1 11 24 691 Eagle Rock Ave zoning application packet to West Orange

inst. # cuzsvezes4 - wage 2 OL GIT/REP-3 State of New Jersey (2-21) Seller’s Residency Certification/Exemption (Print or Type) Seller's Information Ni 3) wy, 1 = Seller is a resident taxpayer (individual, estate, or trust) of the State of New Jersey purgul New Jersey Gross Income Tax Act, will file a resident Gross Income Tax retum, and will pay any applicable taxes on any an oF e from the disposition of this property. 30 Selter is a mortgagor conveying the mortgaged property to a mortgagee in fc sure rina transfer in ew of foreclosure with no additional consideration. ' heise 4. Oo Seller, transferor, or transferee is an agency or authority of the United St of America, an agency or authority of the State of New Jersey, the Federal National Mortgage Association, the Federal Home nm age Corporation, the Government National Mortgage Association, of a private mortgage insurance company. . 5. 1 Setter is not an individual, estate, or trust and is not required to m 6.0 The total consideration for the property is $1,000 or less 7. | w] The gain from the sale is not recognized for federal i APPLICABLE SECTION). If the indicated section doe: file a New Jersey Income Tax felum for the year ofthe and oO Seller did not receive non-tike kind property. 30 The real property is being transferred by an execy decedent's estate in accordance with the proyisi 2 [Lhe reel proeerty Beinn sont © Abad ted Gross income Tax payment. required to make an estimated Income Tax payment. s under 26 U.S. Code section 721, 1031, or 1033 (CIRCLE THE ely apply to this transaction, the seller acknowledges the obligation to ort the recognized gain. tor of a decedent to a devisee or heir to effect distribution of the decedent's will or the intestate laws of this State. ‘instituted by the mortgagee, whereby the seller agreed not to receive any proceeds from the sale and the mortg ive all proceeds paying off an agreed amount of the mortgage. 1.0 The deed is dated prior to August 1, 2004, 2 1S not previously recorded. nO The real property is being tran: a relocation company transaction where a trustee of the relocation company buys the property from the seller and thet jouse to a third party buyer for the same price. 12. 0 The real property is tween spouses or incident to a divorce decree or property settlement agreement under 26 U.S. Code section 1041. 13 a] The property

a third party buyer for the same price. 12. 0 The real property is tween spouses or incident to a divorce decree or property settlement agreement under 26 U.S. Code section 1041. 13 a] The property transfer tery plot. 14. Oo The seller is not receivi proceeds from the sale. Net proceeds from the sale means the net amount due to the seller on the settlement sheet. 15. o The seller is a retirement trust that received an acknowledgment letter from the intemal Revenue Service that the seller is a retirement trust, and is therefore not required to make the estimated Gross Income Tax payment. 16. Oo The seller (and/or spouse/civil union partner) originally purchased the property while a resident of New Jersey as a member of the U.S. Armed Forces and is now selling the property as a result of being deployed on active duty outside of New Jersey. (Only check this box if applicable and neither boxes 1 nor 2 apply.) e undersigned understands that this declaration and its contents may be disclosed or provided to the New Jersey Division of Taxation and that any false statement contained herein may be punished by fine, imprisonment, or both. | furthermore geciare that | have examined this declaration and, to the best of my knowledge and belief , e-BY checking this box J | certify that a Power of Attomey to repre- Lf /9 {2% / Dbte John C Arnold, Jr. / igh Indicate if Power of Attomey or Attomey in Fact Date Signature (Seller) Indicate if Power of Attomey or Attorney in Fact