West Orange Fourth Round HEFSP_adopted 111025_Appendices

GIT/REP-3 12-07 State of New Jersey wean Seller's Residency Certifiration/Exemption 55, P.L. (Please Print or Type) (C55, P.L. 2004) SELLER(S) INFORMATION (see Instructions, page 2): Name(s) Project Live, Inc. Current Resident Address 465-475 Broadway City, Town, Post Office Newark State NJ Zip Code 07104 PROPERTY INFORMATION (Brief Property Description): Block(s) 159.06 Lot(s) 38 Qualifier Street Address 97 Edgewood Avenue City, Town, Post Office West Orange State NJ Zip Code 07052 Seller’s Percentage of Ownership_100% Consideration $1.00 Closing.Date December 12, 2008 SELLER’S ASSURANCES (Check the Appropriate Box) (Boxes 2 through 8 app 10 lam a resident taxpayer (individual, estate or trust) of the State. et seq. and will file a resident gross income tax return and pay 4 ny ap NON-residents): fersey pursuant to N.J.S.A. 54A:1-1 Able taxes on any gain or income from the disposition of this property. 2 0 The real property being sold or transferred is used exclusively 48 my principal residence within the meaning of section 121 of the federal Internal Revenue Code of 1986} S.C. s. 121. 3s O [am a mortgagor conveying the mortgaged proper a mortgagee in foreclosure or in a transfer in lieu of foreclosure with no additional consideration. 40 Seller, transferor or transferee is an agency o ray ie ority of the United States of America, an agency or authority of the State of New Jersey, National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government Nati Mortgage Association, or a private mortgage insurance company. 5 & Seller is not an individual, estate or, as such not required to make an estimated payment pursuant to N.J.S.A.54A:5-1-1 et seq. 6 & The total consideration for th 'y is $1,000 or less and as such, the seller is not required to make an estimated payment pur: US.A. 54A:5-1-1 et seq. 7.0 The gain from the sale Will not be recognized for Federal income tax purposes under I.R.C. Section 721, 1081, 1033 or is a cemete (CIRCLE THE APPLICABLE SECTION.) If such section does not ultimately apply towhis transaction, the seller acknowledges the obligation to file a New Jersey income tax return for the year.of the sale (see instructions). Bb No non-like,kint | pro] erty received. s OD Transfe ecutor or administrator of a decedent to a devisee or heir to effect distribution of the state in accordance with the

e sale (see instructions). Bb No non-like,kint | pro] erty received. s OD Transfe ecutor or administrator of a decedent to a devisee or heir to effect distribution of the state in accordance with the provisions of the decedent’s will or the intestate laws of this state. SELLER(S) DECLARATION: The undersigned understands that this declaration and its contents may be disclosed or provided to the New Jersey Division of Taxation and that any false statement contained herein could be punished by fine, imprisonment, or both. I furthermore declare that I have examined this declaration and, to the best of my knowledge and belief, it is true, correct and complete. December 12, 2008 - Date Project Live, Inc. Signature (Geller) Please inflicate if Power of Attorney or Attorney in Fact Date Signature (Seiler) Please indicate if Power of Attorney or Attorney in Fact i ificati i Printed by ALL-STATE LEGAL® 1647 ~ Seller's Residency Certification/Exemption Powered by aoe ee STATE Internationa, Ine. GIT/REP'S HotDocs' wwwaaslegal.com 800.222.0510 Pagel Rev.12/07 P2/08