2009
                                        Transfer LIHC                                                                                                                                 Massachusetts
                                        Low-Income Housing Department of
                                                                                                                                                                                      Revenue
                                        Credit Statement

For calendar year 2009 or taxable year beginningand ending
Name of transferor                      Social Security or Federal Identification number

Street address                          City/Town                                       State                                                                                         Zip

Name of transferee                      Social Security or Federal Identification number

Street address                          City/Town                                       State                                                                                         Zip

Name of project                         Building identification number

Street address                          City/Town                                       State                                                                                         Zip

Name of project owner                   Federal Identification number

Street address                          City/Town                                       State                                                                                         Zip

Transfer Information
1Total amount of credit being transferred. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2Year(s) credit was earned by transferor

The undersigned is electing to make a transfer of the Massachusetts low-income housing credit and is notifying the Department of Revenue of this election
pursuant to 760 CMR 54.13(4). A copy of this statement should be attached to the transfer contract. A copy of this statement must also be submitted to the
Department of Revenue. Mail to: Massachusetts Department of Revenue, Audit Division, 200 Arlington Street, Room 4300, Chelsea, MA 02150,
Attn.: Low Income Housing-Unit.
Signature of transferor                 Date

Name of contact person                  Telephone number