Massachusetts Department of Revenue
Request for a Certificate of Good Standing and/or
Tax Compliance or Waiver of Corporate Tax Lien
PO Box 7073, Boston, MA 02204; phone: 617-887-6400; fax: 617-660-3611
1. Applicant information
Name of applicant |
Daytime phone number (with area code) |
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Street address. |
Fill in if new address |
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City/Town |
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Zip |
2. Taxpayer classification
Federal Employer or Taxpayer Identification number (required)
Entity filing a combined report. If filing a combined report, enter name and FEIN as shown on return:
Name of principal reporting corporationFEIN of entity (required)
Entity taxed as C corporation
Entity taxed as S corporation
Entity is Disregarded (other than a sole-proprietorship). If Disregarded entity, enter FEIN of filing entity as shown on return:
Name of filing entityFEIN of entity (required)
Nonprofit (tax exempt) organization (see instructions)
Entity taxed as a partnership
Entity taxed as an estate
Entity taxed as a trust
Entity taxed as a individual
Entity taxed as a sole-proprietorship (including LLCs tax as sole proprietorship). If entity is taxed as sole-proprietorship, enter name, SSN and FEIN:
Name of sole proprietorshipSSN of sole proprietorship (required) FEIN (required)
3. Legal form of organization
Corporation
Limited Liability Company (LLC)
Partnership (including Limited Liability Partnership, Limited Partnership, or other unincorporated association)
Trust or estate
4. Purpose of application. Fill in one only.
Certificate of Good Standing or Letter of Compliance
Certificate of Good Standing for a Nonprofit Organization (enclose required copy of IRS exemption certificate)
Certificate of Good Standing Relating to an ABCC Liquor License Tranfer or Operational/Administrative Changes
5. Reason for application
Cannabis
Corporate reinstatement after administrative dissolution from Secretary of State (domestic/foreign corporation doing business in Massachusetts)
Corporate reinstatement after administrative dissolution from Secretary of State (foreign corporation not doing business in Massachusetts)
Gaming
Liquor licenses
Lottery machines
Professional license renewal
Sale of business
Other (specify)
General information on page 2.
Rev. 04/18
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REQUEST FOR CERTIFICATE, PAGE 2 |
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Name of applicant |
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Trade name or DBA |
Federal ID or Social Security number (REQUIRED) |
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6. Sale/transfer of license |
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Fill in if transferring liquor license |
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Name of buyer |
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Address of DBA location |
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City/Town |
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State |
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Zip |
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List all tax identification numbers filed for this entity (e.g., meals, sales, withholding, room occupancy or income) |
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Fill in if Waiver of Corporate Tax Lien has been acquired (does not apply to entities not taxed as corporation) |
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If requesting Waiver of Corporate Tax Lien, attach price and legal description of assets to be sold and complete the following(REQUIRED). |
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Name of transferee |
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Date of transfer or sale (mm/dd/yyyy) |
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Street address |
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City/Town |
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State |
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List assets |
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7. Person to receive response. Fill in applicable ovals.
Send results to taxpayer
Send results to person named below only if taxpayer is in compliance and Power of Attorney is attached
Send results to person named below, even if taxpayer is not in compliance and Power of Attorney is attached
If information is to be mailed to someone other than taxpayer, provide party’s name and mailing address.
Name |
Phone number |
Fax number |
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Address |
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City/Town |
State |
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Affidavit
Under the penalties of perjury, I declare that my company is responsible for the following taxes (REQUIRED; fill in all that apply).
Withholding
Sales/Use
Meals
Room occupancy
Corporate
Other (specify)
Signature of taxpayer or corporate officer (REQUIRED) |
Date |
General information
The fastest and easiest way to obtain a Certificate is via our online application:
Businesses: https://mtc.dor.state.ma.us/mtc/_/?Link=COGS
Individuals: https://mtc.dor.state.ma.us/mtc/_/?Link=COGSIND
If the applicant is a partnership and has not filed a Form 3, Partnership Return of Income, for the last two years, submit complete copies of Form 3 with this application.
Any missing “required” information will delay the processing of your claim.
If a professional license renewal application, all returns must be filed and paid. If in a valid payment agreement, all required payments must be made.