GIT/REP-4A                     State of New Jersey
(06-10)                 Waiver of Seller’s Filing Requirement of
                        GIT/REP Forms and Payment For Corrected Deed
                               With No Consideration
                               (C.55, P.L. 2004) 
(Print or Type)
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. 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.

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            Signature (Owner) Indicate if Power of Attorney or Attorney in Fact

               Date            Signature (Owner) Indicate if Power of Attorney or Attorney in Fact

GIT/REP-4A                                                                                            Page 2
(06-10)

                        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.

         Signature: Seller(s) must sign and date the declaration. If the seller’s representative is signing the dec-
         laration either (1) a Power of Attorney executed by the seller(s) to the representative must be previously 
         recorded or recorded simultaneously with the deed to which this form is attached, or (2) a letter signed 
         by the seller(s) granting authority to the representative to sign this form must be attached.

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.