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meMs“mdCmdfts North Carolina Department of Revenue For calendar year or fleCal year beginning Partners I Partner's Warne, Address, and ZIP Code BLUE CHIP CAPITAL LLC 27 HIGH TECH BLVD THOMASVILLE NC 27360 THERE 11 13 12 and ending 12 31 12 Federal r Partnerehip's Name, Address. and ZIP Code MIDWAY CADENC
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curity Nanber: Last Name: Fket Name: al a2 a3 (o) If Partner Is an Ober Entity (abase orbit clearly) Federal Identification Number, Name: 51 BLUE CHIP CAPITAL LLC b2 (c) Partner's Stale of P.asIdenoe or Commercial Do,Meie cl FL (d) Ind9na lax WIthhed for Nonresident Partner (on WH-I8). _ d .00 (e
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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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