West Orange Township_Fourth Round HEFSP_Final Draft

GITIREP-3 (5-12) State of New Jersey SELLER’S RESIDENCY CERTIFICATION/EXEMPTION (C.58, PL. 2004} Names(s) DIANA SEFCHIK Current Resident Address: Street: 102 READINGTON ROAD City. Town, Post Office WHITEHOUSE STATION TION Zip Cade P Block(s) 162.21 Street Address: 19 TERRACE AVENUE City. Town. Post Office WEST ORANGE Seller's Percentage af Ownership Consideration Closing Dale 1% Zip Cade 07052 federal internal Revenue Code of 1986, 26 U.S.C. 5. 121 [D)\ am a mortgagor conveying the mortgaged property to a,moitgadée in foreclosure or in a lransfer in lieu of foreclosure wilh no nited States of America, an agency or authority of the State of New Jersey, the Federal National Mortgage Association,théFederal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private morigage insurance, camy 5. [Seller is not an individual, estate or trust afd as sugh not required to make an estimated payment pursuant lo N.J.S.A.54A:1-1 et seq. 6. [The total consideration for the property is $4900 pursuant lo N.J.S.A, 544:5-1-1 et se less and as such, the seller is not required to make an estimated payment 7. Fhe gain from the sale will noi be re ized for Federal income tax purposes under 1.R.C. Section 721, 1031, 1033 or is a cemetery plot. (CIRCLE THE APPLICABLE:SECTION). If such section does not ultimately apply to this transaction. the seller acknowledges the obligation ta file a New Jéfsey ingore tax return for the year of the sale (see instructions). [no non-like kind property: 8. (JTransfer by an executor or adginistrator of a decedent to 4 devisee or heir to effect distribution of Ihe decedent's estate in accordance with the provisions of the decedent's will or the intestate laws of this state 9. [The property being sold is subject to a short sale instituted by the mortgagee. whereby the seller has agreed nol to receive any proceeds from the sale and the mortgagee will receive all praceeds paying off an agreed amaunt of the mortgage. 10. ithe deed being recorded is a deed dated prior to the effective date of PL. 2004, c. 55 (Augus! 1, 2004), and was previously unrecorded The undersigned understands that this declaration and its contents may be disclosed os pravided to the New Jersey Division of Taxation and nal any false slalement contained herein could be punished by fine, imprisonmenl, or bath. | furlhermore declare

nd its contents may be disclosed os pravided to the New Jersey Division of Taxation and nal any false slalement contained herein could be punished by fine, imprisonmenl, or bath. | furlhermore declare that | have examined this declaration and, to the best of my knowledge and behef, it is ue. correct and complele. By checking this box O | certify that the Power of Attorney lo represent the seller(s) has been previously recorded or is being recorded simultaneously with the deed to which this form is attached. Heol ta (nse SPewthe Date Te ture {Seller) Piease indicate if Power of Anlorney or Atomey in Fact Date Signature {Sel er) Please indicate f Power of Attorney or Atorney in Fact