HomeMy WebLinkAboutL 13215 P 162 SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 08/23/2023
Number of Pages: 10 At: 01 :56:08 PM
Receipt Number : 23-0108160
TRANSFER TAX NUMBER: 23--02674 LIBER: D00013215
PAGE : 162
District: Section: Block: Lot:
1000 005 .00 02 . 00 003 .002
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $25,000 .00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $50 .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 $12 .50 NO RPT $200 . 00 NO
Transfer tax $100 .00 NO Comm.Pres $0 .00 NO
Fees Paid $537 .50
TRANSFER TAX NUMBER: 23-02674
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
Vincent Puleo
County Clerk, Suffolk County
1
Number of pages (' RECORDED
2023 Aura 23 01:56:08 PM
Vincent Fuleo
CLERIC OF
This document will be public SUFFOLK COUNTY
record. Please remove all L D00013215
Social Security Numbers F' 16'2
priorto recording. DT# 23-02674
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
3 FEES
•DL) Mortgage Amt.
Page/Filing Fee 1.Basic Tax
Handling 20. 00
2. Additional Tax
TP-584 S. r Sub Total
Notation Spec./Assit.
EA-5217(County) S Sub Total �fl Spec./Add.
EA-5217(State) I o`? TOT.MTG.TAX
R.P,T.S.A, Dual Town Dual County _
Held for Appointment
Comm.of Ed. 5. 00 Transfer Tax 100•DD
Affidavit -� • �. Mansion Tax
Certified Copy/ ! p�. S �' �� The property covered by this mortgage is
or will be improved by a one or two
NYS Surcharge y 15. GO- Sub
dwelling only.
Sub Total 3S7 YES or NO
Other
Grand Total L) 7, If NO,see appropriate tax clause on
page# of this instrument.
4 Dist. IOOC 23035427 1000 00500 0200 003002 la 5 Community Preservation Fund
Real Property P T S Consideration Amount$ 25,000
Tax Agency 21-AU A 1111111 gill 1111CPF ax Due $ 0
Verification
mproved
6 Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD&RETURN TO: "C Vacant Land
STEPHEN L. HAM, III, ESQ. a^^ TD
MATTHEWS&HAM TD
38 NUGENT STREET
SOUTHAMPTON, NY 11968 TD
Mail to: Vincent Puleo, Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name Fidelity National Title Insurance Company
www.suffolkeountyny.gov/clerk Title#
7404-016007
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached DEED made
by: (SPECIFYTYPEOF INSTRUMENT)
PNC BANK,NATIONAL ASSOCIATION,AS TRUSTEE U/W The premises herein is situated in
SARA E.F.EVANS&U/A SARA E.FISCHER FBO NANCY E.GRUNER SUFFOLK COUNTY, NEW YORK.
TO In the TOWN of SOUTHOLD
ROSE HOPKINS HARVEY and F.BARTON HARVEY,III, In the VILLAGE
AS TRUSTEES OF THE GAINES GWATHMEY FAMILY 2012 TRUST or HAMLET of FISHERS ISLAND
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
1K Lac
THIS INDENTURE,made the?� day of April,two thousand twenty-three,
PNC BANK,NATIONAL ASSOCIATION,AS TRUSTEE UNDER THE WILL OF SARA E. F. EVANS DATED
APRIL 17,1959 FBO NANCY E.GRUNER AND AS TRUSTEE UNDER THE IRREVOCABLE AGREEMENT OF
SARA E.FISCHER DATED JUNE 29,1915 AS APPOINTED BY WILL OF SARA E.F.EVANS DATED APRIL
17,1959 FBO NANCY E.GRUNER,300 Fifth Avenue,31st Floor, Pittsburgh,Pennsylvania 15222,
party of the first part,and
ROSE HOPKINS HARVEY and F. BARTON HARVEY, III, as TRUSTEES OF THE GAINES GWATHMEY
FAMILY 2012 TRUST UTA DATED SEPTEMBER 20,2012,c/o Brown Investment Advisory&Trust Co.,901 S.
Bond Street,Suite 400,Baltimore,Maryland 21231,
party of the second part,
WITNESSETH, that the party of the first part, in consideration of Ten Dollars and other good and valuable
consideration paid by the party of the second part,does hereby grant and release unto the parry 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 situate,lying and being at Fishers Island,Town of Southold,County of
Suffolk and State of New York,being bounded and described as set forth on Schedule A attached hereto.
BEING AND INTENDED TO BE a portion of the same premises respective undivided one-half interests in which
were conveyed to the parry of the first part by deeds,dated September 27,2022 and recorded in the Office of the
Suffolk County Clerk-on November 14,2022 in Liber 13177 at pages 780 and 781,respectively.
This conveyance of the premises described on Schedule A hereto was approved by the Planning Board of the
Town of Southold by resolution adopted on March 13,2023. By accepting this deed,the party of the second part
acknowledges and agrees that the premises conveyed hereby(being a part of SCTM No. 1000-005.00-02.00-
003.000)shall merge with and become a part of the remaining premises of the parry of the second part adjoining
the premises conveyed hereby on the south and west(formerly SCTM No.1000-005.00-02.00-002.000,a portion
of which premises adjoining on the south and west as heretofore existing being conveyed to the party of the first
part by deed intended to be recorded simultaneously herewith)and shall not, except as so merged with such
remaining premises,constitute a separate building site under applicable laws,ordinances,rules and regulations.
A perimeter description of said merged parcel is set forth on Schedule B hereto and a reduced version of the lot
line change map approved by the Planning Board of the Town of Southold depicting the authorized land transfers
is set forth on Schedule C hereto.
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
partwill 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:
PNC BANK,NATIONAL ASSOCIATION,
as Trustee of the foregoing Trusts
By �I� vN' �--
Kimberly M.JiyksoK,Senior Vice President
Standard N.Y.B.T,U.Form 8002-Bargain and Sale Deed,with Covenant against Grantor's Acts—Uniform Acknowledgment
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE 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
undersigned,personally appeared before me,the 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 individuals whose names are satisfactory evidence to be the individuals whose names are
subscribed to the within instrument and acknowledged to me that subscribed to the within instrument and acknowledged to me that
he/shefthey executed the same in his/her/their capacities,and he/she/they executed the same in his/herttheir capacities, and
that by their signatures on the instrument,the individuals,or the that by their signatures on the instrument,the individuals,or the
person upon behalf of which the individuals acted,executed the person upon behalf of which the individuals acted,executed the
instrument. instrument.
Notary Public Notary Public
(signature and office of individual taking acknowledgment) (signature and office of individual taking acknowledgment)
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE
Commonwealth of Pennsylvania;County of �All
Ads.:
On the Ray of VV�gril1 in-the year 2023 before me,the undersigned,personally appeared
Kimberly M.Jackson
personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the
within instrument and acknowledged to me that she executed the same in he capacity,and that by her signature on the instrument,
the individual,or the person upon behalf of which the individual acted,ex ut the instrument,and that such individual made such
appearance before the undersigned in the City of Pittsburgh in the Co on alth e
Commonwealth of Pennsylvania WMIV
-
CatherineA.Robb,Notary Public Notary Public
Allegheny County
My commission expires July 18,2025
Commission number 1038244
Member,Pennsylvania Associetlon of Not ties
BARGAIN AND SALE DEED DISTRICT 1000
WITH COVENANT AGAINST GRANTOR'S ACTS SECTION 005.00
BLOCK 02.00
Title No. 7404-016007 LOT p/o 003.000
COUNTY OR TOWN SUFFOLK-SOUTHOLD
STREET ADDRESS 137 Pheasant Drive
PNC BANK,NATIONAL ASSOCIATION,as Trustee Fishers Island,NY 06390
TO
THE GAINES GWATHMEY FAMILY 2012 TRUST RETURN BY MAIL TO:
STANDARD FORM OF NEW YORK BOARD OF TITLE UNDERWRITERS
Distributed by
RESERVE THIS SPACE FOR USE OF RECORDING OFFICE
I
SCHEDULE A
to
DEED
Party of the First Part: PNC Bank, National Association, as Trustee
Party of the Second Part: Rose Hopkins Harvey and F. Barton Harvey, lll,
as Trustees of the Gaines Gwathmey Family
2012 Trust u/a dated September 20, 2012
Deed Dated: Tjj6 zF 2023
ALL that certain plot, piece or parcel of land, with the buildings and improvements
thereon erected, situate lying and being on Fishers Island in the Town of Southold,
County of Suffolk and State of New York, being bounded and described as follows:
BEGINNING at a point on the southeasterly line of East Main Road which is located
1104.03 feet South of a point which is 2131.87 feet West of a monument marking the
United States Coast and Geodetic Survey Triangulation Station"East End 2"(which
said"East End 2" monument is located on the summit of the highest hill East of East
Harbor on Fishers Island, New York); and
RUNNING THENCE along said southeasterly line of East Main Road, North 62 degrees
24 minutes 10 seconds East, 53.97 feet;
THENCE South 27 degrees 35 minutes 50 seconds East, 135.69 feet;
THENCE North 67 degrees 37 minutes 30 seconds West, 117.21 feet to a point of
curve to the right having a radius of 27.96 feet and the direction of whose radius at that
point is North 22 degrees 22 minutes 30 seconds East;
THENCE northerly following the arc of said curve, 63.45 feet to the point or place of
BEGINNING.
SCHEDULE B
to
DEED
Party of the First Part: PNC Bank, National Association, as Trustee
Party of the Second Part: Rose Hopkins Harvey and F. Barton Harvey, III,
as Trustees of the Gaines Gwathmey Family
2012 Trust u/a dated September 20, 2012
Deed Dated: 7?u.rs wb , 2023
Perimeter Description of Merged Parcel
ALL that certain plot, piece or parcel of land,with the buildings and improvements
thereon erected, situate lying and being on Fishers Island in the Town of Southold,
County of Suffolk and State of New York, being bounded and described as follows:
BEGINNING at a point in the southeasterly line of East Main Road, said point being
located 1104.03 feet South of a point which is 2131.87 feet West of a monument
marking the United States Coast and Geodetic Survey Triangulation Station"East End
2"(which said"East End 2"monument is located on the summit of the highest hill East
of East Harbor on Fishers Island, New York); and from said beginning point
RUNNING THENCE along said road line North 62 degrees 24 minutes 10 seconds
East, 53.97 feet;
THENCE South 27 degrees 35 minutes 50 seconds East, 161.25 feet;
THENCE South 05 degrees 54 minutes 00 seconds West, 74.11 feet to land now or
formerly of Fishers Island Development Corporation;
THENCE North 84 degrees 06 minutes 00 seconds West, 104.42 feet;
THENCE South 85 degrees 20 minutes 00 seconds West, 45.64 feet;
THENCE North 06 degrees 05 minutes 00 seconds West,42.52 feet;
THENCE North 27 degrees 21 minutes 30 seconds West, 108.50 feet to the
southeasterly side of East Main Road;
THENCE along the southeasterly side of East Main Road North 62 degrees 38 minutes
30 seconds East, 100.00 feet to the point or place of BEGINNING.
SCHEDULE C
to
DEED
Party of the First Part: PNC Bank, National Association, as Trustee
Party of the Second Part: Rose Hopkins Harvey and F. Barton Harvey, Ill,
as Trustees of the Gaines Gwathmey Family
2012 Trust u/a dated September 20, 2012
Deed Dated: 2021
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AREA TO BE CONVEYED
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DEVELOPMENT CORP
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EXISTING LAYOUT PROPOSED LAYOUT
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—6941 SQ, FT.
S 1301.47 ROD
N/F W 1961.20 r�uND
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DEVELOPMENT CORP
GOLF COURSE \
LOT 2
1.48t ACRES -
LOT #/OWNER/BLOCK/LOT
LOT 1-GAMES GWATHMEY-22617 EAST MAIN ROAD
LOT 2-SARAH E F EVANS TRUSTS-137 PHEASANT DRIVE
D LAYOUT
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TYPICAL LOT LAYOUT
NOT TO SCALE
♦ 4'WATER IES7 HOtF DATA-_
MAIN BY: R. STROUSE P.E.L.S. DATE 12/22/2p21
♦ O'-9" TOPSOIL
'♦ 9"-32" SANDY SUBSOIL
♦ 32"-132"SANDS WITH FINES(SM)
\lS`•i *,\ 132"- 1T WELL GRADED SANDS-LITTLE OR NO FINES(SW')
SINGLE FAMILY RESIDENCE WATER ELEVATION 2'
MUNICIPAL WATER
ON SITE SEPTIC SYSTEM SOIL CLASSIFICATION;
�`• i RdR-RNerhaad Bondy loam,3- BX clop_
'I \-• \ R.B-Riverhead.cry tany sandy loom 3-Bt elope.
Q \� PIB-Plymouth loamy.and 3-BE sIopea
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TRANSFORMER
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itp D .\METER
==15 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
/ GREAT RIVER, N.Y.
DATE:
Y% c�
S 5 1717,10"
i" \e ME.RE__?b"E .,;4.00' THIS 15 TO CERTIFY THAT THE MAP OF GWATHMEY/GRUNER LOT UNE
T` IwOUNO) CHANGE-IN THE TOWN OF SOUTHOLD WITH A TOTAL OF Z LOTS WAS
Qp APPROVED ON THE ABOVE DATE.WATER SUPPLIES AND SEWAGE DISPOSAL
GAG`" t ♦:�` �� FACILITIES MUST CONFORM TO CONSTRUCTION STANDARDS IN EFFECT AT
THE TIME OF CONSTRUCTION AND ARE SUBJECT TO SEPARATE PERMITS
PURSUANT TO THOSE STANDARDS.THIS APPROVAL SHALL BE VALID ONLY IF
:0 'THE REALTY SUBDIVISION/OEVELOPMENT MAP IS DULY FILED WITH THE
'1 \ COUNTY CLERK WITHIN ONE YEAR OF THIS DATE,CONSENT IS HEREBY GIVEN
C % �'\\ \„ FOR THE FILING.OF THIS MAP ON WHICH THIS ENDORSEMENT APPEARS IN
THE OFFICE OF THE COUNTY CLERK IN ACCORDANCE WITH PROVISIONS OF
i.
THE PUBLIC HEALTH LAW AND THE SUFFOLK COUNTY SANITARY CODE.
WALTER OAWYDIAK,P,E,-DIRECTOR.
T( •�°F, / DIVISION OF ENVIRONMENTAL QUALITY
� �tihl[di nLq.,
cam. r%`u HH
✓l _ I HEREBY CERTIFY THAT THE WATER SUPPLY AND SEWAGE DISPOSAL
♦r %II HAMILTON RESIDENCE LLC • SYSTEM FOR THIS PROJEC AS DESIGNED BY ME OR UNDER MY
11 _ DIRECTION.BASED UPON CAREFUL AND THOROUGH STUDY OF THE SUL,
SINGLE FAMILY RE$IDENCF F 't SITE AND GRd1N W CONDITIONS, THE LOT,AS PROPOSED,CONFORMS
•� \`• �, ^ MUNICIPAL WATER �' r�:, TO THE DEPARTMENT OF HEALTH SERVICES
ON SITE SEPTIC SYSTEMSs T\St•.��i', Ls; CONSTR RIDS IN EFFECT AS OF THIS DATE.
RICH RD H.STROVSE,P.E./59363
DATE
SIF
I AM FAMrUAR WITH THE STANDARDS FOR APPROVAL AND CONSTRUCTION OF
,.ROD SUBSURFACESEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCE
hIUNDJ AND WILL ABIDE BY THE CONDITIONS SET FORTH THFREW AND ON THE
PERMIT TO CONSTRUCT.
APPUCANT
� N•�-=,'+moi' ((I;
DORMER AREA RE_M5ED AREA
2617 LAST MAIN ROAD 0.67± ACRES (29,355 t S.F.) 0.67± ACRES (29.355 + [F) lcrTLA Orr inn,
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LOCATION MAP SCALE 1 =600'
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MAP REFERENCES, 0 l.. 0-r
1. PLAN OF PROPERTY TO BE CONVEYED TO GAINES GWATHMEY, Ill, 7 W 12 Z
FISHERS ISLAND. NEW YORX, SCALE: V=40'. DATE: JUNE 20. 199E
BY CHANDLER. PALMER &KING 2 V p .',d 6
LJ ��
NOTES J 0- o in
1. T1;5 SURVEY WAS P9RiAliLD FOR-.riE PARTIES AND PURPOSE ('J 7} Z in
INOICA.ED HEREON. ANY EXTENSION OF THE USE BEYOND 111E [L W
PURPOSED AGREED TO-BETWEEN THE CLIENT AND THE SURVEYOR L' g
EXCEEDS THE SCOPE OF THE ENGAGEMENT. _ O _ Ln
Ln
2. IT 15 A VIOLATION OF THE STATE EDUCATION LAW FOR ANY
PERSON. UNLESS ACTING UNDER THE DIRECTION OF A LICENSED
LAND SURVEYOR, TO ALTER AN ITEM IN ANY WAY. 0 r
V)
3. ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND W CV
SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL ? C4
ARE THE PRODUCT OF THE LAND SURVEYOR. <
4. COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST AND
GEODETC SURVEY TRIANGULATION STATION 'EAST END2'
5. SITE IS IN THE TOWN OF SOUTHOLD. SUFFOLK COUNTY TAX MAP
1000, SECTION 05, BLOCK 2, LOT 2 AND LOT 3. _
Cn o
6. SITE IS LOCATED IN ZONING DISTRICT R-120.
a
7. BASE FOR ELEVATIONS-NAVDBB O
- o
B. SITES ARE SERVICED BY MUNICIPAL WATER AND ON SITE SEPTIC vl
SISTEMS. -
> .
w
a �
0
d_
LEGEND
PROPERTY LINE
ABUTTERS UNE —--
EDGE OF PAVEMENT
EDGE OF GRAVEL -------------------
EXISTING
----- -_-_-EXISTING CONTOUR ---20--- Q
STONE WALL a m
RETAINING WALL
FENCE
TREE UNE ./�•-iY1-/1'�../`(�.r'. ¢] '�" i ¢
NOW OR FORMERLY NIF CON 8
BOUNDARY POINT O w o
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MERESTONE tg
ci
a
- -- DATE: 01/11/2022
SCALE: 1" = 40'
PROJECT #066379
SHEET
1 OF 1
INSTRUCTIONS(RP-5217-PDF-INS):www.orps.state.ny.us
FOR CQUNTY USE ONLY - c+
07.SWIS Cods
I 1 1.�7� I New York State Department of
Taxation and Finance
C2.Data Deed Recorded 1 / �J Office
of Real Property Tax SmIces
sae
Ca.Book RP-5217-PDF C4.Page ) h `h�JA�..�I
Real Property Transfer Report(BMe)
PROPERTY INFORMATION
it property 17s PHEASANT DRIVE
.S-FIEE1 aL.TY11[a
•EIeEET hAYE
TOWN OF SOUTHOLD F7SHERS ISLAND
'CITY OR TOWN vi06390
2•Nom GAINES GWATHMF,V FAMiiY 2012 TRUST acODE
LASThFIFICOMP— FIRST
LAST NAIl1.,ew+Mr} NST r4NE
7.Tax Indteate where future Tax Bras ale to be sent
Selene If other then buyer addieselal bosom of term) lbl *Xti:Mry
FlhTKMIE
1rwFE1 LUSE.MICW PE
C'r•'Ca TO9'Rr E1 ATE LFCOD[
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4.In par ade the number of Msasamer Pan d a Pared (Only If Part of■Pmeeq Check nthtrengferrsd a the dsW � a d Parcels grit ® they■PPy:
a.Deed 4A.Planning Board with Subdiv Wm Authority busts
Property •RowrtET X ,, OR -+cps 0-16
SIM Subdivision APpova wasRequired lex Transfer
4C.Parcel APProed hrr Subdiviman with Map Proud W
PNC BANK, NATIONA! ASSOCIATION, TRUSTEE
a.BNler •LWST NAaFx:cuRAxr
Name F'Rsr NWE
LAST hAACrC�IIPAN" ,e1S7 vANE
'7.Salvothe description which moat amunfty describes the Cheek the boxam beloIn nth ■
use of tee prapery at the time of sale: fl.Ownership Type is Condomi�u n.
A.One)'amily Residential S.New COtutmirion on a Vacant Land El0
f 0A.Preperiy Located within an Agricultural Dlddot
too.Buyer received a disclosure notice indlie$ing that to popery is in an ❑
SALE INFORMATION Agricultural 018tricl
I L Check one or mea of tum conditions as applicable to trgnsfer:
11.SW Contract pate 05/12/2022 A.Sate Behesen Relatives or Former Rdalhroe
B.Oat behreen Rdaud l.onrpankm or Parmers in Susiruss.
C.One d the Buyers is also a Seller
•12 Date of sale rniaafgr 02/11/2023 D.Buyer of Seller Is Govonurnent A1ency or Lending Institution
E.Deed Type not IN■arsy of Bargain and Stu(Specify Blow)
•73.full9ale Prla 0-5d OL90.00 F.Sae or Fractional or Lase than Fes InlersN ISpeay Behw)
_ G.Significant Cheap In Properly Between Taxable Sows erre Sae Dates
(Full Sale Price Is IM total amount paid far am PrOPeriy Including personal property. H.Sale Of Business is Included in Sale Price
This pai mmmit may be in the form of cash.Other property or goods,or on assumpton of I.Omer Unusual Factors Aftang SAM Price(Spw)
aafy Bdo
rtwRgeges or other coUgatona 1 Phase rermd to fie r,,rW wfide"era nouTT, J.None
'Commem(s)on Condition:
14,Indicate the value or pgrsorlel
prop-Fly Included tri the EXCHANGE OF BART OF PARCEL
ro sale D•00 EX?CE- =0H PART OF ADJ07;7InG
PA
ASSESSMENT INFORMATION-Oats should reflect the latest Final Assessment Roll and Tax Bill
16.Ynr of Asseasm est Roll from which Infommton taken(M 22 '17.Taal Assnsed Vda 13,10 0
'16.Property China 210
- '12.School District N■me FISHERS ISLAND'20.Tax Nap Id.UftnsyRall Mmdrerp)(If motbd fri
rs mri four,Meech sheth additional klentner(e))
P�IOCC-005.00-02.00-003.000
CERTIFICATION
I Certify that all of the Mme of IMon=tion entered on that form we true grid eorrsce the bele of k \
hate staeNMm of material fact ms'rdn sub0d are to th@-RMZ 2oLOtths aim 4tr s and�ry an i understand that the residue al my willful
IN o b the raking and stand of hie butrommle.
AFI I CgaFl l eluerr�
SLYER CONTACT INn
(EnlerlrLlhrmaem for se pups.sbw xbyrer la LI.C,saoeq,nsodNrm,corponem.pve erre*cpm
/ easy MW Is not an khemdrral MOM er aduCary.then a rota Nee"nor' Parti anew or
C Gt/ iBr- Wry who can•raver commons regarding ee WWWW biter pe ordered.T ee Pdri aurrny�) 4°anePmelae
-a-
EF:rtATeGNATIpE DA
BUYERSf-Neruuoe KIPKE ITACKIE
•LAST NAME eIRS NAIE
(410) 537-5422
RUvE9 ITIGA4.ME WEACIDE :CLFr4CMPPJWER(Ey m7Smj
uTE
901 c BOND STREET - SUTTE 400
'$T9FEThNm4W •xr9EE-NA9F
r BALTIMORE
YnORrv^ MD 21231
B •erAlE •LOCODE
HAN STEEPHEN L., III
..MT hMxE nRST NAYF
(631) 293-2400
MAA IMEAi&P MraSEan,crown)
r