West Orange Township_Fourth Round HEFSP_Final Draft

MUST SUBMIT IN CUPLICATE N C1645 - Affidavit of Consideration _RTE-1 (Rev. 7/08) P3/0B STATE OF NEW JERSEY . : AFFIDAVIT OF CONSIDERATION FOR USE BY SELLER (Chapter 49, P.L., 1968, as amended through Chapter 88, P.L. 2006) (NwJS.A, 46:15-5 0t 809.) BEFORE COMPLETING THIS AFFIDAVIT, PLEASE READ THE INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM. STATE OF NEW JERSEY County Municipal FOR RECORDER'S USE ONLY 5S. Code Consideration $ i086 COUNTY OF ESSEX AZIL RTF paid by seller $ _t pate (2 p)7/ OF By PC. Municipality of Property Location: West Orange Printed by ALL-STATE LEGAL® vawwaslegal.com 600222.U5:0 Page} ————————— 1 Use symbol “C” to indicate that (ve is exctusively for county use. (1) PARTY OR LEGAL REPRESENTATIVE $= (See instructions 3 and 4 attached) Deponent, Rev, Robert Cormier s being duly sworn according to law upon his/her oath deposes {Name} and says that he/she is the President and Grantor inadeed dated 12/12/08 sGractor, Grantee, Lagel Representative. Carporaie Otiver, Officer ef Tue Co, Lendiag Ceatatutéon, etc.) OO transferring real property identified as Black No. 169.06 Lot No. 38 located at 97 Edgewood Avenue, West Orange, New Jersey 07052 and annexed thereto. (ineet Address, Town) (2) CONSIDERATION: $4.60 (See instructions f and 5) (3) Property transferred is Class 4A 4B 40 (circle one). If Class 4A, calculation in Section 3A is required. @A) JIRED LATION OF EQUALTI VALUATION _F. 4A COMMERCIAL PROPERTY TRANSACTIONS: (see Instructions 5A and 7) Total Assessed Valuation + Director's Ratio = Equalized Assessed Valuation $ + % = $ [f Director’s Ratio is Jase than 100%, the equalized valuation will be an amount greater than the assessod valua, If Director's Ratio is equal to or in excess of 100%, the assessed value will be equal to the equalized value. (4) FULL EXEMPTION FROM FEE: (see Instruction 8) Deponent states that this deed transaction is fully exempt from the Realty Transfer Fee imposed by C. 49, P.L. 1968, as amended through C. 66, P.L. 2004, for the following reason(s). Mere reference to the exemption symbol is insufficient. Pxplain in detail, {a) For a consideration of less than $100.00 (5) PARTIAL EXEMPTION FROM FEE: (see Instruction 9) NOTE: Au boxes below apply to grantor(s) only. ALL BOXES IN APPROPRIATE CATEGORY MUST BE CHECKED. Failure to do so will wid claim for partial exemption. Deponent claims that this

: (see Instruction 9) NOTE: Au boxes below apply to grantor(s) only. ALL BOXES IN APPROPRIATE CATEGORY MUST BE CHECKED. Failure to do so will wid claim for partial exemption. Deponent claims that this deed transaction is exempt frorn the State's portion of the Basic Fee, Supplementa. Fee and General Purpose Fee, as applicable, imposed by C. 176, P.L. 1975; C. 113, P.L. 2004 and C. 66, P.L. 2004 for the following reason(s): A. SENIOR CITIZEN (sce Instruction 9) oO Grantor(s} 62 years of age or over.* (J Owned and occupied by grantor(s) at time of sale. 1] One- or two-family residential premises. (] Owners as joint tenants must al! qualify. [_] Resident of the State of New Jersey. B. BLIND (see Instruction 9) DISABLED (see frstruction 9) Oo Grantor(s} legally blind.* oO Grantor(s) permanently and totally disabled.* LJ One- or two-family residential premises. im Receiving disability payments." (7 Owned and occupied by grantor(s) at time of sale. CC) Not gainfully employed.* (C Owners as joint tenants must all qualify. (] One- or two-family residential premises. CJ) Resident of the State of New Jersey. [_] Owned and occupied by grantor(s) at time of sale. “JN THE CASE OF HUSBAND AND WIFE, PARTNERS 1N A [“] Owners as joint tenants must all qualify. 4 i S DS TO A GUALIT OWNED ASTENANTSBY THE ENTIRETY. _L_] Resident of the State of New Jersey. ¢. LOW AND MODERATE INCOME HOUSING (sce Instruction 9) (X] Affordable according to HUD standards. [X] Reserved for occupancy. [X] Meets income requirements of region. [KX] Subject to resale controls. (6) NEW CONSTRUCTION (see Instructions 2, 10 and 12) (J Entirely new improvement. im Not previously occupied. (] Not previously used for any purpose. L] “NEW CONSTRUCTION” printed clearly at the top of the first page of the deed iii makes this Affidavit to induce the Gounty Clerk or Register of Deeds to record the deed and accept the fee submitted herawith in accordance with the provisions of Chapter 49, P.L, 1968, as amended through Chapter 33, P.L. 2006. Subscribed and sworn to before me Rev. Robert Cormier this Twelfth fgnature of Deponent Grantor Name "a Lima Church Cecember _, 20.08 St. Rosa day of__t ~ 1% Gray Street, Newark, NJ . Kuschner, Esquire Deponent Address Grantor Address at Time of Sale XXX-XK-X Jeffrey R. Kuschner, Esquire Last 3 digits in Grantor's Social Security No. Name/Company of Settlement

Street, Newark, NJ . Kuschner, Esquire Deponent Address Grantor Address at Time of Sale XXX-XK-X Jeffrey R. Kuschner, Esquire Last 3 digits in Grantor's Social Security No. Name/Company of Settlement Officer ‘This form is préwée? the Director, Divislon of Taxation ia ‘OR OFFICIAL USE ONLY the Department of the Treasury, #2 required by law, ond may | 1 nant Number f ‘County é not be altered or amended without the prior approval of the oak SOL Te Direrzor, For information on the Realty Transfer Fee or to priat | Deed Number BI7b SE C7 a copy of this Affidavit, vist the Division of Taxation websde at | need Dated oi. ~~ Date Recorded werw stale nj usftreasuryftexetion/pUloemilax, htm. 42 fiz fad. §_ copy of each Affidavit of ‘Consideration for Use by Seller when Section 3A is completed. County Recording Officers shall forward one 4 Trenton, NJ 08685-0251, Attention: Realty Transfer Fee Unit State of New Jersey - Division of Taxation, P.O. Box 2