State of New Jersey SELLER'S RESIDENCY CERTIFICATION/EXEMPTION (Please Print or Type) GIT/REP-3 (9-2015) SELLER'S INFORMATION Name(s) Current Street Address City, Town, Post Office Box State Zip Code PROPERTY INFORMATION Block(s) Street Address City, Town, Post Office Box Seller's Percentage of Ownership Total Consideration State Owner's Share of Consideration Zip Code Closing Date Lot(s) Qualifier SELLER'S ASSURANCES (Check the Appropriate Box) (Boxes 2 through 14 apply to Residents and Nonresidents) 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 return, and will pay any applicable taxes on any gain or income from the disposition of this property. 2. ¨ The real property sold or transferred is used exclusively as a principal residence as defined in 26 U.S. Code section 121. 3. ¨ 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. 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. 7. ¨ 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. 8. ¨ 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. 9. ¨ 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. 10. ¨ The deed is dated prior to August 1, 2004, and was not previously recorded. 11. ¨ 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. 12. ¨ 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. 13. ¨ The property transferred is a cemetery plot. 14. ¨ 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. 5. ¨ Seller is not an individual, estate, or trust and is not required to make an estimated gross income tax payment. 6. ¨ The total consideration for the property is $1,000 or less so the seller is not required to make an estimated income tax payment. 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 may 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 o I certify that a 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 __________________________________________ Date _____________________________________________________________________ Signature (Seller) Please indicate if Power of Attorney or Attorney in Fact _____________________________________________________________________ Signature (Seller) Please indicate if Power of Attorney or Attorney in Fact American LegalNet, Inc. www.FormsWorkFlow.com Seller's Residency Certification/Exemption Instructions Individuals, estates, trusts, or any other entity selling or transferring property in New Jersey must complete this form if they are not subject to the gross income tax estimated payment requirements under N.J.S.A. 54A:8-9. A nonresident seller is required to make an estimated income tax payment if none of the Seller's Assurances apply. Name(s): Enter the name of the seller. If there is more than one seller, each must complete a separate form unless they are a married/civil union couple that files their income tax returns jointly. Address: Enter the seller's primary residence or place of business. Do not use the address of the property being sold. The seller is considered to be a nonresident unless a new residence (permanent place of abode, domicile) has been established in New Jersey and the new residence is listed here. Part-year residents are considered nonresidents. Property Information: Enter the information listed on the deed of the property being sold. Enter the seller's percentage of ownership, the total consideration for the transaction, the seller's share of that consideration, and the closing date. Consideration: "Consideration" means, in the case of any deed, the actual amount of money and the monetary value of any other thing of value constituting the entire compensation paid or to be paid for the transfer of title to the lands, tenements or other realty, including the remaining amount of any prior mortgage to which the transfer is subject or which is assumed and agreed to be paid by the grantee and any other lien or encumbrance not paid, satisfied or removed in connection with the transfer of title. If there is more than one owner, indicate the seller's portion of the total consideration received. If the total consideration for the property is $1,000 or less, the seller must check box 6 under Seller's Assurances. Seller's Assurances: Check the appropriate box(es). If one or more of the Seller's Assurances applies, the seller is not required to make an estimated income tax payment at this time. Any seller claiming the principal residence exemption (box 2) must also be claiming an income/gain exclusion for the property being sold