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        <BusinessNameLine1>Love Jarominski Raymond LLP</BusinessNameLine1>
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        <State>MA</State>
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        <BusinessNameLine1>Black Tavern Historical Society of Dudley MA</BusinessNameLine1>
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      <Title>Treasurer</Title>
      <DateSigned>2013-05-14</DateSigned>
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      <Name>Michael Jarominski CPA</Name>
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      <DatePrepared>2013-05-11</DatePrepared>
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      <ExcessOrDeficitForYear>1941</ExcessOrDeficitForYear>
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          <State>MA</State>
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      <ForeignOffice>false</ForeignOffice>
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      <DoesOrgHaveHospital>false</DoesOrgHaveHospital>
      <TanningServicesProvided>false</TanningServicesProvided>
      <Form720Filed>false</Form720Filed>
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