West Orange Township_Fourth Round HEFSP_Final Draft

GIT/REP-3 (5-12) State of New Jersey SELLER’S RESIDENCY CERTIFICATION/EXEMPTION (C.55, PL. 2004) Names(s} . CAROL DIVITTO Current Resident Address: Street: 232 GRANDVIEW AVENUE City, Town, Post Office NORTH CALOWELL Block(s) Lot(s) 152.24 eee 1391 and 1392 (1393,1394) Street Address: 19 TERRACE AVENUE Qualifier City, Town, Post Office Zip Code WEST ORANGE 07052 Seller's Percentage of Ownership Consideration Closing Date 1% $320,960.00 | am a resident taxpayer (individual, estate, or trust) of the State of Ni resident gross income tax return and pay any applicable taxes on 2, [The real property being sold or wansferred is used exclusively as: federal Internal Revenue Code of 1986, 26 U.S.C. 5. 121... 3. oi am a mortgagor conveying the mortgaged property to agnar ga Se in foreclosure or in a transfer in lieu of foreclosure with no additional consideration. 4, ([JSeller, transferor or transferee is an agency or author Nid the United States of America, an agency or authority of the State of New Jersey. the Federal National Morigage AssociationsthgFederal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a privale mortgage insurance, comp 5, [Seller is not an individual, estate or trust af 8. [[]The total consideration for the properly is $7400, pursuant to N.J.S.A. $4A;5-1-1 et se as sugh not required to make an estimated payment pursuant to N.J.S.A.54A:1-1 et seq. less and as such, the seller ig nol required to make an estimated payment 7, [The gain from the sale will not be recagriizes! for Federal income tax purposes under |.R.C. Section 721, 1031. 1033 or is a cemetery plot, (CIRCLE THE APPLICABLESEC'YON), /f such section does not ultimately apply to this transaction, the seller acknowledges the obligation to file a New JefSey iacomie tax return for the year of the sale (see instructions) Dno non-like kind propenytéceive 8 (Transfer by an executor or administrator of a decedent to a devisee or heir to effect distribution of the 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 not to receive any proceeds from the sale and the mortgagee will receive all proceeds paying off an agreed amount of the morlgage 10. Othe deed being recorded is

tgagee. whereby the seller has agreed not to receive any proceeds from the sale and the mortgagee will receive all proceeds paying off an agreed amount of the morlgage 10. Othe deed being recorded is a deed dated prior to the effective date of PL. 2004, c. 55 (August 1. 2004), and was previously unrecorded ed understands that this declaration and its cortents may be disclosed or provided to the New Jersey Division of Taxation and thal any latse statement contained herein cauld be punished by line, imprisonment. or bath. | furhermore declare Ihat | have examined this declaration and, to the best of my knowledge ard belief, it is te, correct and complete. By checking this box O | certify that the Power of Attorney lo represent the seller(s) has been previously recorded or is being regorded simullaneously with the deed to which W7 atiached. le f2012- _ Udec fun Dat Meee {Seller) Please indicate if Power of Anlomey or Attorney in Fact Dale Signature {Setler) Picase indicate if Power of Atlorney or Allorney in Fact