Township Council Meeting — Packet

GITREP-3 (92015) State of New Jersey SELLER'S RESIDENCY CERTIFICATIONIEXEMPTION Nems(e) + ROCK SPRING CLUB AKA ROCK SPRING CLUB, INC. Curent Street Address 90 ROCK SPRING ROAD * “Cily, Town, Post Office . State Code . WEST ORANGE NEW JERSEY ase TY INFORMATION (Brief Property D Lots) 22 through 34 Zand 10 Band 34 ‘Street Address: 30 Rock Spring Road Gity, Town, Post Office Biats Zip Coda West Orange Now Jersoy O7082 Seller's Parcentage of Cunarship + Total Consideration . ‘Gwnars Share of Consideration Closing Date 100% $1.00 $1.00 Oatober 2048 § {Chack the Apprapriate Rox’ (Boxes 2 through 8 apply to NON-residents) 1 Geller Is a resident taxpayer (Individual, estate, or trust) of the State of New Jersey pursuant to the New Jersey Gross. Income Tax Act, will 2 ‘The real property being sold or transtamed Is used ‘excuslvely as my principal residence within the meaning of 26 U.S. Coda. section 121. 3 Sellaris ‘a motigagor conveying the mortgaged property ta a mortgagee tn foreclosure atin & transfor In Rou of foreclosure with 4 Seller, transferor or transferee 1s ar agency or authority of the United States: of Amorica, an agency of authority of the State 5, 8 7. } -X Seller fs not individual; estate or trust and ict re make aij cslimated gross Incofrie tax payment ., X ‘The total conekderation far the property:is $1,000-0r less ied ke an axtinatd grass incams tax paymont, “Tha gain from tho sala wil ict be tongriized {oF fodiral ‘purposes under 26 U.S, Code section 721, 1031, 1083 (CIRCLE THE Seller did not receive norelike kind property, & ‘The real property buing sod fs balng transferred by an executor or edminfstrator of a decedent to a devisce or her to effect alstibutlon of 8. the real property being sold is subject to a short sale instituted by the moxtyagee, whereby the 10. ‘The dead 1s dated prior to August 1, 2064, and was not previously recorded. WwW ‘The raal property is belng transferred under a relocation company transaction where a trustee of the telocation company buys the property 42. The reel property is being tranaterred belwean spauses or incident to » divorce decree or property setiemant sgreannont under 26 US. 43. ‘The property transferred is. a cemetery plot. 14, ‘The setter Is not receive net proceads from the sale, Net proceeds from the sale means the nel amount due to the seller on the settlement ‘The undersigned

perty transferred is. a cemetery plot. 14, ‘The setter Is not receive net proceads from the sale, Net proceeds from the sale means the nel amount due to the seller on the settlement ‘The undersigned understands that this dectaration ‘and fis contents may be diactosed or provided to the New Jersey Olviaion of Taxation and that any fal statement contained herein couk! ba punished by fine, impsonment, or both jurthermare deciare that | have examined tive declaration and, to the best of my knowledge and bsilef, It true, correct and complete. By checking this box ci cartify that the Power of Atiomay to represent the seflar{s) has been previously recorded or is betng recorded simultaneously with the deed to whic this form Is attached. ROCK SPRIN! ROCK SPRING CLUB, INC., a NJ not for profit. Its sole shareholder, MONTCLAIR GOLF for profit corporation dolZe h e B Date . Gengaro, President 02/44/2019 8:21:08 AM ESSEX COUNTY, Inst 2018086847 - Page 13 of 14