PB 25 12 Application

Inst. # 2025016950 - Page 9 of 9 GIT/REP-3 State of New Jersey (8-24) Seller’s Residency Certification/Exemption (Print or Type) Seller’s Information Name(s) Walgreen Eastern Co., Inc., a New York corporation Current Street Address 104 Wilmot Road, MS 144G Clty, Town, Post Office State ZIP Code Deerfield IL 60015 Property Information Block(s) Lot(s) Qualifier 414 5 Street Address 262 Main Street City, Town, Post Office State ZIP Code West Orange NJ, 07052 Seller's Percentage of Ownership Total Consideration Owner's Share of Consideration 3 Closing Date 100% $1,825,000.00 $1,825,000.00 733 72025 ler’s Assurances (Check the Appropriate Box) (Boxes 2 through 16 a to Residents and Nonresidents 1. [1 Soller is a resident taxpayer (individual, estate, or trust) of the State of New Jersey pursuafif'ta thé New Jersey Gross Income Tax Act, will fle a resident Gross Income Tax return, and will pay any applicable taxes on any gain or ingome from the disposition of this property. The real property sold or transferred is used exclusively as a principal residence’as defined th 26 U.S. Code section 121. Salle is 2 morigagor conveying the morigaged property to a mortgagee in foreclosure orin a transfer in lieu of foreclosure with no additional consideration, Seller, transferor, or transferee is an agency or authority of the United StatéSiof America, an agency or authority of the State of New Jersey, the Federal National Mortgage Association, the Federal Home Loan Marigage Corporation, the Government National Mortgage Association, or a private mortgage Insurance company. Seller is not an individual, estate, or trust and is not required to make an estimated Gross Income Tax payment. The total consideration for the property is $1,000 or less so tHe séller Is:not required to make an estimated Income Tax payment. The gain from the sale is not recognized for faderal i income’ ‘tax Burposes under 26 U.S. Cade saction 721, 1031, or 1033 (CIRCLE THE APPLICABLE CODE SECTION). If the indicated section does hot 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. Seller only received like-kind property. The real property is being transferred by an executor &F adtinistrator of a decedent to a devisee or heir to effect

rt the recognized gain. See instructions. Seller only received like-kind property. The real property is being transferred by an executor &F adtinistrator of a decedent to a devisee or heir to effect distribution of the decedent's estate in accordance with the provisions.6f the decedent's will or the intestate laws of this State. The real property being sold is subject to a short sale instituted by the mortgagee, whereby the seller agreed not to receive any proceeds from the sale and the mortgageé.will receive all proceeds paying off an agreed amount of the mortgage. The deed Is dated prior to August 1, 2004, and'Was not previously recorded. The real property is being transferred under a relocation company transaction where a trustee of the relocation company buys the property from the seller and then, sells. the:Rouse fo a third party buyer for the same prica, The real property is being transfered between spouses or incident to a divorce decree or property settlement agreement under 26 U.S. Code section 1041. The property transferrad is a'Gametery plot, The seller is not receiving n@t.proceeds from the sale. Net proceeds from the sale means the net amount due to the seller on the settlement sheet. The seller is a retirement trust that received an acknowledgment fetter 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. 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 duty outside of New Jersey. (Only check this box if applicable and neither boxes 1 nor 2 apply.) Seller’s Declaration ‘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, itis true, correct and complete. By checking this box [_] | certify that a Power of Attorney to repre- sent the seller(s) has been previously recorded or is being recorded simultaneously with the deed to which this form is attached. WALGREEN EASTERN CO,, INC. a New York

t a Power of Attorney to repre- sent the seller(s) has been previously recorded or is being recorded simultaneously with the deed to which this form is attached. WALGREEN EASTERN CO,, INC. a New York corporation Date Signature (Seller) __Indicat Name MCW ARD A. STEELE, GF 3 Tile: SERIO Rote EI, pa-lo- 202s APO MASPOUS CONSE L ica il Date Signature (Seller) Indicate if Power of Attorney or Attamey in Fact ny > ooOooo0 oom ooo aes es ao 2 oOoooa ey or Attorney in Fact