PB 25 12 Application

RTPA (Rov. aat23) WUGT SUBMIT IN DUPLICATE ‘STATE OF NEW JERSEY AFFIDAVIT OF CONSIDERATION FOR USE BY SELLER {Chapter 49, P.L,1988, a3 amended through Chapler 33, P.L_ 2008) (N.J.S.A. 46:15-5 at 26q.) BEFORE COMPLETING THIS AFFIDAVIT, PLEASE READ THE INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM. ‘STATE OF NEW JERSEY FOR RECORDBR'S USE QNLY Coie 'SS. County Munpal Code Rei os. & = COUNTY Essex oraz daled {O45 By MUNICIPALITY OF PROPERTY LOCATION WEST ORANGE *Useayrtbol-C" lo Indicate thet fees exctuelooly for ecunty ute. (1) PARTY OR LEGAL REPRESENTATIVE (Seo instructions #9 and #4 on reverse sto) Deponent, GEORGE FASOULETOS being duly sworn accovding to law upon higher oath, comand en HOMER UL ee FERRY 0.8 _ sere real property Klentified ag Block number 114 Lot number _59 Jocated at 2TOMAIN STREET, WEST ORANGE, NEW JERSEY 07512 and annexed thereto, {Stroat Address, Town) (2) CONSIDERATION 5,209, ome 0 {instructions #1 and #5 on reverse side) C)no prlor mortgage to which property is subject, © Property Hanstereds ClasAgA) 48 4G (circle cne). If property Vansfarred Ie Class 4A, calculation In-Seation 9A below Is required, (QA)REQUIRED CALCULATION OF EQUALIZED VALUATION FOR ALL GLASS 4A: (COMMERCIAL PROP) RTY TRANSACTIONS: (See Instructions #5A and #7 on roverse sie) Total Assessed Valuation + Director‘ Ratlo > Equalized Assessed Valuation $494,500 + 72.08 4h §882,070.497 = Director's Ratios less than 700%, the equaltzed valuation willbe an emount greater than ihe asgessed val 100%, the assessed value wie equal to tho equalized valuation, (4) FULL EXEMPTION FROM FEE (See instruction 8 on revorse site) Deponent states that this deed transaction Ls fully exempt {rom the Realty Transfer Fee Iniposed by C. 40, ls .L, 1988, a6 amended through C. 66, P.L, 2004, for the following reason(s). Mera relerenca fo exemption sym Insufficient. Explain In deta, (©) PARTIAL EXEMPTION FROM FEE ( Insiniction #9 on reverse side) NOTE: Alrboxes below apply to grantor(o) only. ALL BOXES IN Astaoraatechresony MUST BE CHECKED. Fallure to do so will vold clalm for partial exemption. Deponent clalms that this deed prentlag Sram t from State portions of tha Basic, Supplemental, and General Purpose Fees, 8s applicable, imposed hy G. 176, P.L. 4976/6, 443, Pil. 2004, and . 86, P.L. 2004 for the following reason(s}: ot, RK’ _ SENIOR GINREN —“Gaiogn) TS yens eset gly,

mental, and General Purpose Fees, 8s applicable, imposed hy G. 176, P.L. 4976/6, 443, Pil. 2004, and . 86, P.L. 2004 for the following reason(s}: ot, RK’ _ SENIOR GINREN —“Gaiogn) TS yens eset gly, Toskonian dt onverea ats Ao) B. [ BUNDPERSON —— Grntoris) C2 legally tind of;" DISABLED PERSON —Grenior(s) El pormanantiy ae led 1) receiving dinabilty payments C1 not galtully employed” ‘Senlor citizens, blind persons, or ehsublod porsons tear all of tho following erkoria: Uonced and occu by ota nat JResxion! cf Stato of Now Jaraoy. Tone or two-tamdy residerilal praises. Tlowmers 98 join tenanta must ail qualty. “INCASE OF SCAND AND WIFE, PARTNERS IN ACT JPLE, ONLY ONE GRANTOR NEED QUALIFY IF TENANTS BY THE ENTIRETY. ©, TERT AND MODERATE INCOME AUBIN Taslnvelfan 0 on raverso sto) \F APPLIES ALL BOXES MUST BE CHECKED. /Atlordable necordhng {0 H.U.D. Ci Resacvad for occupancy. Diiests income requirements of d 1 Subjoct to rasala oonscts. (ons #2, #10 and 612 on reverse sie) IF APPLIES ALL BOXES HUST BE CHECKED. TlEnizety now improvem TNot previously occupted, Gi Not protouaty used for rp spse ‘NEW CONSTRUCTION” printed claarly a top of first page ofthe dood. () RELATED LEGAL ENTITIES TO LEGAL ENTITIES (insiructions NG #12, #74 on reverse sida) IF APPLIES ALL BOXES MUST BE CHECKED. ‘CiNoprlar merigage Gesumod nape lo wen ronaty subject al tne of aale. EiNo contihulfnto cop cna gest or anton tga en CNostock or mone ;ngad by or betiveen granior or Grantes logal entidos, © (iF APPLIES ACL BOXES MUST BE CHECKED, (Instruction #19 on reverse sida) alg ai {ranafor between combined group mombera as part of the unitary buslnose Dicombines grotip. NU ID number (Required) 18) Depenent makes this Aifidavil (o Induce caumly clerk or regiolar of deeds to record [ha }ioad and gecapt the fos submilled herewith In accordance wah the provisions of Chepler 49, P.L. 1965, 2s amended through Chapter 33, P.L. 2006. ‘Subscribed id een frome: . 4 COUSINS LLC oe | goeny “0S a Signature of Bopsnerd ‘or antor ane 1683 AMBOY AVE, EDISO! WEST ORA ou ‘Doponent Adeies ‘Grantor Addrees at Tne of Sela Jerfy Maroules Lesnar Sa SS una WanalCompary of Salonen Oca ttorney at Lavt FOR OFFICIAL USE ONLY cs cy State of New Jersey ovation sag Doad Datos Dato Roeadad 3 /IU7S County recording officers shall forward ane capy of each RITF-1 farm waen Section 3A is completedto: STATE OF NEW

FICIAL USE ONLY cs cy State of New Jersey ovation sag Doad Datos Dato Roeadad 3 /IU7S County recording officers shall forward ane capy of each RITF-1 farm waen Section 3A is completedto: STATE OF NEW JERSEY PO BOX 251 ‘TRENTON, NJ 08698-0251 ATTENTION: REALTY TRANSFER FEE UNIT ‘The Director af tho Division of Taxalion in the Department of the Treasury has prescribed this form as required by law, and may nol be allered or amended \wilhout prior approval of the Director. For intarmation on tha Realty Transfor Fao or to print a copy of this Affidavit, visit tha Division of Taxalian wabsita at: ‘worw.statn}.ueitrosguryitestationiipliacaltexchim