West Orange Fourth Round HEFSP_adopted 111025_Appendices

GIT/REP-3 (5-12) State of New Jersey SELLER’S RESIDENCY CERTIFICATION/EXEMPTION (C58, PL. 2004) Names(s) Jeannette Whaley and Mark Whaley Current Resident Address: Street: &4 Summit Drive _ City, Town, Post Office State Zip Code Basking Ridge NJ . 07920 PROPER TYJINFORMATION: (Brief Property. Description) i Block(s) Lot(s) Qualifier 155 27 C0177 Street Address: 177 Marion Drive City, Town, Post Office Zip Code West Orange 907052 Seller's Percentage of Ownership Consideration Closing Date 7 a DID G G0 ¢ OO ISELEER’ASSURANCES|(Check'the Appropriate;Box) (Boxes-2ithro 1. Blam aresident taxpayer (individual, estate, or trust) of the State of resident gross income tax return and pay any applicable taxes on 'o|Residents/and Non-residents): pursuant to N_J.S.A. 54A:1-1 et seq. and will file a or income from the disposition of this property. 2. [ithe real property being sold or transferred is used exctusi federal Internal Revenue Cade of 1986, 26 U.S.C. 5. 121 3. [7]! am a mortgagor conveying the morigaged property to aig ‘ipal residence within the meaning of section 121 of the in foreclosure or in a transfer in lieu of foreclosure with no additional consideration. 4. {[]Seller, transferor or transferee is an agency or auth shape United States of America, an agency or authority of the State of New Jersey, the Federal National Mortgage Associati sal Home Loan Mortgage Corporation, the Government National Morigage Association, or a private mortgage insuran m| 5. [Seller is not an individual, estate or trust any not required to make an estimated payment pursuant to N.J.S.A.54A:1-1 et seq. St |The total consideration for the property is Jess and as such, the seller is not required to make an estimated payment pursuant to N.J.S.A. 54A:5-1-1 et s 7. [the gain from the sale will not be he for Federal income tax purposes under I.R.C. Section 721, 1031, 1033 or is a cemetery plot. (CIRCLE THE APPLICABLI ION). If such section does not ultimately apply to this transaction, the seller acknowledges the obligation to file a New J ie tax return for the year of the sale (see instructions). Eno non-like kind propert 8. []Transfer by an executor or adfiinistrator 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. 9. [the property being

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. 9. [the property being sold is subject to a short sale instituted by the mortgagee, whereby the seller has agreed not to receive any proceeds from the sale and the mortgagee will receive all proceeds paying off an agreed amount of the mortgage. 10. the deed being recorded is a deed dated prior to the effective date of P.L. 2004, c. 55 (August 1, 2004), and was previously unrecorded. 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 ierein could be punished by fine, imprisonment, or both. | furthermore declare thal | have examined this declaration and, to the best of my knowledge and belief, it is true, correct and complete. By checking this box © | certify that the Power of Attorney to represent the seller(s) has been previously recorded oF is being recorded simullaneously with the deed to which this form is attached. lry fia \Qracdurkler VT Date Signatup {Seller} Please indigate. if Power of Att: Attorney in Fact 81403 Qt” CK Date Signature a (Seller) Please indicate if Power of Attorney or Attorney in Fact