investor profile form

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STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY

DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION

INVESTOR PROFILE

Please complete the information requested and return to the address printed below. Your tax ID or Social Security Number is mandatory. If you have any questions, please contact Brian Adams at (609) 292-9523. You may fax this form to (609) 292-2828

State of New Jersey Division of Property Management and Construction

28 W. State Street P.O. Box 229

Trenton, NJ 08625-0229

Tax ID or SS#: _____________________________________________ Name of Organization/Individual: ___________________________ Organization Type: ________________________________________ Charter Type: ____ Corporation ____ Sole Partnership ____ Partnership ____ Individual Contact Person: ___________________________________________ Mr/Mrs/Ms/ First Name Middle Last

Title: ___________________________________________ Department: ____________________________________ Address: ________________________________________ Street or Apartment Number/Post Office Box

________________________________________ Town/City State Zip Code

Phone: (___)_______________ (___)________________ Business Home

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Fax: (___)_______________ (___)________________

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REAL ESTATE ASSETS

COMMERCIAL: ____ Office Building: ____ Less than 50,000 s.f. ____ 100,000 to 200,000 s.f. ____ 50,000 to 100,000 s.f. ____ Greater than 200,000 s.f. ____ Industrial/Warehouse: ____ Less than 50,000 s.f. ____ 100,000 to 200,000 s.f. ____ 50,000 to 100,000 s.f. ____ Greater than 200,000 s.f. ____ Medical Facility/Private Hospital: ____ Less than 50,000 s.f. ____ 100,000 to 300,000 s.f. ____ 50,000 to 100,000 s.f. ____ Greater than 300,000 s.f. ____ Nursing Home/Retirement Home: ____ Less than 50,000 s.f. ____ 100,000 to 300,000 s.f. ____ 50,000 to 100,000 s.f. ____ Greater than 300,000 s.f. ____ Marina/Boat Yard ____ School ____ Parking Garage/Lot ____ Other ____ Multi-Family: ____ 5 to 20 units ____ 40 to 80 units ____ 20 to 40 units ____ Greater than 80 units ____ Single Family ____ Land ____ Unimproved Commercial/Residential: ____ 5 to 20 acres ____ 51 to 100 acres ____ 21 to 50 acres ____ Greater than 100 acres ____ Agricultural Ranch/Pasture: ____ 20 to 50 acres ____ 76 to 100 acres ____ 51 to 75 acres ____ Greater than 100 acres

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GEOGRAPHIC LOCATION

____ Entire State ____ Northern New Jersey: ____ Bergen ____ Essex ____ Hudson ____ Morris ____ Passaic ____ Sussex ____ Union ____ Warren ____ Central New Jersey: ____ Hunterdon ____ Mercer ____ Middlesex ____ Monmouth ____ Ocean ____ Somerset ____ Southern Jersey: ____ Atlantic ____ Burlington ____ Camden ____ Cape May ____ Cumberland ____ Gloucester ____ Salem If you are a broker, are you willing to act as a principal? ____ Yes ____ No ____ N/A Where did you hear about us? __________________________________________ _____________________________________________________________________

PRIVACY ACT STATEMENT

The primary use of the information required above is to match qualified prospective investors with specific assets for sale. Furnishing the information is voluntary; failure to furnish all or part of the information may result in the prospective investor not receiving notice of the availability of an asset offering. The information provided may be disclosed to other State or Federal agencies that also may have asset offerings; appropriate Federal, State or local agencies for law enforcement purposes concerning persons involved in the conduct of judicial or administrative proceedings; for tax administration purposes; and to a congressional or legislative office in response to an inquiry made at the individual's request. The information is collected pursuant to 5 U.S.C., 522a, 42 U.S.C., 405, and P.L. 1995, c. 158.

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