Form Cert-103 - Residential Condominium Association Certificate - Connecticut Page 2

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DECLARATION BY CONDOMINIUM ASSOCIATION

As of the first day of the calendar year covered by this certificate, there were

units in this residential condominium association, of

which

units were not occupied by their owners as a dwelling. This information concerning occupancy was obtained from unit owners.

In accordance with Conn. Agencies Regs. §12-407(2)(i)(I)-1(f)(4), because

% of the units were not owner-occupied, the same percentage of any

charges made to this condominium association by any service provider rendering services to industrial, commercial or income-producing real property, as

defined in Conn. Agencies Regs. §12-407(2)(i)(I)-1(g), is subject to sales and use taxes during the calendar year covered by this certificate.

I declare under the penalty of false statement that I have examined the information in this certificate and that to the best of my knowledge and belief it is true,

complete and correct. (The penalty for false statement is imprisonment not to exceed one year or a fine not to exceed two thousand dollars.)

Name of Condominium Association

By:

Signature of Principal Officer

Title

Date

CERT-103 (BACK)

(Revised 11/98)