HomeMy WebLinkAboutL 13236 P 352 SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 02/15/2024
Number of Pages: 3 At: 11 :44 : 05 AM
Receipt Number : 24-0019562
TRANSFER TAX NUMBER: 23-19974 LIBER: D00013236
PAGE : 352
District: Section: Block: Lot:
1000 070 .00 04 .00 026. 000
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $0 .00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $15. 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 $5.00 NO RPT $200.00 NO
Transfer tax $0 .00 NO Comm.Pres $0.00 NO
Fees Paid $395.00
TRANSFER TAX NUMBER: 23-19974
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
VINCENT PULEO
County Clerk, Suffolk County
2❑
Number of pages 3
RECORDED
2024 Feb 15 11:44:05 AM
VINCENT PULED
This document will be public CLERK OF
record. Please remove all SUFFOLK COUNTY
Social Security Numbers L D00013236
P 352
prior to recording. DT# 23-19974
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
3 1 FEES r\
Ul
Page/Filing Fee 15pMortgage Amt.
i.Basic Tax
Handling 20. 00 2. Additional Tax
TP-584 S, Zc) Sub Total
Notation
Spec./Assit.
or
EA-5217(County) S Sub Total L 0-b Spec./Add.
EA-5217(State) TOT.MTG.TAX
R.P.T.S.A. =;a D'7 "CCD Dual Town Dual County
Held for Appointment
Comm.of Ed. 5, 00 Transfer Tax
ffidavit e �. Mansion Tax
ertified j, GC] �� The property covered by this mortgage is
or will be improved by a one or two
NYS Surcharge 15. 00 family dwelling only.
Sub Total 3S�• LYD YES or NO
Other z
Grand Total 39 S.0'0/ O,s appropriate tax clause on
# of this instrument,
4 Dist. 24005725 1000 07000 04n{00 I026000 ' -5 Community Preservation Fund
Rea[Property P TGR Il�����®111`I®11�11 Consideration Amount$
Tax Service C IWIWO III
Agency 14F J CPF Tax Due $ n
Verification
Improved
6 SatisfactionstDischarges/Releases List Property Owners Mailing Address
RECORD&RETURN TO: Vacant Land
Record 8 Return to: p\ / TD 1 4r_T)0
Scolaro Fetter Grizanti 8 McGough,PC. �/ TD
507 Plum Street,Suite 300
Syracuse,NY 13204 TD
Mail to: Vincent Puleo, Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name
www.suffo[kcountyny.gov/clerk Title#
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached Bargain and Sale Deed made
by: (SPECIFYTYPEOF INSTRUMENT)
Elizabeth Van Bourgondien The premises herein is situated in
John Van Bourgondien SUFFOLK COUNTY, NEW YORK.
TO In the TOWN of Southold
Elizabeth Van Bourgondien , as Trustee In the VILLAGE
John Van Bourgondien, as Trustee or HAMLET of
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
over
BARGAIN AND SALE DEED
WITH COVENANT AGAINST GRANTOR'S ACTS
THIS INDENTURE, made the P-eday of f��Q�y , 2024.
BETWEEN: ELIZABETH VAN BOURGONDIEN AND
JOHN VAN BOURGONDIEN,husband and wife,
of 875 Hill Road, Southold,NY 11971,
Grantor,
AND: ELIZABETH VAN BOURGONDIEN, AS TRUSTEE OF THE
ELIZABETH VAN BOURGONDIEN REVOCABLE TRUST
dated S,►vc.,y 2 ,2024, as to a 50% interest,
- AND-'
JOHN VAN BOURGONDIEN, AS TRUSTEE OF THE JOHN
VAN BOURGONDIEN REVOCABLE TRUST dated
r. 2.5 , 2024, as to a 5O% interest,
of 875 Kill Road, Southold, NY 11971,
Grantee,
WITNESSETH,that the Grantor, in consideration of Ten and 00/100 Dollars($10.00)and
other valuable consideration paid by the Grantee, does hereby grant and release unto the Grantee,
the heirs or successors and assigns of the Grantee forever,
ALL that certain plot,piece or parcel of land, with the buildings and improvements thereon
erected, situate, lying and being at Southold, Town of Southold, County of Suffolk and State of
New York, known and designated as Lot number 5 on a certain map entitled, "Map of Calves Neck
at Southold" and filed in the Office of the Clerk of the County of Suffolk on February 15, 1972 as
Map number 5673.
SUBJECT to casements, covenants and restrictions of record, if any.
FOR REFERENCE ONLY: Property Address: 875 Hill Rd
Tax Map No.: 70.4-26
BEING the same premises described in the Deed to the Grantor herein dated October 12,
2023 and recorded on December 1, 2023 in the Suffolk County Clerk's Office in Liber 13227 of
Deeds at Page 813.
TOGETHER with all right, title and interest, if any, of the Grantor 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 Grantor in and to
said premises;
TO HAVE AND TO HOLD the premises herein granted unto the Grantee, the heirs or
successors and assigns of the Grantee forever.
AND the Grantor covenants that the Grantor has not done or suffered anything whereby
the said premises have been encumbered in any way whatever, except as aforesaid.
AND the Grantor, in compliance with Section 13 of the Lien Law, covenants that the
Grantor 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 Grantor has duly executed this deed the day and year first _
above written.
EL ABETH VAN BO AGONDIEN
/JOHN AN BOURG NDIEN
STATE OF NEW YORK )
COUNTY OF Svf foc.n )ss.:
On this Z S day of vTA '• , 2024, before me,the undersigned, a Notary Public in
and for said State, personally appeared ELIZABETH VAN BOURGONDIEN AND JOHN
VAN BOURGONDIEN, 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 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) on the instrument, the individual(s), or the person upon behalf of which
the individual(s) acted, executed the instrument.
otary Public
JEFFREY M.FETTER
Notary Public,State of Now York
Record& Return To:. No.o2FE4aos3s2
Qualified in Onondaga County
Scolaro Fetter Grizanti&McGough,P.C. Commission Expires September 30.20L C
507 Plum Street, Suite 300
Syracuse,NY 13204 866390.1
INSTRUCTIONS(RP-5217-PDF-INS):www.orps.state.ny.us
FOR COUNTY USE ONLY Now York State Department Of
C1.SwIS code j l.`,-],�, ,� ,c1� Taxation and Finance
C2.Dam Deed Recorded I / 5 /�^ I Once of Real Property Tax Services
_ W,^ Lan •� RP-5217-PDF
C3.Book I 1,.l,�-,7 & I C4.Page J Real Property Transfer Report(5110)
PROPERTY INFORMATION
I.Property e73 HILL ROAD
Location
'S'7EET h.-YSF.i 'lriF•--YF
31971
•GI'YZA TOM vs.AGE •du CODE
2.Buyer (SEE Arr'A`-.I(i D,
Name ` VQ.n t Lr�d A.^n�i^L/1 5
•aST N�IY.KAYPSW y IIVSrANi-
491 1-VLC:w'xIVr Re-N-VF
3.Tax Indicate where future Tax Bills are to be sent
Bng it other than buyer address(at bottom of form) ,As-,awLICOM-ww I Ns•NAW
Atltlress
5-aEET r.:waF+wAU MM[ CT'Y^a TOM S1w:L LP CODE
4.Indlerte the number of Assessment 1 Part or is Parch (Only N Part of a Pere40 Check as they apply:
Roll parcels transferred on the deed e of Parcels OR 4A.Planning Board with Subdivision Authority Exists
5.Dead X ()I>. 0.44 4B.Subdivision Approve!was Required for Transfer
Property •FPGY-I LL' •IYJ•'F 'gC�Es
Ste. 4C.Parcel Approved for Subdivision with Map Provided
VAN BOJRG0XD=?V =',Tl.ALiI'll
G.Seller •1A51 F.M_T.r:Y.+iwT I:s•WWI.
Name VAN BOURGO'.-I TEN OH
!A5'Nw,FA:MF LW R-ST+Awa
'7.Select the description which most accurately describes the Check the bozos below as they apply:
use of the property at the time of sale: 8.Ownwsllip Type is Condominium
A•One Family Residential 9.New Consvunlon on a Vacant Land
1DA.Property Locided within an Agricultural District
106.Buyer received a disciosum notice indicating that the property is in on ❑
Agricultural Dlsolct
SALE INFORMATION 15.Check one or more of these condittom as applicable to transfer.
A Salo Between Relatives or Former Relatives
71.Safe Corhtrad Dab B.Sale between Rdated Companies or Partners In Business
C ore or the Buyers is also a Seller
•12.Dots of Salartmnsfer LaS'3•tL1t-/ D Buyer or Seller in Govemmerd Agency or Lending Insdiulion
f 1 E.Dead Type not Vvarronty or Bargain and Selo(Specify Below)
F.Ss:e of Frocllom!or Less than Fee Interest(Specify Below)
113.Full Sale Price 0.00 G.Significant Change 1n Property Between Taxable Stdus and Sole Dates
11,Sole of Business is Included In Sale Para
t Full Sale Prima Is the total amount paid for 11-m property Including personal property I Other Unusual Factors Affecting Sale Price(Specify Bolow)
This payment may be in the form of rash,ooer property or gems.or-,me assumption or J.None
mortgages or other obligations.)Please round to the nearest whale dollar amount.
Camment(s)on Condition:
14.Indicate the value of personal D.DO
property Included In the sale C:ONVls':ANCE TO YPUSTS
ASSESSMENT INFORMATION-Data should reflect the latest Final Assessment Roll and Tax t3i11
l 1s.Year of Assessment Roll from which Information ta(un(YY) 13 '17.Total Are assed Value
•1a.Property Class 210 _ •19.School District Nome 50i"Hoi d)
•20.Tom Nlep ldemiflogsyRoll IdentlMr(s)(If more than four,attach sheet with additional Idantlear(a))
i70.•r-2o
CERTIFICATION
I Certify that all of the trams of informallon entered on this form are true end correct(to the best of my knowledge and bollor)and I undamtond that the making of any willful
false statemant of material fad herein subject me to the prpvielgMi nt the stem!law rolative to the making and Sling of false Instruments.
SELLER SIGNATURE BUYER CONTACT INFORMATION
(c aN rvama:a%our the Ixeer,Nse'a oui er Is LLC.ssaely e5roar el,c.orpersllpn•Firm srxt mmwrry.esMe or
lsns:esse,oi NElagee Ordmfi:,ry ale%■muss vile Type
r1rdc wily.) rMpmewe
pub wrc Lan anw.w 9.resunn rMarJrg:'Ie:mvW must 6e aMand.TYW or MIw aNsAy.)
5�.Ea SIGtiwTJP-a t
VAN F.OURGOED=EN FT.T7.ABFTr!. AND COHN
WMER SIGNATURE
((n� ///^l• •IAtTMYC R-11,NAM=
V • /�
'ti F4S^Cf '-n F14.C•F r.J4W1•L.9r111R0I
vlr•LP S'GY�• Gs1-
3'1 III T R,
•S•a_:'AABEa '51NLLIpxw-
r SOUT"OLD NY 1_471
•_Ih OR•G-N 'STATE -r PCOOF
BMUMAT-T.ORNEY
I I I i F MCG')':]GE P.C.
:�!C_n-.0 :�F'.''r^R ,,^.•R=ZAttiTI ,
'JS:MAUI. 'N5'NNJr'
I I
' 13,5) 47:-Si_1
l , II -•xP_s Coe: 1LLLPI.74:NwMCNIC,SWUM
ATTACHMENT TO FORM-5217
2. BUYER NAME:
ELIZABETH VAN BOURGONDIEN,AS TRUSTEE OF THE
ELIZAI 11 VA!!BOURGONDIEN REVOCABLE TRUST
dated/9NVAn 7_6-, 2024,as to a 50% interest,
of 875 Hill Roa , Southold,NY 11971
- AND -
JOHN VAN BOURGONDIEN,AS TRUSTEE OF TILE JOHN
VAN BOUR(:ONDIEN REVOCABLE,TRUST
dated 2024,as to a 50%interest,
of 875 Hill Road Southold,NY 11971