Conference/Public Meeting Agendas/Documents — Packet

GITIREP-3 (5-12) aes ‘ State" of New Jersey” acl eene SELLER’S RESIDENCY CERTIFICATION/EXEMPTION : vo oo (G95. P.L;.2004).. | , Page 2) i Names(s) re eon | Township of West Orange, a municipal corporatién"s« | Current Resident Address: . r ar ang cas 7 a 7 = Street: 66 Main Street ! City, Town, Post Office Hl West Orange, NJ. 07052 1 PROPERTY INFORMATION (Brief Property Description) Block(s) Lot(s) ° ‘ Qualifier 25 10 ! Street Addres: : 7 23 Nutman Place . 1 ‘ ‘ City, Town, Post Office West Orange, NJ 07052. . Seller's Percentage of Ownership Consideration 400% . = i I g4-00° fasta . . SELLER ASSURANCES (Check the Appropriate Box) (Boxes 2 through 10 apply to Res! 1. Edi am a resident taxpayer (individual, estate. or trlist) of the State oF New Jérsey pursuant to'N.J'S.4" S4A'T-1 et Seq. ‘and will file a i resident gross income tax return and pay any applicable taxes on any gain or income from the disposition of this property. 2. [the real property being sold or transferred is used exclusively as.my principal residence within the meaning of section 121 of the federal Internal Revenue Code of 1986, 26 U:S:C. s::121) 3. EZ] am a mortgagor conveying the mortgaged property to. a mortgagee in foreclosure or in a transfer in lieu of foreclosure with no additional.consideration. , Zip Code Closing Date lents ‘and Non-re: 1 4. EcSeller. transferor or transferee is an agency or authority of the:United:States of America, an-agency or authority of the State of New yersey. the Federal National Mortgage, Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association. or a private mortgage insurance company. a . _E7]}Seller is not an individual, estate or trust and as such -not requited.to make, an estimated Payment pursuant to N.J:S.A.54A;1-1 et seq. » EJ The total consideration for the property is $1,000 or iess and as such, the’séller is not required to: make an estimated payment pursuant to N.J.S.A. 54A:5-1-1 et seq. i) 7. [7] The gain from the sale will not be recognized for Federal income tax purposes under |.R.C. Section 721, 1031, 1033 or.is a cemetery H plot. (CIRCLE THE APPLICABLE SECTION). If such section does not ultimately apply to this transaction, the seller acknowledges i the obligation to file a New Jersey income tax return for the year of the sale (see instructions). i E2INo non-ike kind

ection does not ultimately apply to this transaction, the seller acknowledges i the obligation to file a New Jersey income tax return for the year of the sale (see instructions). i E2INo non-ike kind property received. . 8. [Transfer 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. ~ 9. [}the property being sold'is Subject to a short sale instituted by the mortgagee, whereby the seller has agreed not to receive any Proceeds from the sale and the mortgagee: will receive all'proceeds paying off an agreed amount of the mortgage. 10. Bzlthe deed being recorded is a deed dated prior to thé effective’ date'of PL. ‘2004, c. 55 (August 1,'2004), and Was previously unrecorded, : 3 : : SELLER(S) DECLARATION The undersigned understands that this deciaration and its contents may be disclosed or provided to the New Jersey Division of Taxation and that any false ‘statement contained herein could 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 ox [1 | certify that the Power of Attorney to represent the seller(s) has been previously recorded or is being recorded simultaneously with the deed to which this form is attached. Date Signature . (Selien Please indicate if Power of Altorney or Attorney in Fact Daie To Signature (Seller) Please indicate If Power of Atlomey or Attorney in Fact _ i t i