State of New Jersey WAIVER OF SELLER'S FILING REQUIREMENT OF GIT/REP FORMS AND PAYMENT FOR CORRECTED DEED WITH NO CONSIDERATION (C.55, P.L. 2004) (Please Print or Type) GIT/REP-4a (12-04) OWNER(S) INFORMATION Name(s) Current Resident Address: 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 OWNER(S) DECLARATION The undersigned is (are) the title owner(s) of the real property identified under the "Property Information" section above. By presenting this declaration fully completed and signed by me (us), I (we) represent that the deed to which this form is attached is for corrective or confirmatory purposes only. In other words, the deed needs to be recorded or re-recorded solely due to a typographical, clerical, property description or other scrivener error or omission and there is no consideration for the corrective or confirmatory deed. The county recording officer will accept this form for recording along with such deed. The recording officer may also, however, continue to accept the GIT/REP-4 form with the Division's raised seal in lieu of the GIT/REP-4A. This waiver form may be presented to the appropriate county recording officer for recording along with the deed of the owner as identified in the information above. Accordingly, the county recording officer is hereby authorized to accept this waiver form in lieu of any other GIT/REP form without any further payment of any tax on estimated income gain pursuant P.L. 2004, c. 55. _________________ Date _________________ Date _________________________________________________________________ Signature (Owner) Please indicate if Power of Attorney or Attorney in Fact _________________________________________________________________ Signature (Owner) Please indicate if Power of Attorney or Attorney in Fact American LegalNet, Inc. www.FormsWorkflow.com Waiver of Seller's Filing Requirement Instructions This form is only to be completed by a title owner recording a deed to which this form is attached for corrective or confirmatory purposes only which needs to be recorded or re-recorded due to a typographical, clerical, property description or other scrivener error or omission and there is no consideration for the corrective or confirmatory deed that is subject to the Gross Income Tax estimated payment requirements under C.55, P.L. 2004 and is not covered by one of the other GIT/REP forms. The information to be put on the form includes: Name(s): Name of owner(s) listed on the deed as the grantee(s). Address: Owner(s) primary residence or place of business. Property Information: Information as listed on the corrective or confirmatory deed being recorded. All information requested on this form must be completed. Failure to complete the form in its entirety will result in the deed not being recorded. The owner or owner's attorney must submit the original Waiver of Seller's Filing Requirement of GIT/REP-4A form to the County Clerk at the time of recording the corrective or confirmatory deed. Failure to submit this form or a Nonresident Seller's Tax Declaration (GIT/REP-1) or a Nonresident Seller's Tax Prepayment Receipt (GIT/REP-2) or a Seller's Residency Certification (GIT/REP-3) or other waiver form (GIT-REP-4) will result in the deed not being recorded. The county clerk will attach this form to the deed when recording the deed. American LegalNet, Inc. www.FormsWorkflow.com