RockSpringCluB-Hendricks Appraisal.pdf

GIT/REP-3 (9-2015) State of New Jersey SELLER'S RESIDENCY CERTIFICATIONIEXEMPTION Nama(s) ROCK SPRING CLUB AKA ROCK SPRING CLUB, INC, Currant Street Address $0 ROCK SPRING ROAD City, Town, Post Office State Zip Code WEST ORANGE NEW JERSEY 07052 Block(s) Lot{s) Qualifer 46.01 22 through 31 160 Zand 10 460.01 30 and 34 7 ‘Street Address 80 Rock Spring Road ~\ City, Town, Post Otfice State ,) Zip Code West Oranga Now Jorsay 07082 Sellers Porcantage of Ownership Total Consideration nets Shae cf-consideration Closing Date 100% $1.00 October 2018 SELLER ASSURA! S {Check the Appropriate Sox) (Boxes 2 through 8 apply to NON-residents) Seller is a resident taxpayer (individual, estate, or trust) of the Stzte of New Jersey pursuant to the New Jersay Gross Income Tax Act, will ‘The real property being sold or transferred Is used exclusiyélyas hy Principal residence within the meaning of 26 U.S. Code. section 121. 1. 2 3. Solaris sage smepoge mraaed ay age in foreclosure or in a transfer in few of foreclosure with 4. ‘Seller, tansferor or transferee is an agency or inited States of America, an agency or authority of the State 5. 6. 7. | XX Seller is not individual, estate or trust and ‘r Snake an estimated gross income tax payment X The total consideration for the property Sako 50 the sellers not required tn make an estimated gross income tax payment. “The gain from the sala will not be for tederal Income tax purposes under 26 U.S, Code section 721, 1031, 1033 (CIRCLE THE Seller did not recaive non-lke kind 8, The real proparty being sold is 9. The real property red by an executor or administrator of a decedent to a devises or heir lo effect distribution of ds subject to a short sale instituted by the mortgagee, whereby the 10. ‘The deed is dated |, 2004, and was not previously recorded. Ww ‘The real proparty Is red undar a relocation company transaction where a trustee of the relocation company buys the property 12. ‘The real property is being Wifisferred between spouses or Incident to a divorce decree or property sattlement agreement under 26 U.S, 13, ‘The propemty transferred Is a cemetery plot. 14. ‘The seller is not receive net proceeds fram the sale. Net proceeds from the sale means the net amount due to the seller an the settlement SELLER(S) DECLARATION ‘Tha undersigned understands that this declaration and its contents may be

eeds fram the sale. Net proceeds from the sale means the net amount due to the seller an the settlement SELLER(S) DECLARATION ‘Tha 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 could ba punished by fine, imprisonment, or both. { furthermore declare that | have examined this declaration and, to the best of my knowledge and bellef, it is true, correct and complete, By checking this box o | certify that the Power of Atlomay to represent the seller(s) has been previously recorded or is belng recorded simultaneously with tha deed to which this form is attached, ROCK SPRING CLUB, ING., a NJ not fts sole shareholder, MONTCLAIR for profit corporation B' A Gengaro, President elzele