2010
                                                               Form BCA                                                                               Massachusetts
                                                            Brownfields                                                                               Department of
                                                                                                                                                      Revenue
                                                         Credit Application

For calendar year 2010 or taxable year beginning                                                                                                                   and ending
Name of company/nonprofit organization                                  Federal Identification or Social Security number

Mailing address                                                         City/Town                                       State                         Zip

Name of contact person                                                  Telephone                                       E-mail address

Type of entity:
  Corporation      TrustPartnership   Sole proprietorshipLLC   Nonprofit  Other:
Address of property                                                     City/Town                                       State                         Zip

Date(s) eligible costs incurred

1 Percentage of costs with respect to the assessed value of the property prior to remediation. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Net response and removal costs incurred during the taxable year. Net response and removal costs are eligible costs as 
  described in TIR 99-13. However, the environmental response action commencement cutoff date has been extended to 
  August 5, 2011 and the time for incurring eligible costs that qualify for the credit has been extended to January 1, 2012 . . . . . 2
  Note: Include only those eligible costs pertaining to an environmental response action which has been commenced and diligently pursued and which
  achieves and maintains a permanent solution or remedy operation status in compliance with M.G.L. Ch. 21E and the regulations promulgated there
  under. Eligible costs must pertain to a property owned or leased for a business purpose and which is located in an economically distressed area as
  defined in M.G.L. Ch. 21E, sec. 2. The costs must be equal to or greater than 15% of the assessed value of the property prior to remediation. The credit
  cannot be claimed until a response action outcome statement or remedy operation status submittal has been filed with the Massachusetts Department
  of Environmental Protection.
3 Brief description of environmental response action to which the eligible cost relate

I declare under the pains and penalties of perjury that to the best of my knowledge, the information contained herein is accurate and complete.
Signature                                                               Date

Mail to:Massachusetts Department of Revenue, Audit Division, 200 Arlington Street, Room 4300, Chelsea, MA 02150, attn.: Brownfields Unit.