copy of Insurance Settlement Letter AND C-19 Form (Affidavit of Lost or Stolen Plate) from the Registry of Motor Vehicles. |
| 4. ( ) | Moved From Haverhill Before January 1,_______ | Proof of garaging as of January 1, ______ AND copy of insurance Coverage Selection Page. |
| 5. ( ) | Moved from Mass: | Date:______________. Supply copy of registration form from new state or country AND MA Registration cancellation receipt. |
| 6. ( ) | Exempt: | Proof of entitlement to statutory exemption. |
| 7. ( ) | Other: | ___________________________________ (Please specify) |
Name:_________________________________ Telephone:__________________
Mailing Address:____________________________________________________
Bill Number:___________________ Plate Number:_________________
Signature:__________________________________________ Date:____________