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on) I.:Islet b h Ct. K Resident status (nark an Xi's. bases that pal 0 M'S fullyear resident '--
ents, and Credits North Carolina Cope Mount of Revenue or fiscal year beginning 11 13 12 and ending 12 31 12 rumen Hanle, Address, and ZIP Code BLUE CHIP CAPITAL LLC 27 HIGH TECH BLVD THOMASVILLE NC 27360 Federal =Is Partnershiel Name, Address, and ZIP Code MIDWAY CADENCE LLC 27O LAFAYETTE STREET SUITE 409
e member El foreign partner member-manager H I Xi Domestic paltrier II Mat type of entity Is this
and Credits North Carolina Department of Revenue For calendar ',ear or fiscal year beginning Partners " Partner's Name, Address, and ZIP Code BLUE CHIP CAPITAL LLC 329 SEABREEZE AVENUE PALM BEACH FL 33480 01 01 13 Wending 12 31 13 Federal Partnership's Name, Address, and ZIP Code MIDWAY VISTA PARK LLC 2
rs pert-year resident C WC pert-year resident [Xi NYS nonresident 0 Yonkers nonresident L It th
ubbly traded prthershIP (PIP) ISIff Information About the Partner E Partners laentrylnp number F Partners name. address. cly, stab, and ZIP code BLUE CHIP CAPITAL LLC 27 HIGH TECH BOULEVARD THOMASVILLE, NC 27360 13 lip Omenl partner of LLC member-manager H Domestic partner C Foreign partner T1 What 1700 cf
J8 J7 23,433. 8) Method of accounting (rnwk an Xi!? the appropriate box) X Tex basis C GAAP 0
7 Check If this is a publicly traded partnership (PIP) NW Information About the Partner Liter F Partners name, address, city, state, and ZIP code BLUE CHIP CAPITAL LLC 27 HIGH TECH BOULEVARD THOMASVILLE, NC 27360 G t_J General partner or LLC IL limited partner or other LLC member-manager member N 0onestic pa
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Joi Ito
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William Barr
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