West Orange Township_Fourth Round HEFSP_Final Draft

GIT/REP-3 State of New Jersey {12-07} SELLER’S RESIDENCY CERTIFICATION/EXEMPTION (0.55, PL. 2004) {Please Print o Typel SELLER(S} INFORMATION (See Instructions, Page 2} Namef{s} RICHARD $. ZACKIN AND JACK M. ZACKIN, CO-EXECUTORS OF THE ESTATE OF DENA H. ZACKIN Currant Resident Address. ~ Street: 21 Longview Road / §7 Oak Avenue City, Town Post Office State Zip Coce Lebanon / West Orange NJ 08833 / 07052 PROPERTY INFORMATION (Brief Property Description} Biockjs) Lot(s} ‘Qualifler 164 27 Street Address: 23 Oak Avenue City, Town, Post Office _ — _ ” Sate Zip Code West Orange . NJ 07052 Seller's Percentage of Qwnersh.p Consideration Closing Date 100% $437,000.00 110108 SELLER ASSURANCES (Check the Appropriate Sox) (Boxes 2 through 8 apply to NON-residents} 1, BR] | ama resident taxpayer lindlvidval, estate, or (rust) of ha State of New Jersey pursuant to N.J.S.A, S4A:1-1 el seq. and a on omg oa will file 2 resident gross income lax return and pay ary applicable taxes On any gain or income from the disposition of this property. jm] The tea! property being sold or transferred is used extiiisively as my ptincipat residence within Ine meaning of section 421 of he federai intemal Revenue Cade of 1966.26 US C s. 124 Tam a morigager conveying the srorgaged: property toa mortgagee In foreclosure o- in a transfer in lew of foreclosure wilh no additonal consideration, ‘ Selle, (ransferar of transferee is an agency of authority of the United States of America, an agency or authority of (ne State ol New Jersey, the Federal Natori Mortgage Association, the Federal Home Loan Mortgage Corgoration, the Geverrrnent Natonal Morigage Associaton, or a p* vate morigage insurance company. Setier ‘s not an individuar, ‘slate O° trust ané as such not required lo make an estimated payment pursuant to NS A.54A:1-1 gt seq. The total consideration for the proverty is $1.000 9° ‘ess and as such, tie seller 1s NO! required lo make an estimated oaymenl pursdant toN. S.A 54A5-1-1 et seq. Tne gain for tne Sale wil rot be recognized for Federai income tax purposes under LR.C. Section 721, 1034, 1033 ors a cemetery piol, (CIRCLE THE APPLICABLE SECTION). If such section does not ullimately apply to this transaction, the seller acknow edges the obiigation to file a New Jersey income tax retum for (he year of the sale (see instructions}, No non-like Kind propery

ction does not ullimately apply to this transaction, the seller acknow edges the obiigation to file a New Jersey income tax retum for (he year of the sale (see instructions}, No non-like Kind propery received. Transfer by an executor or administrater of a decedent to a devisee or neir to effect distribution af the decedent's estate in accordance wilh the provisions of the decedent's whi or Ihe intestate laws of this state SELULER(S) DECLARATION The undersigned unzerslands thal th’s dectaration and ils contents may be dischased of pro} falso statemen! contained herer col fo the best of myknowlegge anc tel: LLlele & sey Diviston of Taxation and thst any 0 w at Ehave axamined (ris dectaration and, 5¢ punishad by Fine imprisonment, o° beth. : furl s we, corrett and complay _¢ ltolo% = Dena x. Zackir Terr age Power of Altorney of Miziey 7 Fact Date Richad S Zackin, Co-Executor of ihe Estate of J, Sigreture Date Jack MY. Zackin, Co-Exediyon the Balate oS Signature Oena H. Zackin ener) PIR ale. Powgr 0) Allomey o« Ane Tey FEN