West Orange Fourth Round HEFSP_adopted 111025_Appendices

MUST SUBMIT IN DUPLICATE Printed by ALL-STATE LEGAL® NC1645 - Affidavit of Consideration _RTF-1 Rev. 108) | POS STATE OF NEW JERSEY vowweaslegalcom 800222.0510 Page 1 AFFIDAVIT OF CONSIDERATION FOR USE BY SELLER (Chapter 49, P.L.. 1968, as amended through Chapter $3, PL. 2006) (N.LS.A. 46:15-5 et seq.) 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 COUNTY OF ss. Code Consideration $ L00 ESSEX 6722. RTF paid by seller $ 4 + Date _2)17/0§- By BG. Municipality of Property Location: West Orange = "t Use symbol “C” to indicate that fee is exclusively for county use. (1) PARTY OR LEGAL REPRESENTATIVE § (See Instructions 3 and 4 attached) Deponent, Rev. Robert Cormier , being duly sworn according to law upon his/her cath deposes (Name) and says that he/she is the President and Grantor inadeed dated 12/12/08 (Grantor, Grantee, Legal Representative, Corporate Officer, Officer of Title Co., Lending Institution, etc.) transferring real property identified as Block No. 159.06 Lot No. 38 located at 97 Edgewood Avenue, West Orange, New Jersey 07052 and annexed thereto, Giree’ Address, Town) (2) CONSIDERATION: $4.00 (See Instructions 1 and 5) (8) Property transferred is Class 4A 4B 4C (circle one). If Class 4A, calculation in Section 3A is required. (8A) REQUIRED [LATION OF E A VALUATION _F CLASS 4A MMERCIAL PROPERTY TRANSACTIONS: (sce Instructions 5A and 7) Total Assessed Valuation + Director’s Ratio = Equalized Assessed Valuation $ + % = $ If Director's Ratio is less than 100%, the equalized valuation will be an amount greater than the assessed va 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 Re Transfer Fee imposed by C. 49, P.L. 1968, as amended through C. 66, P.L. 2004, for the following reason(s). Mer¢’re etéthe exemption symbol is insufficient. Explain in detail. (a) For a consideration of less than $100.00 jrector'# Ratio is equal to or in exeess (5) PARTIAL EXEMPTION FROM FER: (see Instruction 9) N ALL BOXES IN APPROPRIATE CATEGORY MUST BE CHEC: Deponent claims that this deed transaction is exempt fro! and General Purpose Fee, as applicable, imposed by C. 176, . 113, P.L, 2004 and C. 66, P.L, 2004 for

ES IN APPROPRIATE CATEGORY MUST BE CHEC: Deponent claims that this deed transaction is exempt fro! and General Purpose Fee, as applicable, imposed by C. 176, . 113, P.L, 2004 and C. 66, P.L, 2004 for the following reason(s): A. SENIOR CITIZEN (see Instruction 9) © CO Grantor(s) 62 years of age or over.* a (J Owned and occupied by grantor(s) at time of sale. (J One- or two-family residential premi CL] Owners as joint tenants must all qualify. LJ Resident of the State of New Jerse: B, BLIND (see Instruction 9) ?) DISABLED (see Instruction 9) Pp es. CJ Grantor(s) legally blind.* C1 Grantor(s) permanently and totally disabled.* L] One- or two-family resiffent CO Receiving disability payments.* (J) Owned and occupied by grantor{s) at time of sale. (1 Not gainfully employed.* oO Owners as joint tenan' qualify. oO One- or two-family residential premises. oO Resident of th ite of New Jersey. oO Owned and occupied by grantor(s) at time of sale. * IN THE CASE OF ND AND WIFE, PARTNERS IN A [_] Owners as joint tenants must all qualify. Seer ie OWNED ASTEN, Fe aaa ORT To (J Resident of the State of New Jersey. Cc. LOW INCOME HOUSING (see Instruction 9) Xx] ding to HUD standards. [K] Reserved for occupancy. Xx} M ‘equirements of region. [X] Subject to resale controls. (6) NEW CONSPRUCTION (see Instructions 2, 10 and 12) im Entirely new improvement. oO Not previously occupied. (1 Not previously used for any purpose. LJ “NEW CONSTRUCTION” printed clearly at the top of the first page of the deed. (7) Deponent makes this Affidavit to induce the Gounty Clerk or Register of Deeds to record the deed and accept the fee submitted herewith 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 08 St. Rosa Lima Church day of December _, 20.05. 44 Gray Street, Newark, NJ Deponent Address Grantor Address at Time of Sale XXXK-XX-X Jeffrey R. Kuschner, Esquire Last 3 digits in Grantor’s Social Seeurity No. Name/Company of Settlement Officer ‘This form is pr the Director, Division of Taxation in FoR PEFIOIAL USE ONLY the Department of the Treasury, as required by law, and may ] 1st ment Number & //0 YY A come Eisex not be altered or amended withont the prior approval of the ao ES Director. For information on the Realty Transfer Fee

the Treasury, as required by law, and may ] 1st ment Number & //0 YY A come Eisex not be altered or amended withont the prior approval of the ao ES Director. For information on the Realty Transfer Fee or to print | Deed Number a copy of this Affidavit, visit the Division of Taxation website at | ooq Dated Date Recorded www.state.nj.us/treasuryitaxation/Ipt/localtax.htm. 12 f12 fb. ____ i i is by Seller when Section 3A is completed. ding shall forward one copy of each Affidavit of Consideration for Use by Sell " ; oe of New A oeey Division of Taxation, P.O. Box 251, Trenton, NJ 08695-0251, Attention: Realty Transfer Fee Unit