Schedule Qip-C - Qualified Investment Partnership Certification - 2010 Page 2

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SCHEDULE

100007QP

QIP-C

PAGE 2

LABAMA

EPARTMENT OF

EVENUE

Qualified Investment Partnership Certification

For Calendar Year 2010 or Fiscal Year

Beginning ___________________, 2010 and ending _____________________, ________

1a. LEGAL NAME OF PARTNERSHIP

1b. FEIN

QIP Asset Test:

RATIO OF TOTAL

QUALIFYING

TANGIBLE

TOTAL

OFFICE

TOTAL

QUALIFYING

INVESTMENT

PERSONAL

QUALIFYING

FACILITIES

ASSETS

ASSETS TO

SECURITIES

PROPERTY

ASSETS

TOTAL ASSETS

2a. Beginning of Taxable Year . .

2b. End of Month 1 . . . . . . . . . . .

2c. End of Month 2 . . . . . . . . . . .

2d. End of Month 3 . . . . . . . . . . .

2e. End of Month 4 . . . . . . . . . . .

2f. End of Month 5 . . . . . . . . . . .

2g. End of Month 6 . . . . . . . . . . .

2h. End of Month 7 . . . . . . . . . . .

2i. End of Month 8 . . . . . . . . . . .

2j. End of Month 9 . . . . . . . . . . .

2k. End of Month 10 . . . . . . . . . .

2l. End of Month 11 . . . . . . . . . .

2m. End of Month 12 . . . . . . . . . .

2n. Average Qualifying Asset

Percentage for the

Taxable Year . . . . . . . . . . . . .

QIP Gross Income Test:

3a. Interest Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3b. Dividend Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3c. Gains and Losses from the Sale or Exchange of QIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3d. Management Fees Paid to the Entity by Members/Owners of the Entity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3e. Total Qualifying Income for the Taxable Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3f. Gross Income for the Taxable Year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3g. Qualifying Gross Income Percentage for the Taxable Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .