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Form M-990T Unrelated Business Income Tax Return For calendar year 2012 or taxable year beginning Massachusetts Department of Revenue 2012 and ending Name of company Federal Identification number Mailing address City/Town Name of treasurer State Is a Taxpayer Disclosure Statement enclosed Yes No Excise Calculation Zip Use whole dollar method Foreign state or local income franchise excise or capital stock taxes deducted from U.S. net income. 3 2 S.

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