HomeMy WebLinkAboutL 13164 P 802 11111111111111111111111111111111111111111!11111 I I I I I I I I
II!!IlIIIIIIIIIIIIIIIIIII
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 07/14/2022
Number of Pages: 6 At: 02 :58 :09 PM
Receipt Number : 22-0115241
TRANSFER TAX NUMBER: 21-41463 LIBER: D00013164
PAGE : 802
District: Section: Block: Lot:
1000 007 . 00 05 . 00 002 . 000
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $0 .00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $30 .00 NO Handling $20 .00 NO
COE $5 . 00 NO NYS SRCHG $15 .00 NO
EA-CTY $5 . 00 NO EA-STATE $250 .00 NO
TP-584 $5 . 00 NO Notation $0 .00 NO
Cert.Copies $0 .00 NO RPT $200 .00 NO
Transfer tax $0 .00 NO Comm.Pres $0 . 00 NO
Fees Paid $530 .00
TRANSFER TAX NUMBER: 21-41463
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
RECORDED
2022 Jul 14 02:58:09 PM
JUDITH R. PASCALE
Number of pages CLERK. OF
SUFFOLK COUNTY
L %00013164
This document will be public P 802
record. Please remove all DTit 21-41463
Social Security Numbers
prior to recording.
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
3 1 FEES
Page/Filing Fee Mortgage Amt.
1.Basic Tax
Handling 20. 00 2. Additional Tax
TP-584 Sub Total
Notation Spec./Assit.
or
EA-52 17(County) Sub Total Spec./Add.
EA-5217(State) /j TOT.MTG.TAX
�� Dual Town Dual County
R.P.T.S,A. Held forAppointment
Comm.of Ed. 5. 00 6(tip Transfer Tax
Affidavit Mansion Tax
The property covered by this mortgage is
Certified Copy or will be improved by a one or two
NYS Surcharge 1s. 00 family dwelling only.
Sub Total YES orNO
Other 2
Grand Total 53a I f/ If NO, see appropriate tax clause on
�l page of this instrument.
'911 siy/z z
4 Dist. • 22034149 1000 00700 0500 002000 1100 5 Community Preservation Fund
ReaTax1Service R POL A 1111(Illy Ill lllllIIII lllll 111 VIII IIIIlli CPF Consideration
Amount$ a
Agency 12-1UL-22
Verificatior
Improved
Satisfactions/Discharges Releases List Property Owners Mailing Address ✓
6 R CORD&RETURN TO: it Vacant Land
STEWART TITLE INSURANCE COMPANY TD /O
2 GRAND CENTRAL TOWER TD
140 EAST 45th STREET-33rd FLOOR �It
NEW YORK, NY 10017 �n,� TD
Mail to:Judith A.Pascale,Suffolk County Clerk Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name STEWART TITLE INSURANCE COMPANY
www.suffolkcountyny.gov/clerk
TitleN NY105096
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached Deed made
by: (SPECIFY TYPE OF INSTRUMENT)
Nancy Ellen Werner Hunt The premises herein is situated in
SUFFOLK COUNTY,NEW YORK.
TO In the TOWN of Southold
Nancy Werner Parsons Living Trust u/a/d January 24,2022 In the VILLAGE
Nancy Werner Parsons,as Trustee or HAMLET of
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIORTO RECORDING OR FILING.
over
—Bargain and Sake Decd,wish Covenant against Grantor's Acts—Individual or Corporation(Single Sheet
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT—THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY,
THIS INDENTURE,made the 4T" day of� in the year 2022
BETWEEN Nancy Ellen Werner Hunt,having an address at 1865 Bay Road,4309F,Vero Beach,FL 32963,
party of the first part,and
Nancy Werner Parsons,Trustee of the Nancy Werner Parsons Living Trust ula/d January 24,2022,having an address at 865
Bay Road,9309F,Vero Beach,FL 32963,
party of the second part,
WITNESSETH,that the party of the first part,in consideration of
TEN AND NOI100($10.00) -------------------------------------- dollars
paid by the party of the second part,does hereby grant and release unto the party of the second part,the heirs 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 located at Fishers Island,Town of Southold,County of Suffolk,and State of New York,as more particularly bounded
and described in Schedule A attached hereto.
l000- pal.00 - a5.00_fl02,VOC7
T BEING and intended to be the same premises conveyed to the Grantor herein by Deed dated January 23, 1997,and recorded
on September 9, 1997,in the Office of the Suffolk County Clerk,in Liber 11850 at Page 575.
Said premises being more commonly known as a portion of Off East End Road,Fishers Island,NY 06390.
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 parry 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"whenever 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:
NANCY ELLEN WERNER HUNT
r
ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE ACKNOWLEDGEMENT TAKEN IN NEW YORK STATE
State of New York,County of ,ss: State of New York,County of .ss:
On the day of in the year before me,the On the day of in the year before me,the
undersigned,personally appeared undersigned,personally appeared
personally known to me or proved to me on the basis of personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(s)whose name(s)is(are) satisfactory evidence to be the individual(s)whose name(s)is(are)
subscribed to the within instrument and acknowledged to me that subscribed to the within instrument and acknowledged to me that
helshelthey executed the same in his/her/their capacity(ies),and that by he/she/they executed the same in his/her/their capacity(ies),and that by
his/her/their signature(s)on the instrument,the individual(s),or the his/her/their signature(s)on the instrument,the individual(s),or the
person upon behalf of which the individual(s)acted,executed the person upon behalf of which the individual(s)acted,executed the
instrument. instrument.
ACKNOWLEDGEMENT BY SUBSCRIBING WITNESS TAKEN ACKNOWLEDGEMENT TAKEN OUTSIDE NEW YORK
IN NEW YORK STATE STATE
State of New York,County of ss: *State of rl or,'rlr✓. ,Countyof
ss:
On the day of in the year before me,the *(Or insert District of Columbia,Territory,Possession or Foreign
undersigned,a Notary Public in and for said State,personally appeared County)
the subscribing witness to the foregoing instrument,with whom H
1 am personally acquainted,who,being by me duly sworn,did depose On the �/T. dayof in the year 2022,before
and say that he/she/they reside(s)in me bc, I r (Notary Name)the undersigned
personally appeared by Phl/50
lif the place of residmcc is in a city,include the street and street number if any,hhereot); "116,1
Clk n J-Ar�4 04C
(itrP/
that helshe/they know(s) Personally known tome or proved tome on the basis of satisfactory
evidence to be the individual(s)whose name(s)is(are)subscribed to the
to be the individual described in and who executed the foregoing within instrument and acknowledged to me that he/shelthey executed the
instrumcntt that said subscribing witness was present and saw said same in his/her/their capacity(ies), that by his/her/their signature(s)on
the instrument,the individual(s)or the person upon behalf of which the
execute the same;and that said witness at the same time subscribed individual(s)acted,executed the instrument,and that such individual
his/her/their name(s)as a witness thereto make such appearance before the undersigned in the City of
LyV 6w-4)-County of Tiu/o., A, .!^ &State of
(add the city or political subdivision and the state or country or other
place the acknowledgement was taken).
+ DEEBA HAIDARY t
,T Notary Public-State of Ftorlda
. =�� Commission/GG%7177 ( f
µy Canm.fxPtres Mar 6,2071
Bargain and Sale Deed Banded through HationalNam Assn.
With Covenants
SECTION:DISTRICT:1000
SECTION:007,000
Title No. N y(9 S�`] /3 BLOCK:05.00
LOT:002.000 --
Nancy Ellen Werner Hunt,
COUNTY OR TOWN:SUFFOLK ,
TO
Nnney Werner Parsons,Trustee of the Nancy Werner Parsons
Living Trust,u/a/d January 24,2022
RETURN BY MAIL TO:
Lawrence S.Blumberg,Esq.
DISTRIBUTED BY Kurzman Eisenberg Corbin&Lever,LLP
One North Broadway,12"Floor
White Plains,NY I0601
YOUR TITLE EXPERTS
The Judicial Title Insurance Agency LLC
800-281-TITLE(8485) FAX:800-FAX-9396
w
All that lot or parcel of land,with the buildings and improvvmeaoa thenen, in the'fawn+.f
Sooilr.ld.Suffolk{'nutty.Mate of New York,being o part of that portion of F'Ishcm ltbmd betoegiag to
ttmntor lwhich padion is berrinarter called the'IA*')lying to the rant of NRIMala Road,said I.t or
parol of land heing hnum4rd and desrribed as fallows:
Fight certain trwb or parcels of laid listed at Fishers Island.Town of Soffntk,State of New York.
being bpoaded and described as follo".
... Troo No. 1
1 Ft"InnioR,at a pniat on the Norrbwntrrty line nr the road leading to the Fast Fa'd,said point
being krratrd AtFl.II fret Nartb of R point which it 691.74%yest of a monument marking Ike I7-oited
Sates Coast■od'Gcod"le Curvy Triangulation Flatten'NIN'and{hence runalag along tuid rwad
y lite Nertb 64 degrees 42 minutes 10 secands Fast 243.23 root to a point or curve to the kfl wlwwr
;1 radiaf.at that point b North 25 degrees 17 minutes 50 secaods West;thence Nerthrm1wardly uheltg
the Harybrntetly line of another read, fallout"the are of said cerve 21.95 rest;thence along The
Snmthweslrrly liar of saidroad North It deV s 29 minutes 00 tetmndt West;thence
Nirthtrtstwardly along said read line,following the are of Laid curve, 1611.46 feel;41heore S.4b 47
degrer 01 minutes 13 womb West 233.[10 feet; tbrom%vlh IS degrees 17 mlatttts SO mean& Fsrl
16R.I10 r"1 1.The point of beglaulag.
Containing 1.2$ares, more of leu mud{ging designated by the f:rnatnr as fns 1 la Block 37. Tile
+ otm%r dracriS-rd Tract is swn%ryed subject to a right of way far the use and maltlraaacw of a water
male ar..stfag said parol.
Tram \n,I
llrginoiog at a poiat nn the Narthwestrdy lime or Thr road leading to the Fist Eod..aid posiat
being k.rattd I419,1I fret North of a point which 6 691.73 feel Weil of a monument marking the
Iralted States Vnast and(noddle Survey Triangulation Ctitieo'NIN'and tbestce rumsing North 25
s, dcgrres I$minutes 70 wands West 1611.00 feet;thencr North
42 degrees 2J minutes t I sicnads West 62.Sg feet;throve Rmdb 65'degrres 34 miaatm 111 seroe.ds
trent _311.64 feet; thence South 25 degrees 17 minutes SO seromdv FA%t 231.45 feet
~ lv said road lint:Thrace along said read line Narlb 6.8 drvv" 32 minutes 10 tesonds west LRN,00
feet to The point of beginning.
1'nutaining I.3S acres. mars or Ira and bring detlgnaled by the Gruntnr as Int 2 in Shrctc 37,
The.bore deserit—1 tract is rnneryrd subject to a right of way for the ase and maiatenuncr,of a
water main crwatnr,•aid parr-f.
ItsS
t tie,
R"himing at o point an the Nnrtbunterly line or the read leadiag to the Fast End,Laid palet being
located 707.97 fed North of a point which b 9:5.00 feet West of a menameal mOsAing the limited
States('oast Rad(;vneirtle Strvey Triangulation Station 'YIN'mad Ibrace tuaniag along said nod
line`..ulh 64 degrees a2 minutes 10 teewnds test I rn.00 fret to a paint of curse m tke telt.boar
radio%633X.22 fees and the dirretien..f who"radios NO that point 11 South 23 detrnr+ l7 miouies
sal.ee..nds Kati:ihrnce alai*%aid road liar. fallowint the are of said runt 01.110 fret; ttseove North
25 drkreva 17 minutes 41 w-adi%Vest 234.79 feet; themes Neetb 611 degrees J4 miaate.141-,._ad,
Fust 23t.a2 feel: Thrace math IS dtir"m t7 minuirs S0 sseands Fast 231.45 rest to rhe pniat of
t.rgianiat,
}+ Cismaini at 1.24 mecca, more..r Ins and Ming detignalyd by 11r Iran for us I at J It Illo.k 37,
+
t Trost NO.4
•i
.l
Beginning at a point an the Northeasterly line of a road,laid paint being located 457.77 free North
nr a point rhich is I45J•95 fret Wirt of a tonnu+trnt markiag the (tailed Slate C-i and Ce detic
Sar.ey TrUngutalkoo Station'Nl\and thew"running ah+o=told road 0u Soath 44 drgsee.Jt
mlawn I0 secaads Fast 267.91 fret to an Irvin at a point of cane to the left whole rodins 6 13.19
feet and the dirvellaw of-haw radius Is N.rrh 4S drgreeo 1t miewlrs 40 setnade Fast;thrower
SoaTheastwardly along said road,line.following the an of aid cone.12.5:feet to the\ash-eiterh
line of the road leading in the Fait FAd;thence along said road line North 38 degree 59 miauln 1! =
seconds Fast If+4.IS feet to a point of curve to the right wbnu radius is 338.:2 rM-qnd the diteati■n
of abase rnMus sI Ibal point 6 South 51 detnea 00 minutes 45 recants Fast;theater
1Snnhemtwardly olaag said road'llor, following the air of said road•cvrwr. 70,00 fres;thrteer North
4S deg.: 17 enlaatn SO seconds Wfe z 244.79 rrm.ebence*;oath SI degrtn 50 minute, 15 vvcvud.
µeat 145.44(eel to the point of br*Ianiat•
t'nntaining 1.39 arm. mare or less and being dr.ignated by the Gruninr as lad J is H1.A 37.
Subject [i a guying right far■pule liar Rua circ from on rlrettic pole trrtuted on theroad in ibr
Fast 1?ewt.
r
Trott No, t
_ Beginning tot■point■m the Northeasterly line of a road,said point being located 6:7,77 rove N.rth
of a point whlrb is 1453.95 Ire: West of a monument norMaR the t1fthasV Stain Coast and(;..dak
Survey Triangetaliew Station'14151'and thence running atong=W road line North 44 degrees;SR
minute 20 seceads :Fest 192.00 rrel to a point of carve to the fight-busy radius i+149$.57 fret and
the dirniim of oboe radivs at that point is North 45 degrees I1 minutes 40 seconds Far+:;them,
14ortbwntwurdty along said rltad line.fallowing The are or said Neve, 105,72!M In an ima al a
point of cane In thr right obnw radius I1 15.M rsve and the direclian of ohme sellae al that point
i is North ti degrwr% 14 minutes 40 u andt Fast-,then"Nonbwardly,ainag sold road line. falinrtag
r the arc of said eanr. 111.56 hoe to a paint or cunt to the left-base rutin 11 9736.01 fiat and the
r ;y 41rsetlna of-b- radius at that point Is Nor1b 21 degrees 29 minute+36 second.Neat;thence
NonNe mwordly alnag the Snaibealerly line of another road,fnllowlalt the ort of said sunt, 279.11
feel;thenct South 35 degree:et7 minutes 55 snmads Fast 135.16 fret;throe Snnth!1 drgrets 511
minutes 15 seconds wrgl feet In the point of begioning,
f'antaiaisal 1,69 aeras. more or telt and being designated by the(;rawar as Lal 9 in Bbork 37.'I'be
afoave drarrihrd tract n con.r.ed sobjewl to a right of ray 20 fere In-idth for Jn infittwtian pinkn
.t y
rrol.ing.aid tract.
Tract No.A
6.t[inniag vii o print on the Srruthraseerty liar of a rnad.Bald point helaIt located 111ti1.T6 free \Drib
or o pniot which is 1396.211 reel West of a mnnvmenl markllig the llntsed States Cnast and Geodetic
Survey Triumllublboa Statioa'NISI'*ad thowe running Soatl JS degrees 07 minute$S lsewadt
FAss:35.16 feet;thence North 65 degrees J4 minutes 10 seconds }ase 225.00 feel; [brute North 24
• detrvc% M minutes$1 swords West 111.54 fret to a pial an said road line at a pilar of rune to for
right -bove radlw 1."361W flee aad the dirtrti.w of-hose radius at that point is Noah 24 drpee.
4n Minotrs 40 serwad. W-1: l6worr S.alhwrsiwaedly along told rr.ad Use.following the am of void
curve. 269.95 fete to the
print of hrginning.
Containing 1.30 acres. more or less and brie;dnigaatrd by the f;ranlor in lent 10 In Bhots 37.
Pratt Nn,7
i
flrtinnint:at a point as the Noathew%scrty line of u road,void point briny located I 111.Ire fret N.nh
s of a"Int which i1 1149.46 feet Nevi of■m.+amens marklwt she united S1.1-C.a.t and t;avodetk
;
tarvey Triangutalbon Slallnn'NIN'and thence rawniat stoat laid road Urre,tnlho+Ing the an a!r
I
��L;+7�:Whw;.: ].. ../-� .y� - .}..ti�1w•:r...'._ 1. .r+�..i..L... s1:�1...+�.1 .r.'4-�■
tun. ew the ten.6o,,e radius is 90.16.1it reel and the dirxlien of
• -brise radius at that petiwl n North 2S drgrcrs ill ruinutn 4tl srcwttds West.a dwaa"of IXe,62;
ertenee along said read kine Monk&4 degrees 14 minutn-1I1+tc.nd% F.x%t 53.2!1 Frei to a p..lat of
curve In the right wh.l%e radius Is 2114,97 f"t and the dirrTtlua ret whose radius at that paint Is`.such
23 degrsa•s 43 minutes 26 seconds Va,t;then"along%aid rnad line, rwllawiag the art;tit said rune,
75.1111 fat; thso"youth 14 degrees 33 minutes 38+eewnds Fast 227.72'feet;thence tinuth 65 dc%rrrs
JJ minutn In second!Nest 275,nn reel;thence North 2i degree%116 minutn 32 kmindi \Vat 2211.5
rent to the point nr brginniar.
not'aining 1.«arrr+, mnrT or Ins%and taring dn12nalyd b+ the Granlur as IAt I I in Block 37.
Tract tin,tl
Retinniott at a point on the Soulhwesterly line of a road. told polat bring loratrd 11 40.1t)(err \milt
or a p int which 1%377.X5 feet Weal of u monument marking the halted Staler('oast and(:eodrlie
�Aurvr%'Trianitulailao`talion'NIY'and thence running along sold rand tine,ratlawlag the air of a
rune to Ike left "host radius b 384.41 feet and the direrllna of whose radius at that point Is Math
43 degrees 24 minutes 26 m"nds Neal,a distance of I5Q.OW feet to a paint or curve to the left
"!rise rudtut is 289.97 fro alsd the direction of whose radio at that pedol b tinuth 21 degrees CU
lt ira
minutes Orndt Wesk, bruce Weilwurdly along the Snutherir liar of said road 161.X11 rent;thence
youth 42 degrees U minutes 11 serr.wd% Fast 62.SX reel: theorr 227.72 feet;thence\ortb 47 degrees
cel minutes 13 seconds Fait:53.116 reel to the point of beginning.
Containing 1.111 acres, more or Mai and hiring designated by the Crantor a%Int 12 in Rkwk 37,
together with the appurieftancrs. avid alt the ntate Lind rights or the party of the rust purl in and In
said prrmitn;
St1)13Ft'1'tit nay%13tr cel fun an accurair Lune% may tho".and
Sttnif.1'T to co%enant%, m1rlc1111n., rmrtrtent%. rights,gram+,and dniaralions or rvr,r.rd, it ant,
and rairments for use or public utilitirs:and
In all applic-able laws and rrgulatinn%or Federal, %lair and local amterumental oulhorilir+;
URSFRVENG to Ihr grantor heroin lmm the grant of the land and premisn hrrehy con%r,rd
eutrmetM%and rights of way withro it strip of land apprnsimutrly five feel wide rnr the erwilow lke►n.tt Lir
poles to support cairn fur the iranamlttion of electricity for light,best,telephone and other purposes,and
far the c:.ostructl..n.apention and laaiotroanec of pipe lion or conduits under the%urfa"wf told
rr—rvakina rnr any tawral purpn%v uhatsoe%rr, but The gronenr shall have the right to rrlea%r the premis,
above detrribrd from lhnr particular ea%ement%and rights or way;
PRt1VIDn, lt()WFVFR. that whenever The surface ret the ground%hull be disturbed b) the
Itruntor, its surm"m or nutgns, for Ike purpose of constructing or m"Iring any such Palo line,pipr line
or conduit,it%hart lterwmr the duty of The granter, its tueertson or ns%Igw,forthwith,at th or Their oua
!' expanse, In mpalr toad resew"the+urf s of lbr gmuod sn disturbed to inlrttrallafty the%amr cwndllloo
as%hall havr e%heed hefare the time of sorb driturhaocr,
! The gr ator hereby grants and r..nsr)%att the party of the%e%nnd part, their heirs and attiga%,an
i ra%emrnt (tit ingress In and eters% from the prrmisn alwtse described o%rr and alnag%orb private Bonds
as www or mal bereanrr rust manerling the+aid premie%"illi the public highway. The troatwr n"r%rt
live right to rhange the location.muir or grade of said rs.od% rrtm tine in time,pro%ided that such
change shall"I pr"rot reatanably rnavrnieal and adeyaale owns its the pr►rai%es hernia .+.n+r)ed a..r
nareusueably Irntlhrn the ill-lot"to he tro%rlod to"writ such public highway,
i
TO IIAVF.ANDT0 11111.11 the prernitn herein granted unto thr party of the%tsnnd part,and"wt..
Ihr tarVlror of them and unto tach%ur%l%4W% hrin and sunt%%rnrevrr.
t
INSTRUCTIONS(RP-5217-PDF-INS):ww .orps.state.ny.us
FQR COUNTY USE ONLY wNew York Slate OepaRrnotlt of
C1.SMS Code Taxation and Finance
CL Date Doed Recorded L -7/ 1412-2—I Office of Real Property Tax Services
Da
RP-5217-PDF
MMIF •N
C9.Book � J c4 Pasta Real Properly Transfer Report(8110)
PROPERTY INFORMATION
1.Property 0 Off East End Road
Locdlm
•HmEET NIIYSER •STREET NAPE
Southold 06390
•CITYCR TOIMn vLLAGE
Nome Nat01/24/Z07,?_
•I,ncooE
2. Nancy Werner Parsons Living Trusu/a/d 01/24/ 07,?_
Name
•W}NAIPJCaYPANY FRET ANYE
Trustee, Werner Parsons Nancy
LAST NAMEFWWAM 1 NST NAME
7.Tax Indicate when future Ta(BBs aro to be sent
Boling ff Other than buyer eddred(d bottom of ham) LAST kyWX'OMPA FAST WUIE
Address
STREET NUUM AND NAM CITY OR TOWN STATE Z-CODE.
4.Ind kale the number of Asamamem1 e d Paresis OR [:]Post d ray a Parcel (only If Part of a Parcel]MOON as tapply:
ro
Roil peslsriron tsdarrad the dead 4A.Planning Board wdh Subdvidon AWb
airy E:dals
5.Dad OR 10.60
Prepory •RAONr FEET 48.Subdvisian Approver was Regl:retl for Transfer
S� •oEVTN -ACRES
4C.Parcel Approved for Subdivision wish Map Provided
Werner Hunt Nancy Ellen
e.Seller •LAST NAMEIC01PAm Aar NAME
Name
LAST NAMEICOIPA FIRST NATE
'7.Saint the description which most accurdety dascriesa do Check the boxy below as they apply:
on&tai property at the dme of aN: 8.Ownership Type Is Condominium
C.Residential Vacant Land s.New constructor on a vacant Land
10A.Property Located within an Agricultural Dania �.
10B.Buyer received a disclosure notice indicating that the property is in an ❑
Agricultural District
SALE INFORMATION 16.Check ons car more or thea conditions as applicable to transfer.
A.Sale Between Raldtves or Former Relatives
11.Sale Contract Data B.Sale bdwear Related Comparia or Partners in Business.
C.One d the Buyers is also a Sellar
te
12.Daof SaWYmnsfm 115,— ZoZZ D Buyer or Sailer Is Government Agency of Lancing Institution
E.Dow Type not warranty or Bargain and Sale ISpeafy Below)
F.Safe of Ffadional or Las than Fee Interest(Specify Below)
'17.Full Sale Price 0.0o G Signifiram Change In Properly Between Tareda Status and Sale Daws
H.Sala of Business is Included in Sale Price
(Full Sale Price loom told a. IT!paid for the properly including personal property. I.Other Unbwlat Factors Affecting Sale Price(Specify Below
This mem )
pay may be in the farm d ash.Other propariy car goads,a the assumption d J.None
mortgage or other obligations.)PNE6a round to the nearest whole doterwrmaf
'Cmunant(sl on Condition:
14.Indicate No valve at personal
prepartyIncluded Inthe"is 0 •W Zero Conveyance - Here Change of Identity
ASSESSMENT INFORMATION-Data should reflect the latest Final Assessment Roll and Tax Bill
18.Year of Asassmard Roll from which ITtime adon th REOLI ) 21 '17.Total Aasased Value 1,10 0
'is.Properly Close 311 _ •19.SahoolDistrict Nome Fishers Island UFSD
'20.Tex Map IdentM@r(syRoll ldomiRegs)111 more than four,atlach shed with additional ldmtflehsll
1000-007.00-05.00-002.000
CERTIFICATION
I Certify that as Otto ftwo arInfmmatlm entered on this form are true and.aorrect(to the best Of my knowledge and ball&)and I understand that the making of any willful
false stotoma d of material fact herein subject me to th@AWISIW a9LMI PODR Ml6.roladve to the making and gong of Ida Instruments.
SELLER Sly NATURE BUYER CONTACT INFORMATION
lEnter rrawalon lar ole IAym Nene II!Ayers I.I.C.I I-it.sa mum,rirpouoan.)dM once rmlpay,alece a
` wry avec la rep an SIEM w neem or xoxJwy.Ren a cone anti Warta InIOnTs col of an kgmdwhespor"s
pony wft Can wwaer@•eellmw Taaaldrla caw barterer must be axaed.Type car prim clearly)
ll��••��+X�LLER�a{KVNRAElrll
�/LN4xq?,Qe1l*rtRf TY,En f1�TUr�FyE}ryy l I Iy■I Werner Parsons Nancy
Iftirt �qa tKA p&n O�r_l t[,[S�Lsr(A{'T�M•�I�l •HAST NAME
111 1 FART NAPE
Ww;RSIriHAilwE �� •AREACOOE -rELEAIONLNUMURIErelrerI"
GAIL
Na7►G�V "nel'�arSJ �Trl�Sacc_ 1665 Bay Road, 1309F
'STREETNWarA 'STREETNALE
Vero 'Beach FL 32.963
'CITY OR TOwN 'STATF. •CODE
1!1.1111 SAIIOBNEY
Blumberg Lawrence S
yL LAST NAME FAST NAYS
I (914) 285-9600
ARLACOLIF TLLENHONENUMBERIES ererrew
11
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