PB 26 01 Application

Inst, # 2025062136 - Page & of 9 GITREP-3 * State of New Jersey (8-24) ., . | (Print of Type) Seller’s Residency Certification/Exemption Seller's Information -’ Name(s) Shalom Naim, unmarried Current Street Address Via Dello Zeffiro N.8, San Casciano Del Bagni City, Town, Post Office State ZIP Coda Siena, Ital 53040 Property Information 8-7-6 sae bee ta “s Block(e) tots) ~ = Galler 188 28.01 Street Address. 15 Ridgeway Avenue Clty, Town, Post Office State ZIP Code West Orange: NJ 07052 Seller's Percentage of Ownership Tota! Consideration ‘Owner's Share of Consideration 100 $960,000.00 $960,000.00 Seller’s Assurances (Check the Appropriate Box) (Boxes 2 throug to Residents and Nonresidents) 1 Oo Seller is a resident taxpayer (Individual, estate, or trust) of the State of New Jersey pursuant to the New Jersey Gross Income Tax Act, will file a resident Gross Income Tax raturn, and will pay any applicable taxes on any gain or Income from the disposition of this property. 2, E] The reat property sold or transferred Is ysed exclusively as a principal residence as defined In 26 U.S. Code section 121. 3 im} Seller is a mortgagor conveying tha mortgaged property to a mortgages in foreclosure or In a transfer in lieu of foreclosure with no additional consideration. 4 mt} Seller, transferor, or transferee Is an agency or authority of the United States of America, an agency or authority of the State of New Jersey, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government Nationa! Mortgage Association, or a private mortgage Insurance company. 5. oO Sellar is not an individual, estate, or trust and Is not required to make an estimated Gross Income Tax payment. 6 Oo The total consideration for the property Is $1,000 or less so the seller is not required to make an estimated Income Tax payment. va the gain from the sale Is not recognized for federal Income tax purposes under 26 U.S. Code section 721, 1031, or 1033 (CIRCLE THE APPLICABLE CODE SECTION). If the indicated section does not ultimately apply to this transaction, the seller acknowledges the obligation to fila a New Jersey Income Tax retum for the year of the sale and report the recognized gain. See instructions. 7b. 1 setter only received like-kind property. # 8. thereal property Is being transferred by an executor or administrator of a decedent to a

he sale and report the recognized gain. See instructions. 7b. 1 setter only received like-kind property. # 8. thereal property Is being transferred by an executor or administrator of a decedent to a devises or heir to effact distribution of the decedent's estate In accordanes with the provisions of the decedent's will or the intestate laws of this State. . a im) ‘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 mortgagee will recelve all proceeds paying off an agreed amount of the mortgage, 10, 1 the deed is dated prior to August 1, 2004, and was not previously recarded. 11.1 the reat 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 house to a third party buyer for the same price. 12, 1 the reat property Is baing transferred between spouses or Incident ta a divorce decree or property settlement agreement under 26 U.S, Cade section 1041, 13. 1 The property transferred Is a cemetery plot. 44, im ‘The seller is not receiving net proceeds from the sale. Net proceeds from the sale means the net amount due fo the seller on the settlement sheet 48.1 The seller is a retirement trust that received an acknowledgment letter from the intemal Revenue Service that the seller {s a retirement trusl, and Is therefore not required to make the estimated Gross Income Tax payment, 16.1 the setter {and/or spouse/¢ivil 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 nelther boxes 1 nor 2 apply.) ‘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 hereln may be punished by fine, Imprisonment, or both, I furthermore declare that | have examined this dectaration and, to the best of my knowledge and beliel Kis true, cor complete. By chacking thls box Oo I certify that a Power of Attorney to repre- sent the seller(s) has been previously reco Is bell ded simultaneously with the deed to which this form Is attached. Talo had

ete. By chacking thls box Oo I certify that a Power of Attorney to repre- sent the seller(s) has been previously reco Is bell ded simultaneously with the deed to which this form Is attached. Talo had Shalom Naim Date V Jsignature (Seller) Indicate if Power of Attorney or Attomey In Fact Date Signature (Seller) Indicate if Power of Attorney or Attorney in Fact