PB 25 12 Application

Inst. # 2025016950 - Page 7 of 9 RTF-1 (Rov, 22:22) MUST SUBMIT IN DUPLICATE. STATE OF NEW JERSEY AFFIDAVIT OF CONSIDERATION FOR USE BY SELLER (Chaptor 49, P.L.1968, as amended through Chapter 33, P.L. 2006) (N.J.S.A. 46:15-5 ol seq.) BEFORE COMPLETING THIS AFFIDAVIT, PLEASE READ THE INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM. ‘STATE OF NEW JERSEY FOR RECORDER'S USE ONLY Consideration § ‘SS. Covnly Munizial Code RTF paid by sellor § COUNTY Essex 0722 ! Date By MUNICIPALITY OF PROPERTY LOCATION West Orange *Use symbol °C" to indicate thal fee is exclusively for counly use. oO) IVE (See Instructions #3 and #4 on reverse side) Deponent, ein 2 being duly swom according to law upon hisiher oath, (Name) deposes and says that he/she is the in adeed dated March 13 +2025 transferring (Grantor, Legal Reprosentalive, Corporate OMfawr, Officer of Tila Company, Lending Institution, ete.) real property identified as Block number 114 Lot number _95 located at 262 Main Street, West Orange Township and annexed dere, (Street Address, Town) (2) CONSIDERATION §,1,825,000.00 (Instructions #1 and #5 on reverse side) [Ino prior morigage to which property is subject. (@) Property transferred Is Clas B_ 4C (circle one). If property transferred Is Class 4A, calculation In Section 3A below Is required. (3A}REQUIRED CALCULATION OF EQUALIZED VALUATION FOR ALL CLASS 4A (COMMERCIAL) PROPERTY TRANSACTIONS: (Seo Instructions #5A and #7 on reverse side) Total Assessed Valuation + Director's Ratio = Equalized Assessed Valuation §.1,644,000.00 + 72.06 th = $2,281,492.14 It Director's Ratio is fess than 100%, the equaled valuation willbe an amount grealar than the assessed volucw If Dieta is equal 10 or in excess of 100%, the assessed value will be equal o the equallzod valuation, a (4) EULL EXEMPTION FROM FEE (Sao Instruction #8 an reverse side) : Deponent states that this deed transaction is fully exempt from the Realty Transfer Fee imposed by\C. 49, P.L. 1968, as amended through . 66, P.L. 2004, for the fellowing reason(s). Mere reference to exemplion symbol is insufficient. Explain in detal. (©) PARTIAL EXEMPTION FROM FEE ( instruction #9 on reverse sido) = NOTE: All boxes below apply to grantor(s) only. ALL BOXES IN APPROPRIATE CATEGORY MUST BE CHECKED. Fallure to do so will vold daim for partial exemption, Deponent claims that this deed transaction ls exempt, ffom State portions

to grantor(s) only. ALL BOXES IN APPROPRIATE CATEGORY MUST BE CHECKED. Fallure to do so will vold daim for partial exemption, Deponent claims that this deed transaction ls exempt, ffom State portions of the Basic, Supplemental, and General Purpose Fees, as appilcable, Imposed by C. 176, P-L. 1975, C. 113/P.£°2004, and C. 66, P-L. 2004 forthe fellowing reasons): A. SENIORCHIZEN ——Grartr(s)_ 162 years of age orover® of (rst #8 (90 revorsa site or A ar Bp 8. BLIND PERSON Granter(s) Ctegally bind or;* 5 DISABLED PERSON —Granicr(s) Cl pormanently and totity eid Clreccivng diabily payments C] nat gantlly employed ‘Senior ctizons, ind parsons, or disablad porsons must als@ricot allof the following criloria: lowned and occupiad by grantor(s) at time of sale. G.JResident of Stato af New Jersey. ‘Cons or two-family residential premises, © GOyiners as join: tenants must all qualify. “IN CASE OF HUSBAND AND WIFE, PARTNERS IN A CIVIL union cour = ‘ONLY ONE GRANTOR NEZD QUALIFY IF TENANTS BY THE ENTIRETY. 3. LW ao woDERATE INCOME HOUSING rsh 130 reverse side) IF APPLIES ALL BOXES MUST BE CHECKED, Cl Affordabla according to H.U.. standards oT] Reservad for eccupancy. Ci Meets incame requirements of regian. 4 OF Susject to resale contrals. (6) NEW_GONSTRUGT ON flasinicions H2, W10 afd #12 oa averse side) IF APPLIES ALL BOXES MUST BE CHECKED. C Entirely new improvement |Not previously occupied. Nol previously used for anypurpuse, ‘NEW CONSTRUCTION" printed cleaily af lop offre! paye of the deed. (7) RELATED LEGAL ENTITIES TO LEGAL ENTITIES (instuctions &S, #72, 874 on roverse side} IF APPLIES ALL BOXES MUST BE CHECKED. (No prior mortgage assummdoeto wich property is subject at lime cf sale, (No contributions to capita! by eittier grantor or grantee legal entity. CiNo stock or monayexchanged by er between grantor or rantse legal ens. (®@ INTERCOMPANY TRANSFER IPAPPLIES ALL BOXES MUST BE CHECKED, (Instruction #16 on reverse sida) ‘Ciintarcompany transter Between combired group members as part of the unitary business CoCombined group NU ID number (Required) {3) Deponent makes this Affidavit to induce county clerk or register of deeds to, 8 deed and accept te fee submitted herewith in accordance with provisions of Chapter 49, P,L, 1968, as amondod through Chaplor 33, PL. 2 sechecnon Subserbed and ewan to before ma Z = Walgreen Easter Co., Inc. this) day of FeBRLAeY 20

d herewith in accordance with provisions of Chapter 49, P,L, 1968, as amondod through Chaplor 33, PL. 2 sechecnon Subserbed and ewan to before ma Z = Walgreen Easter Co., Inc. this) day of FeBRLAeY 20 2g ‘Signature of Dapatont Grantor Namo iE Wilmot Rd. MS MAG, Deere 60015194 wager Rd, MS UG, Dette HL 60015 Fagen Delis re mera ae 026 Last three digits in Grantors Social Securily Number “NamelCompany of Satiament Officor OFFICIAL SEAL JAMIE M BATES: & NOTARY PUBLIC, STATE OF ILLINOIS My Commission Expires 11/16/26 Instrumert Number Deed Number Book__ Deed Dated Date Recorded, FOR OFFICIAL USE ONLY ‘County, ‘County recording officers shall forward ane copy of each RTF-I form when Section 3A is completed ta: STATE OK NEW JERSEY PO BOX 251 ‘TRENTON, NJ 08695-0251 ATTENTION: REALTY TRANSFER FEE UNIT ‘The Director of the Division of Taxation In the Department of the Treasury has arescribed this form as required by laW, and may no: be altered or amended \Wlhout prior approval ofthe Director. For information on the Realty Transfer Foo or to print a copy of th's Affidavit, visit the Division of Taxetlon website at https:/hwww.stata.nj.usftreasury/taxation!ipUiocaltax.shiml