Poll Tax Exemption Request, Groveland MA, 1943

Front:
FORM 95A THE COMMONWEALTH OF MASSACHUSETTS Groveland 27 TO THE BOARD OF ASSESSORS OF I hereby request exemption under General Laws, Chapter 59, Section 5, Clause 17A, from the payment of the 194 POLL TAX assessed to me. DATE OF BIRTH Oct. 1 # day of...Feb. 1862 Woburn, mass. th SUBSCRIBED UNDER THE PENALTIES OF PERJURY this...9 , 1943 (SIGNED) Orin W. Stevens NO. Sylvan STREET Groveland CITY OR TOWN THIS FORM APPROVED BY HENRY F. LONG. COMMISSIONER OF CORPORATIONS AND TAXATION.

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50 UNITED STATES OF AMERICA INDUSTRY AGRICULTURE FOR DEFENSE CENZA BOARD OF ASSESSORS So Groveland MASSACHUSETTS