West Orange Township_Fourth Round HEFSP_Final Draft

GITAREP-3 (5-12) State of New Jersey SELLER'S RESIDENCY CERTIFICATION/EXEMPTION (C.55, PLL, 2004) (Pease Print of Type} SELLER(S) INFORMATION {See Instructions, Page 2) Names(s) THE ARC OF ESSEX COUNTY, INC. Current Resident Address Seat: 123 NAYLON AVENUE City, Town, Post Office State Zip Code LIVINGSTON NJ 07038 PROPERTY INFORMATION (Brief Property Description) Block{s) Lot(s) Qualifier 455 27 COW? ‘Street Address: 177 MARION DRIVE City. Town, Post Office ~ State : Zip Code WEST ORANGE NJ o7052 Seller's Percentage of Ownership Consideration Closing Date 100 1,00 OB17/2014 SELLER ASSURANCES {Check the Appropriate Box) {Boxes 2 through 76 apply to Residents and Non-residents) O am a resident taxpayer (individual, estate, ar trust} of the Stale of New Jersey pursuant to N_J.S.A. 54A:1-1 et seq. and will fle a resident gross income laa return and pay any applicable taxes on any gan or income from the d-sposition of this property. 2. (]the teal property being sold or transferred S used exclusively as my principal residence wilhin the meaning of section 121 of he federal intemal Revenue Code of 1986, 26 U.S.C. s. 121 3 Oh am a mongagor conveying the mortgaged propeny to a mortgagee in foreclosure or in a transfer in beu of foreclosure with no additional consideration. ae 4 seller, \ansferar or lransleree is an agency or authority “Ot, Libe United States of America, an agency or authority of the Stale of New Jersey. the Federal National Mortgage Assacialion? Ane Federal Home Loan Morigage Corporation. the Government National Mongage Association, or a privale mortgage insurance enmpany. Seller is not an chy dual, eslale or trust and as such not required to make an estmaied payment pursuant to N J.S.A 54A:1-1 et seq. 6. iw]the total consideration for ie property is $ 1000 ér less and as such, the seller is not required lo make an eshmated payment pursuant to N.J.S.A 544:5.1-1 et seq. 7 _The gain irom the sale voll not be rgvagnized for Federal income tax purposes under LR.C, Section 721, 1031, 1033 or is a cemetery plot (CIRCLE THE APPLICABLE, SECTION). ff such section does nol ultimately apply to this wansaction, the selter acknowledges the obligation to file a New Jersey i ineorne lax return for ihe year of the sate (see instructions) De non-tke kind property’ received 8 (Jansfer by an executor of administrator of a decedent to a devises or heir

to file a New Jersey i ineorne lax return for ihe year of the sate (see instructions) De non-tke kind property’ received 8 (Jansfer by an executor of administrator of a decedent to a devises or heir to effect distribution of the decedent's eslale in accordance with the provisions of the decedent's will or the intestate laws of this stale 9. [_]the property being sold is subject to a short sale instituted by the mongagee. whereby the seller has agreed not to receive any proceeds fram the sale and the mongagce wil receive all proceeds paying off an agreed amount of the mortgage 10. L)the deed being recorded is a deed dates prior to the effective date of PL 2004, c $5 (Augusl 1, 2004), and was previously unrecorded. SELLER{S} DECLARATION Tre undersiqned understands that this declaration and sts conlaais may de disclosed or provided (o the New Jersey Division of Taxakon and that any fatse statament contained herein could be purashed by fine, mprisonment, or bolh | furthermore declare that | have examined this dedayakor and, te the best of my kaomtedge and bele!, itis (tue, correct and complete By checking this box OU certify that the Power of Allomey lo rapresant the seller{s) has been previously recoréad oF 1s deing recorded simullaneously with Ite Good to which this form «5 alta 06/17/2014 ~ Daie a —_ g ~ (Sollez) P'case wet care f Power of Aclorray or ANomaey wn Fact ~~ Date _ ° Signature !Seber) Please eicate if Pawar af Atorney of Atonncy 1 Fact