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Town of Wellesley

itd@wellesleyma.gov

525 Washington Street, Wellesley, MA, 02482, US

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Partnership Provide names of all partners
Limited Liability Company Provide names of all members
if an insurance company filing premium excise return 63-20P or 63-23P GL c 63, 20 & 23
Executoradministrator Indicate estate of
Other Specify
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Individual Do not include social security number above
Association or Trust Provide names of all memberstrustees
Effective date
or b by election form, check here
To be classified as a manufacturer, an application must be made to the Commissioner on or before January 31 on form 355Q GL
if entity filing federally as a corporation files Massachusetts return 63-20P, 63-23P, 63FI or PS1 see below
Corporation Check this box only if an incorporated entity
application must be made to the Commissioner on or before January 31 on form 355Q GL c 63, 38C & 42B; c 58, 2; c 59
if a financial institution filing financial institution excise return 63 FI GL c 63, 1 & 2
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