West Orange Fourth Round HEFSP_adopted 111025_Appendices

Ares fag. 74010) , MUSTSUBMIT IN DUPLICATE STATE OF NEW JERSEY . AFFIDAVIT OF CONSIDERATION FOR USE BY SELLER (Chapler 49, P.L.1968, as amended through Chapter 33, P.L. 2006) (N.. BEFORE COMPLETING THIS AFFIDAVIT, PLEASE READ THE INSTRUCTIONS ON J.S.A. 46:15-5 et seq.) THE REVERSE SIDE OF THIS FORM. STATE OF NEW JERSEY Consideratior }ss. County Municipal Code RTF pgid by seller, COUNTY ESSEX 0722 bate a LELY 9y FOR RECORDER’S: oY rn $ MUNICIPALITY OF PROPERTY LOCATION__West Orange *Use symbol °C” to indicate that fee is exclusively for county use (1) PARTY OR LEGAL REPRESENTATIVE (See Instructions #3 and #4 on reverse side) Deponent, Kenneth R. Sauter . being duly sworn — according = to. = faw-—supon __ his/her —_ oath, (Name) 1 17, 204 deposes and says that he/she is the Legal Representative in a deed dated une 17, 2014 transferring (Grantor, Legal Representative, Corporate Officer, Officer of Title Company, Lending Institution, etc.) real property identified as Block number 155 Lot number 27 C0177 focated at 177 Marion Drive, West Orange, New Jersey and annexed thereto. (Street Address, Town) (2) CONSIDERATION § 1.00 (instructions #1 and #5 on reverse side) [Who prior mortgage to which property is subject. (3) Property transferred is Class4A 4B 4C (circle one). If praperty transferred is Class 4A, calculation in Sec in 3A below is required. (3AJREQUIRED CALCULATION OF EQUALIZED VALUATION FOR ALL CLASS 4A (COMMERCIAL) PROF JRANSACTIONS: {See instructions #5A and #7 on reverse side) 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 100%, the assessed value will be equal to the equalized valuation, v tio is equal to or in excess of (4) FULL EXEMPTION FROM FEE (See Instruction #8 on reverse side) Deponent states that this deed transaction is fully exempt from the Realty Transfer Fe C. 66, P.L. 2004, for the following reason(s). Mere reference to exemption symbol is insu C. 49, P.L. 1968, as amended through lain in detail. (5) PARTIAL EXEMPTION FROM FEE ( insiruction #9 on reverse side) NOTE: All boxes below apply to grantor(s) only. ALL BOXES IN APPROPRIA\ void claim for partial exemption. Deponent claims that this deed transacti General Purpose Fees, as applicable, imposed by C. 176, P.L. 1979, C.

below apply to grantor(s) only. ALL BOXES IN APPROPRIA\ void claim for partial exemption. Deponent claims that this deed transacti General Purpose Fees, as applicable, imposed by C. 176, P.L. 1979, C. 1 (a) For a consideration of less than $100 ‘GORY MUST BE CHECKED, Failure to do so wilt xGFApt from State portions of the Basic, Supplemental, and 004, and C. 66, P.L. 2004 for the following reason(s): K SENIOR CITIZEN Grantor(s)[_]62 years of age or 8. BLIND PERSON —_Grantor(s} [“Jlegally blind or; DISABLED PERSON Grantor(s) [~)permanently an > tion #9 on reverse side for A or B) bled [_ ]receiving disability payments [__|not gainfully employed* eet all of the following criteria: ior citizens, blind persons, or disabled person ;wned and occupied by grantor(s) at time of die. ‘esident of State of New Jersey. ne or two-family residential premises. wners as joint tenants must all qualify “IN CASE OF HUSBAND AND WIFE, PARTNERS IN A GIVIL UI ONLY ONE GRANTOR NEED QUALIFY IF TENANTS BY THE ENTIRETY. c AND MODERATE INCOME, iction #9 on reverse side) |Affordable according to H.U. Reserved for occupancy. Meets income requirements. {_] Subject to resaie controls. (6) NEW CONSTRUCTION (instrugtions #2, 1d #12 on reverse side) Entirely new improve lot previously occupied. Ose. NEW CONSTRUCTION" printed clearly at top of first page of the deed. (7) RELATED LEGAL ENTITU [4No prior mor lo contributio: lo stock ‘or to which property is subject al time of sale. either grantor or grantee legal entity hanged by or between grantor or grantee legal entities. Affidavit to induce county clerk or register of deeds to record the di (8) Deponent makes s of Chapter 49, P.L. 1968, as amey¥ded through Chapter 33. accordance with the prov: Subscribed and sworn to before me this 23rd day of June ,2014 Signature of Deponent Hill Wallack LLP 89 Headquarters Plaza Ma D oO Morristown, NJ 07860 jleed and accept the fee submitted herewith in L. 2006. The Arc of Essex County, Inc. Grantor Name 123 Naylon Avenue Livingston, NU 07039 Deponent Address ANDREAG. peciHoupt i Ad Notary y Public of New Jersey XXOW0OG Grantor Address at Time of Sale Kenneth R. Sauter, Esq. My" Comi ssion Expires: April 22, 2019 Last three digits in Grantor's Social Security Number Name/Company of Settlement Officer instrument Number. FOR OFFICIAL USE ONLY County, Deed Number Book

. My" Comi ssion Expires: April 22, 2019 Last three digits in Grantor's Social Security Number Name/Company of Settlement Officer instrument Number. FOR OFFICIAL USE ONLY County, Deed Number Book Page. Deed Dated Date Recorded County recording officers shall forward one copy of each RTF-| form when Section 3A is completed to: STATE OF NEW JERSEY PO BOX 251 TRENTON, NJ 08695-0251 ATTENTION: REALTY TRANSFER FEE UNIT The Director of He Division of Taxation in the Department of the Treasury nas prescribed this form as required by law, and may not be altered or amended without prior approval of the Director. For information on the Realty Transfer Fee or to print a copy of this Affidavit, visit the Division of Taxation website at: www.state.nj.us/treasury/taxation/|pt/localtax.htm