West Orange Fourth Round HEFSP_adopted 111025_Appendices

GIT/REP-3 State of New Jersey (12-07) SELLER’S RESIDENCY CERTIFICATION/EXEMPTION {C.55, P.L. 2004) (Please Print or Type} SELLER(S) INFORMATION (See Instructions, Page 2) Name(s) RICHARD §. ZACKIN AND JACK M. ZACKIN, CO-EXECUTORS OF THE ESTATE OF DENA H. ZACKIN Current Resident Address: Street: 31 Longview Road / 57 Oak Avenue City, Town, Post Office Sle Te Cate 08833 / 07052 Lebanon / West Orange NJ PROPERTY INFORMATION (Brief Property Description) Block(s) Lot(s} Qualifier 161 27 Street Address. 23 Oak Avenue Gity, Town, Post Office ‘State Zip Code West Orange NJ 07052 Seller's Percentage of Ownership Considerati Closing Date 100% $437,0 Lig lB D 1am a resident taxpayer (individual, estate, or tryst) 21 ate of New Jersey pursuant to N.J.S.A. 54A:1-1 et seq. and will file @ resident gross income tax return *~ pplicable taxes on any gain or income from the disposition of this property. 2. The reat property being sold or transferred oe ‘usively as my principal residence within the meaning of section 121 U.S.C. s. 121 of the federal Internal! Revenue Code of lam a mortgagor conveying the mgrtgat pféperty to a mortgagee in foreclosure or in a transfer in lieu of foreclosure with no additional consideration, Seller, transferor or transferee | of New Jersey, the Federal Nationa National Mortgage Associ: xy of authority of the United States of America, an agency or authority of the State gage Association, the Federal Home Loan Mortgage Corporation, the Goverment , oF a private mortgage insurance company. Seller is not an indivi NJSAS4A1-1 trust and as such not required to make an estimated payment pursuant to e property is $1,000 or less and as such, the seller is not required to make an estimated PSA. 54A:5-1-1 ef seq. The gain from th le will not be recognized for Federal income tax purposes under |.R.C. Section 721, 1034, 1033 or is a cemetery plot, (CIRCLE THE APPLICABLE SECTION), If such section does not ultimately apply to this transaction, the seller acknowledges the obligation to file a New Jersey income tax return for the year of the sale (see instructions), No non-like kind property received. oo ooo onog 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. ER(S)

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. ER(S) DECLARATION ‘The undersigned understands that this declaration and its contents may be disclosed or pro’ false statement contained herein could be punished by fine, imprisonment, or both. | furl to the best of my&nowiedge and belle, itis true, correct and compiesg. LfLlel GF d to the Naw Jersey Division of Taxation and that any re dectay at | have examined this declaration and, Date Richard S. Zackin, @o-Executor of the Estate of Signature Dena H. Zackin se indi 'f Power of Attomey or Attorney in Fact G l lo l ot = a Date Jack M, Zackin, Co-Exe ory the Bstate off Signature Dena H. Zackin Sailer} Ph licate f Powar of Allorney or Attorney in Fact