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)
1.
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.
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.
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.
4.
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.
5.
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.
6.
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.
7.
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.
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.
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
(Seller) Please indicate if Power of Attorney or Attorney in Fact