23 9 12 Bolivar 17 Wheatland West Orange Curent Deed Recorded Copy

Inst. # 2023058315 - Page 4 of 6 GIT/REP-3 State of New Jersey (2-21) Seller’s Residency Certification/Exemption (Print or Type) Seller’s Information Name(s} 19 WHEATLAND DEVELOPMENT LLC. ‘Current Street Address $2. 63rd Street, West New York City, Town, Post Office West New York NJ Property Information BIOcr 39 56.06 Seller's Percentage of Ownership ‘Total Consideration $210,000 ]Qo52 sidents) ® New Jersey Gross Income Tax Act, Seller is a resident taxpayer (individual, estate, or trust) of the State of New Jersey 2 from the disposition of this property. will file a resident Gross Income Tax retum, and will pay any applicable taxes on any g 3. 5 Seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclos: additional consideration. 4 Oo Seller, transferor, or transferee is an agency or authority of the United of America, an agency or authority of the State of New Jersey, the Federat National Mortgage Association, the Federal Home Corporation, the Govemment National Mortgage Association, or a private mortgage insurance company. ). Seller is not an individual, estate, or trust and is not required tonal timated Gross Income Tax payment. . Oo The total consideration for the property is $1,000 or less so t required to make an estimated Income Tax payment. q o The gain from the sale is not recognized for federal income: under 26 U.S. Code section 724, 1031, or 1033 (CIRCLE THE APPLICABLE SECTION). If the indicated section does: apply to this transaction, the seller acknowledges the obligation to file a New Jersey Income Tax retum for the year of the port the recognized gain. 11 seller did not receive nonlike kind property. iministrator of a decedertt 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 0 The real property is being transferred by an decedent's estate in accordance with the py i 2, C1 The real property being sold is subject to short Procaeds from the sale and the ive all proceeds paying off an agreed amount of the mortgage. 10. 1 the deed is dated prior to August 1,/2004, and was not previously recorded. 11. Ete real property is being trar relocation company iransaction where a trustee of the relocation company buys the Property from the saller and then. e to a third party buyer

previously recorded. 11. Ete real property is being trar relocation company iransaction where a trustee of the relocation company buys the Property from the saller and then. e to a third party buyer for the same price. 20 The real property is being ‘spouses or incident to a divorce decree or property settlement agreement under 26 U.S. Code saction 1041. 13, C1 the property transferred k tery plot 4.0 The seller is not receiving net from the sale. Net proceeds from the sale means the net amount due to the seller on the setticment sheet. 15. o The seller is a retirement trust that received an acknowledgment letter from the Intemal Revenue Service that the sellor 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. Asmed 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.) eller’s Declar n The undersigned understands that this declaration and its contents may be disclased or provided to the New Jersey Division of Taxation and that any false statement contained herein may be punished by fine, imprisonment, or bath. | furthermo! re that | have examined this declaration and, to the best of my knowledge and belief, it is true, correct and complete. By checking this box | certify that a Power of Attomey to repre- ‘sent the seller(s) has been previously recorded or is being recorded simultaneously with the deed to,which this fonm is attached. PLR /D3 SLE Signature (Seller) Indicate if Power of Attomey or Attorney in Fact Date Signature (Seller) Indicate if Power of Attomey or Attorney in Fact