PB 25 12 Application

Inst. # 2025011243 - Page 7 of 8 GIT/REP-3 State of New Jersey (8-24) Seller’s Residency Certification/Exemption (Print or Type) Seller’s Information Name(s) 4 COUSINS LLC Current Street Address 270 MAIN STREET City, Town, Post Office Stale ZIP Code WEST ORANGE NJ 07052 Property Information Block(s) Lot(s) Qualifier 114 50 Street Address 270 MAIN STREET City, Town, Post Office State ZIP Code WEST ORANGE. No 07052 Seller's Percentage of Ownership Total Consideration Owner's Shareiof Consideration Closing Date 100 $900,000.00 $900,000.00 2/19/2025 1, Bel Setter is a resident taxpayer (individual, estate, or trust) of the State of New Jersey pursuantito the New Jersey Gross Income Tax Act, will file a resident Gross Income Tax return, and will pay any applicable taxes on-ay gain. or income from the disposition of this property. 2. 1 The real property sold or transferred is used exclusively as a principal residence as defined in 26 U.S. Code section 121. Be 0 Seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure’or in a transfer in lieu of foreclosure with no additional consideration, 4. im] Seller, transferor, or transferee Is an agency or authority of the United StéteSof America, an agency or authority of the State of New Jersey, the Federal National Mortgage Association, the Federal Home ean Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. 5. [1 Seller is not an individual, estate, or trust and is not required to make an [bctimated Gross Income Tax payment. 6. Othe total consideration for the property Is $1,000 or less. 50) ‘the séller i is not required to make an estimated Income Tax payment. Ta. Oo The gain from the sale is nol recognized for federal ir incom tax Purposes under 26 U.S. Code section 721, 1031, or 1033 (CIRCLE THE APPLICABLE CODE SECTION). If the indicated seolion ‘dges not ultimately apply to this transaction, the seller acknowledges the obligation to file a New Jersey Income Tax return for the year.of the sale and report the recognized gain. See instructions. 7p, L1 seller only received like-kind property. _, 8. oO The real property is being transferred by an ex utor of administrator 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

perty is being transferred by an ex utor of administrator 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. im The real property being sold is subject to,a short gale instituted by the mortgagee, whereby the seller agreed not to receive any proceeds from the sale and the mortgage@wll ceive all proceeds paying off an agreed amount of the mortgage. 10. o The deed is dated prior to August 4, 2004, and was not previously recorded. 1. oO The real property is being transferred nder a relocation company transaction where a trustee of the relocation company buys the property from the seller and thent sells, the house to a third party buyer for the same price. 12, The real property is being transfered between spouses or incident to a divorce deoree or property settlement agreement under 26 U.S. Code section 1041. AN 13, 1 The property transferrediis a cemetery plot. 14, oOo The seller is not receiving nét proceeds from the sale. Net proceeds from the sale means the net amount due to the seller on the settlement sheet. 15. D1 the seller Is a retirement trust that received an acknowledgment letter from the Internal Revenue Service that the seller is a retirement trust, and is therefore not required to make the estimated Gross Income Tax payment. 16 The seller (and/or spouse/civil union partner) originally purchased the property while a resident of New Jersey as a member of the U.S. ‘Armed Forces and is now selling the property as a result of being deployed on active duly oulside of New Jersey. (Only check this box if applicable and neither boxes 1 nor 2 apply.) Seller’s Declaratio. ‘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 may be punished by fine, imprisonment, or both. | furthermore declare that | have examined this declaration and, to the best of my knowledge and belief, it is true, correct and complete. By checking this box o | certify that a Power of Attorney to repre- sent the seller(s) has been previously recorded or is “tT —ee with the deed to which this form is attached, 2/19/2025 BY: GEORGE FASOULETOS, MANAGINGg jignature (Seller) Indicate if Power of Attorney or Attorney in

(s) has been previously recorded or is “tT —ee with the deed to which this form is attached, 2/19/2025 BY: GEORGE FASOULETOS, MANAGINGg jignature (Seller) Indicate if Power of Attorney or Attorney in Fact Date Date Signature (Seller) _ Indicate if Power of Attorney or Attorney in Fact