219-22 Exhibits - Execution of Deed and Closing Document for Sale of Lot to Valerie Ford - August 2022.pdf

GIT/REP-3 State of New Jersey (2-21) Seller’s Residency Certification/Exemption (Print or Type) Seller’s Information fame(s) Township of West Orange Current Street Address 66 Main Street City, Town, Post Office State ZIP Code West Orange NJ 07052 Property Information Block(s} ous) Qualifier 175.08 11 Street Address Mellon Avenue City, Town, Post Office State ZIP Code West Orange NJ 07052 Seller's Percentage of Ownership Total Consideration ‘Owner's Share of Consideration Closing Date 4100 $5,000.00 $5,000.00 iate Box) (Boxes 2 through 16 a to Residents and Nonresidents eller’s Assurances 1. 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 retum, and will pay any applicable taxes on any gain or income from the disposition of this property. The real property sold or transferred is used exclusively as a principal residence as defined in 26 U.S. Code section 121. 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. 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 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 seller is not required to make an estimated Income Tax payment. 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 SECTION). If the indicated section does 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. Seller did not receive non-like kind property. The real property is being transferred by an executor or 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. The real

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. 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 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 house to a third party buyer for the same price. The real property is being transferred between spouses or incident to a divorce decree or property settlement agreement under 26 U.S. Code section 1041. The property transferred is a cemetery plot. The seller is not receiving net 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 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. 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. Amed 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.) a ooo ad OoOo0n aon og 00 ao P 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. | furthermorg geclare that | have examined this declaration and, to the best of my knowledge and belief, itis true, correct and complete. By checking this box L_] | 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. ao @ o Ss Robert D. Parisi, Mayor Date Signature (Seller) Indicate if Power of Attorney or Attorney in Fact Date Signature (Seller) _Indicate if Power of

th the deed to which this form is attached. ao @ o Ss Robert D. Parisi, Mayor Date Signature (Seller) Indicate if Power of Attorney or Attorney in Fact Date Signature (Seller) _Indicate if Power of Attorney or Attorney in Fact