West Orange Fourth Round HEFSP_adopted 111025_Appendices

, a GIT/REP-3 Os (6-10) State of New Jersey SELLER’S RESIDENCY CERTIFICATION/EXEMPTION (C.55, PLL. 2004) E NFORMATION:(Séé)liistri Name(s) ESTATE OF MILDRED CERRATO Current Resident Address Street: 102 READINGTON ROAD Gily, Town, Post Office — State Zip Code WHITEHOUSE STATION NJ 08889 Block(s) Lous) Qualifier 152.24 1391 and 1392 (1293,1394) Street Address: — 19 TERRACE AVENUE City, Town, Post Office Slate Zip Code WEST ORANGE é 07082 Seller's Percentage of Ownership Consideration Closing Date 98% 1, JR] | am a resident taxpayer (individual, estate, or ust) of the:State-of New Jersey pursuant lo N.J.S.A, 54A;1-1 et seq. and will file a resident gross income tax return and pare anager laxes on any gain or income from the disposition of this property, : Cocos 11 (0 a mortgagee in foractosure or in a transfer in lieu of foreclosure with 3. [[] Lam a mortgagor conveying the mortgage no additional consideration 4. 1 Seller, transferor or transferee is al of New Jarsey, the Federal National National Mortgage Association, or a pi gency‘gr authorily of Ihe United States of America, an agency or aulhorily of the State rigage Association, the Federal Home Loan Mortgage Corporation, the Government 1é mortgage insurance company, Seller is not an individual, estatt’ NJS.ASAA:1-1 et seq trust and as such not required to make an estimated payment pursuant to The total consideration te payment pursuantta.| perty is $1,000 or less and as such, the seller is not required to make an estimated A. S4A;5-1-1 et Seq im 7. O The gain from the safé&yvilt not be recognized for Federal income tax purposes under |,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 lhe obligation to file a New Jersey income tax return for the year of the sale (see instructions), oO Oo No non-like kind property received Transfer by an executor or administrator of a decedent ta a devisee or heir to effect distribution af the decedent's estate in accordance with the provisions of the decedent's will or the intestate laws of this state. ige that any false statement contained herein could ne punished by fine, imprisonment, or bath, | furthermore declare thal | have examined this declaration and. lo the best of my knowledge and belief, il is (tue, correct and complete,

ined herein could ne punished by fine, imprisonment, or bath, | furthermore declare thal | have examined this declaration and. lo the best of my knowledge and belief, il is (tue, correct and complete, By checking this box (1) | cently thal the Power af Atiorney to represent the seller(s) has been previously recorded oF is being recorded Simultaneously with the deed to which this form is allached Z of baie Signature 7 (Seller) Please inthe il Power of Attorney er Attorney in Fact Dale Signature {Seller] Please .ndicaie if Power af Attorney of Attorney in Fact