Seller'S Residency Certification / Exemption Form Git/rep 3

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GIT/REP-3

(6-10)

State of New Jersey

SELLER’S RESIDENCY CERTIFICATION/EXEMPTION

(C.55, P.L. 2004)

(Please Print or Type)

SELLER(S) INFORMATION (See Instructions, Page 2)

Name(s)

Current Resident Address:

Street:

City, Town, Post Office

State

Zip Code

PROPERTY INFORMATION (Brief Property Description)

Block(s)

Lot(s)

Qualifier

Street Address:

City, Town, Post Office

State

Zip Code

Seller’s Percentage of Ownership

Consideration

Closing Date

SELLER ASSURANCES (Check the Appropriate Box) (Boxes 2 through 8 apply to Residents and Non-residents)

I am a resident taxpayer (individual, estate, or trust) of the State of New Jersey pursuant to N.J.S.A. 54A:1-1 et seq. and

will file a resident gross income tax return and pay any applicable taxes on any gain or income from the disposition of this

property.

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.

I am 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 as such not required to make an estimated payment pursuant to

N.J.S.A.54A:1-1 et seq.

The total consideration for the property is $1,000 or less and as such, the seller is not required to make an estimated

payment pursuant to N.J.S.A. 54A:5-1-1 et seq.

The gain from the sale will not be recognized for Federal income tax purposes under I.R.C. Section 721, 1031, 1033 or is a

cemetery plot. (CIRCLE THE APPLICABLE SECTION). If such 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 (see instructions).

No non-like kind property received.

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.

SELLER(S) 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 could be punished by fine, imprisonment, or both. I furthermore declare that I have examined this declaration and, to

the best of my knowledge and belief, it is true, correct and complete. By checking this box

I 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

(Seller) Please indicate if Power of Attorney or Attorney in Fact

__________________________________________

_____________________________________________________________________

Date

Signature