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ment tax creak component 40 41 Excelsior research and development tax credit component 41 42 Excels)°, real property tax credit component 42 Farmers' school tax credit (Form IT-217) 43 Acres of qualified agricultural property 43 44 Acres of waited conservaton property 44 46 Eligible school
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
tment tax credit component 40 41 ExcelScr research and development tax cacti component 41 42 Excelsior real property tax credit component 42 Farmers' school tax credit (Form 1T-2 I 7) 43 Acres of qualified agricultural property 43 44 Aces of qualified conservation property 44 45 Eligible s
ses * Information About the Partner Net Inag-term carkl gain (lose) E Partners kis number F Parteer's name. address. city. state. and ZIP code BLUE CHIP CAPITAL LLC 2. 3 290. O General partner or I.LC member-manager 20 Other Information Limited partner or other Lig mentor °mastic partner El Foreign part
t tax credit component . , 40 41 Excelsior research and development tax credit component 41 42 Excelsior real property tax credit component 42 Farmers' school tax credit (Form 17-217) 43 Acres of qualified agricdtural property 43 44 Acres of qualified conservation property 44 45 Elgible school
-term capital gain (loss) I 90 Collectibles (28%) gain (loss) I 19 Distributions number F Partners I Lim e. address. city. state, and ZIP code BLUE CHIP CAPITAL LLC 329 SEABREEZE AVENUE PALM BEACH, FL 33480 9e Unrecaplured sec 1250 gain [ 20 Other information 10 Net section 1231 gain (lesS) 11 Other income
tax credit component 40 41 Excelsior research and development tax credit component 41 42 Excelsior real properly tax credit component 42 Farmers' school tax credit (Form 1T-217) 43 Acres of CNEllifled agricultural property 43 44 Acres of qualified conservation property 44 46 noble sch
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
ment taxcredit component 40 41 Excelsior research and development tax credit component 41 42 Excelsior real property tax credit component 42 Farmers' school tax credit (Form IT-217) 43 Acres of qudified aghcuttural property 43 44 Acres of qualified conservation property 44 46 Eligible ech
g 11 13 12 amending 12 31 12 Partnersidenti In Number Federal Partner's Name, Address, and ZIP Code Partnership's Name, Address, and ZIP Code BLUE CHIP CAPITAL LLC MIDWAY CADENCE LLC THERE ARE NO ADJUSTMENTS OR CREDITS FOR THIS PARTNER Partnership's Pro Rata Share Items All Partners 1. Share of partnerahlp
omponent .. .. .. . . 40 41 Excelsior research and development tax credit component 41 42 Excelsior real property tax credt component 42 Farmers' school tax credit (Form 17--217) 43 Acres of qualified agricultural property 43 44 Acres of qualified conwystion property 44 45 Eligible school
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
stment tax credit component 40 41 Excelsior research and development tax credit component 41 42 Excelsior real property tax credit component 42 Farmers' school tax credit (Form ff.217) 43 Acres of qualified agricultural property 43 44 Acres of qualified conservation property 44 45 Eligible schoo
's LrJoitc.:y truirc, palnerstip (P- P• ik—Abornesktma E Partners inernfylna number 20-3161309 F Penners num address. city. Matt and 2IP code BLUE CHIP CAPITAL LLC 27 HIGH TECH BLVD. THOMASVILLE, NC 27380 O n General oarlfief r lC E Limited partneror otter LLC tnertbrr-rnanast neater H RI Domed: Penny
stment tax creak component 40 41 Excelsior research and deve.opment tax credal component 41 42 Excelsim rea property tax credit component 42 Farmers' school tax credit (Form fT-217) 43 Acres of qualified agricultural property 43 44 Acres of qualified conservation property 44 45 Eligible sc
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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