Fillable Printable Form 13

Form 13

Notice of Designation of Fiscal Year

Rev. 4/99

Massachusetts

Department of

Revenue

Name(s) of taxpayer(s) Date of death (if applicable) Date fiscal year ends

Street address City/Town State Zip code

Social Security number(s) Federal Identification number (if applicable) Date

The undersigned, doing business as

Business name Type of business Individual Partnership Trust Estate

Principal business address City/Town State Zip code

hereby gives notice to the Commissioner of Revenue that (he/she/it) has established a fiscal year ending on

Day Month

of each calendar year, upon the basis which (his/her/its) books of account are regularly kept upon the accrual basis; and hereby

makes application for the approval of the Commissioner of Revenue of the use of said fiscal year thus established for the making

of (his/her/its) income tax returns of business income on the basis thereof, in lieu of returns upon the basis of the calendar year.

The undersigned hereby agrees that if this application is granted, (he/she/it) will continue to make such returns upon the basis

of such fiscal year period thereafter until permission is given by the Commissioner of Revenue in writing, to change to the calen-

dar year or to some other fiscal year period; and further agrees that until such permission to change is granted, the returns will

be made in accordance with further requirements as may be issued from time to time, to which requirements the undersigned

hereby expressly assents.

Signature Title Date

Signature (if a partnership) Title Date

For the Commissioner of Revenue Title Date

Mail to: Massachusetts Department of Revenue, 200 Arlington Street, Room 4300, Chelsea, MA 02150.