PRINT IN BLACK INK. Ovals must be filled in completely. Example:

Massachusetts Form CA-6A                                          Additional Tax Periods
Before filling out this form below, be sure you have completed Form CA-6, Application for Abatement/Amended Return. Form CA-6A, Additional Tax Periods,
is to be used solely to provide additional line item information when more than one tax period is being adjusted.
TAXPAYER NAME (IF INDIVIDUAL, ENTER LAST NAME FOLLOWED BY FIRST; IF BUSINESS, ENTER FULL LEGAL NAME)                    SOCIAL SECURITY OR FEDERAL IDENTIFICATION NUMBER
                                                                                                                                                ––

Line Item Information. If disputing penalties, complete tax period end and filing frequency items only.
For the period in which a change to tax is being made, enter below: the line item number being changed in Column A; the original amount reported in
Column B; and enter the corrected amount in Column C. If you have completed and enclosed a revised tax return, omit items A, B and C and enter the
net change below.
Tax period
Tax period end: Month  Year Filing frequency:                     Annual                             MonthlyQuarterly
                            B. Original amount                                                       C. Corrected amount
              A.      �If showing a loss, mark an X in box at left                                  �If showing a loss, mark an X in box at left

Line item no.               ,,                                                                       ,,

Line item no.               ,,                                                                       ,,

Line item no.               ,,                                                                       ,,

Net change. If you have completed and enclosed a revised tax return, enter the net change to tax here.                  ,,

Tax period
Tax period end: Month  Year Filing frequency:                     Annual                             MonthlyQuarterly
                            B. Original amount                                                       C. Corrected amount
              A.      �If showing a loss, mark an X in box at left                                  �If showing a loss, mark an X in box at left

Line item no.               ,,                                                                       ,,

Line item no.               ,,                                                                       ,,

Line item no.               ,,                                                                       ,,

Net change. If you have completed and enclosed a revised tax return, enter the net change to tax here.                  ,,

Tax period
Tax period end: Month  Year Filing frequency:                     Annual                             MonthlyQuarterly
                            B. Original amount                                                       C. Corrected amount
              A.      �If showing a loss, mark an X in box at left                                  �If showing a loss, mark an X in box at left

Line item no.               ,,                                                                       ,,

Line item no.               ,,                                                                       ,,

Line item no.               ,,                                                                       ,,

Net change. If you have completed and enclosed a revised tax return, enter the net change to tax here.                  ,,