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Home My WebLink AboutL 12997 P 207 SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEED Recorded: 01/16/2019 Number of Pages : 4 At: 03 :00 : 17 PM Receipt Number : 19-0010763 TRANSFER TAX NUMBER: 18-20497 LIBER: D00012997 PAGE : 207 District: Section: Block: Lot: 1000 128 . 00 01 . 00 016 . 000 EXAMINED AND CHARGED AS FOLLOWS Deed Amount: $300, 000 . 00 Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $20 . 00 NO Handling $20 .00 NO COE $5 . 00 NO NYS SRCHG $15 . 00 NO EA-CTY $5 . 00 NO EA-STATE $125 .00 NO TP-584 $5 . 00 NO Notation $0 . 00 NO Cert.Copies $0 . 00 NO RPT $200 . 00 NO Transfer tax $1,200 . 00 NO Comm.Pres $3,000 . 00 NO Fees Paid $4 ,595 .00 TRANSFER TAX NUMBER: 18-20497 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County as • 4 I RECORDED Number of pages 0l9 .Ian 16 03:00:17�ti:17 FM .JUDITH R. PASCALE CLERK OF This document will be public SUFFOLK COUHTY record. Please remove all L 000012557 Social Security Numbers P 207 prior to recording. DT# 18-20497 Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps 3 1 i6) FEES Page/Filing Fee Mortgage Amt. 1.Basic Tax Handling 20. 00 2. Additional Tax TP-584 Sub Total Notation Spec./Assit. or EA-52 17(County) Sub Total Spec./Add. EA-5217(State) TOT.MTG.TAX R.P.T.S.A. Dual Town Dual County Held forAppointment Comm.of Ed. 5. 00 Transfer Tax }2d11— Affidavit + Mansion Tax Certified Copy The property covered by this mortgage is or will be improved by a one or two NYS Surcharge 15. 00 family dwelling only. Sub Total YES orNO Other n Grand Total �+f If NO, see appropriate tax clause on page# of this instrument. 4 Dist.10 190014431000 12800 0100 016000 0 5 Community Preservation Fund Amo Tax Ag e rye R -A 19 I Illlll l ll�[II��I�VIII fIIII ILII VIII IIII Ill CPF Tax Due Amount Verification �— Improved Satisfactions/Discharges Releases List Property Owners Mailing Address 6 s ORD&RETURNTO: Vacant Land Robert Fischette, Esq. Fernan&Fischette TD �QQ 320 Hampton Road Southampton, NY 11968 TD TD JL Mail to:Judith A.Pascale,Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 Co.Name South Bay Abstract,Inc. www.suffolkcountyny.gov/clerk Titleq S-16240W 8 Suffolk County Recording & Endorsement Page This page forms part of the attached Deed made by: (SPECIFY TYPE OF INSTRUMENT) John H.Peters and Eileen H.Peters The premises herein is situated in SUFFOLK COUNTY,NEW YORK. TO In the TOWN of Southold HSA Holdings II LLC In the VILLAGE or HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. over CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY THIS INDENTURE,made the day of January 2019 BETWEEN John H.Peters&Eileen H.Peters 4895 Peconic Bay Boulevard,Laurel,NY 11948 party of the first part,and HSA Holdings II LLC 108 Remington Road,Manhasset,NY 11030 party of the second part, WITNESSETH,that the party of the first part,in consideration of paid by the party of the second part, does hereby grant and release unto the party of the second part,the nens or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the SEE SCHEDULE"A"ANNEXED HERETO Being and intended to be the same premises described in Deed dated August 31,1984 recorded December 20,1984 in Liber 9699 page 259. TOGETHER with all right,title and interest, if any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part,the heirs or successors and assigns of the party of the second part forever. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever,except as aforesaid. AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word 'party shall be construed as if it read 'parties'when ever the sense of this indenture so requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: n H.Peters Eileen H.Peters Standard N.Y.B.T.U.Foran 8002-Bargain and Sale Deed,with Covenant against Grantor's Acts—Uniform Acknowledgment Form 3290 ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE State of New York,County of Suffolk ss: State of New York,County of Suffolk ss: On the. lynday of January in the year 2019 On Zh day of January in the year 2019, before me,the undersigned,personalty appeared before me,the undersigned,personally appeared John H.Peters Eileen H.Peters personally known to me or proved to me on the basis of satisfactory personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s)whose name(s)is(are)subscribed to the evidence to be the individual(s)whose name(s)is(are)subscribed to the within instrument and acknowledged to me that he/she/they executed the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies),and that by his/her/their signature(s) same in his/her/their capacity(ies),and that by hisiher/their signature(s) on the instrument,the individual(s),or the person upon behalf of which on the instrument,the individual(s),or the person upon behalf of which the individual(s)acted,executed the instrument the individ (s)acted,executed the instrument. PJIICHELLF KISS MICH LLE ESS Notary Public.State of New York Notary Public,State of New York No.01 KI3065407 No.01 K15065407 OLW..lified in Suffolk County Oualified in Suffolk County Commission Expires September 3,2 Commission Expires September 3,21]22_ ACKNOWLEDGEMENT BY SUBSCRIBING WITNESS TAKEN ACKNOWLEDGEMENT TAKEN OUTSIDE NEW YORK IN NEW YORK STATE STATE State of New York,County of ss: *State of County of ss: '(Or it u District of Colmnbm,Te irmy,Possession or Foreign County) On the day of in the year before me,the undersigned,a Notary Public in and for said State, On the day of in the year personally appeared , before me,the undersigned personally appeared the subscribing witness to the foregoing instrument,with whom I am personally acquainted who,being by me duly sworn,did depose and say Personally known to me or proved to me on the basis of satisfactory that he/she they reside(s)in evidence to be the individual(s)whose name(s)is(are)subscribed to the within instrument and acknowledged to me that be/she/they executed the same in his/her/their capacity(ics), that by his/her/their signature(s)on (if the place of residence is in a city,include the suoot and street mmber if any,thereof): the instrument,the individual(s)or the person upon behalf of which the that he/she/they know(s) individual(s)acted,executed the instrument,and that such individual make such appearance before the undersigned in the to be the individual described in and who executed the foregoing instrument;that said subscribing witness was present and saw said (add the city or political subdivision and the state or country or other execute the same;and that said witness at the some time subscribed place the acknowledgement was taken). his/her/their name(s)as a witness thereto Bargain and Sale Deed With Covenants Title No. SECTION: 128,00 BLOCK: 01.00 John H.Peters&Eileen H.Peters LOT: 016.000 COUNTY OR TOWN: Suffolk County TO Southold Town HSA Holdings II LLC RETURN BY MAIL TO: Robert M. Fischette,Esq. Fernan&Fischette,LLP P.O.Box 1283 320 Hampton Road Southampton, NY 11969 S-16240W Amended 10/1/18 AMENDED DESCRIPTION ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being at Laurel,Town of Southold, County of Suffolk and State of New York, bounded and described as follows: BEGINNING at a point on the northwesterly side of Great Peconic Bay Boulevard distant 450 feet southwesterly from the intersection of the southwesterly line of land of George H. Turner with the northwesterly side of Great Peconic Bay Boulevard; RUNNING THENCE alongthe northwesterly side of Great Peconic Bay Boulevard south 39 degrees 46 minutes 30 seconds west 70 feet; RUNNING THENCE north 50 degrees 13 minutes 30 seconds west 95 feet; RUNNING THENCE north 39 degrees 46 minutes 30 seconds east 70 feet; RUNNING THENCE south 50 degrees 13 minutes 30 seconds east 95 feet to the northwesterly side of Great Peconic Bay Boulevard the point or place of BEGINNING. FOR COUNTY USE ONLY �i l 2 a Q New York State Department of L I, C1.SWIS code ,O , i Taxation and Finance C2 1 „Date Deed Recorded I 1 /I jD / i q I OIfICe Of Real PmPertyr Tax Services '"-Mi °'" "°` RP-5217-PDF Lq C9.Book Lal Zq r lQ4 n� I C4.Page I— h 20. I PROPERTY INFORMATION Real Property Transfer Report(8110) t•LL cation 4985 Peconic Bay Boulevard •STREET NUMBER •STRECF 140M Southold arvoR row4 _i 9 4 8 W.lADE 2.Buyer HSA 11o1d_ngs .3 LLC IrPCODh Name ''J18T NWF.ICOMPAW FIRST NAME :AST%%1KX YPANY FIRST hatE 3.Tax Indicate where future Tax Bills are to be Sam 9811ng if other than buyer address(al bottom of form) Agh RAURccaPAvr Address FELST VAMC STREET 4UMBER MD•NAME CRY OR TOWN FrAM IIP CODE. 4.Indicate the number of Anws Tit Part of a Parcel (Only 9 Part of a Parcel)Check as they appy: Roll parcels transferred on the dead - 0 of Parcels OR s.DOW4A.Planning Board with Subdivision Authority Exists E] prop" •ritovr rEET X •oEPrx-OR 0.Ac ¢e 46.Subdivision Approval was Required for Transfer Ste. 1-1 4C.Parcel Approved for Subdivision with Map Provided ❑ Peters John 11. L Salla, ,AST KAYSIC'DWAW Name rIRST W WE Peters Eileen 11. LAST 4MEl MAMY FlRST NM1E 7.Selset tune description which mast accurately dsaaribss the Check the boxes below as they appy: use of the Properly at the ams of Sale: B.Ownership Type is Condominium A.One Family RrsidrrttialEl 8.New Construction on a Vacant Land E] 10A PmPoRy Located within an Agricultural District 1 OR.Buyer received a disclosure notice mdirwting that the property is rn an ❑ Apnculwral Disbhct SALE INFORMATION 18.Check one or more of thaw conditions am applicable b transfer. A.Sob Between Relatives or Farmer Relatives 11.Bab Contract Date 01/07/2019 B.Salo between Related Companies or Partners in Business. C.One of the Buyers is also a Seller '12 Data of SaWtmmfor D.Buyer or Sorier is Government Agency or Lending Institution E.Dead Type not Warranty or Bargain and Selo(Specify Below) F.Sale of Fractional or Loss than Fee Interest(Specify Below) '17.Full Sale Price 3 C 0,0.10,On G.Significant Charge in Property Between Taxable Status and Sale Dates (Fug Selo Prion is the total amount paid for the property Include H.Selo of Business is Included in Selo Price This payment may be in the farm of cash,other prop" personal property. I.Other Unusual Factors Atfsabng Sale Price(Specify Below) p pert'or goods,a Ina assumption o1 mortgages or other obligations.)Please round to the neared w/wk dollar amount W J.Nano Comment(s)on Condition: 14.Indicate the value of personal Property Included In the Selo C .00 ASSESSMENT INFORMATION-Data should reflect the latest Final Assessment Ad-land Tax Bill 18.Year at Assessment Rail from which Information teken(M '8 'IT.Total Awsoaed Value 3,300 •t&Properly Chu 210 _ •19.School District Namsi Matt tuck-Cutchgue-Laure_- '20.Tex Map kle iflor(spRoll kbntMr(s)(a man thee four•attach sheat with additional identiWa)) 1000-128-1-16 CERTIFICATION I Certify that all dahe items of lnkw aftn entered an this form ars true and correct(to the hest of my knowledge and bend)and t understand that the making at any wlliful false statement of material fact hassle Subject me to the PFUdl10fie of the Repel haw-mladve to the making and filing of}alae instruments. BUYER CON RMATION (Enter'recreation fa as buyer Now:IT buyer is LLC, and sooety,awadstbm n. rpm arallon,John adad mparry.swam or /� ,rl seUlyUal a not M IedrYdliel agent or fiduciary Bien a nand mnact Inbrmalbn of an indltduataesponsibhs ,fC`-'e 4 parry who nn arisver querela regarding the bawler must be armored.Type or pelt ergdy I BE:LER SinSATURE DATE RK Peters Sean LAST NM1E FIRST NMC ?' �f (917) 292-0540 ER Sxe4ATURE DATE •MGCOO[ -rE:LPHONL 4UMRER(E.-elates, Remi n ton Road 'SRaETHUMBER - •STIIEET NME Manhasset NY 030 •CJIY OR Town 'STATE •IIPfAOF BUYER'S ATTORNEY + r_schette Robert 'J15i NAME FIRST.4ME (631) 283-3510 AREACOUE T PHOIE 4UM36R(4 SSwen