HomeMy WebLinkAboutTown of Southold-quitclaim deed parcel @ Flint St
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11436PD586 '
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THIS INDEN'IURE, made the /1- day 01
"~') f ,,- ,-
""'-d..I:} r-
L(.".-,
. Din_hundred and ninety_
!~
BEIWEEN the TOWN
County of Suffolk,
York 11971.
OF SQUTHOLD, a municipal corporation of the State of New York,
having its principal office at 53095 MainRoad, Southold,_-" New
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party of the lint part, aDd
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CC!U~qy...-",,_:.-
.. ,..;.............v<'""""___..;.... .' ,,..',,, ".=.-'"'''' ..
having its principal office
at 18 South Street,
the NORTH FORK HOUSING ALLIANCE,
Greenport, New York 11944,
2Z599
party of the oecond part,
WlI'NESSETH, that the party of the first part. in consideration of OY\.L GLo I Icif
doUars.
paid
lawful m<mey of the United States,
by the party of the second part, does hereby remise, release and quitclaim unto the party 01 the second part,
the heirs or succenors and llIIigDs 01 the party of the M!CIIIId part mTCYel'.
'ALL that ""rtain plot, piea: or parcel of land, with the buildings and improvements then:on erected. situate.
lying and beiag in the Town of Southold, County of Suffolk and State of New York, and
acquired by Tax Deed on May 14, 1987, from the County of Suffolk, New York, and
recorded on May 14, 1987 in Liber 10318, Page 541, and otherwise known as and by
Town of Southold, Greenport Driving Park Map 369, Lot 83,
FURTHER, notwithstanding the above description, it is the intention of this
conveyance to give title only to such property as was acquired by the Town of
Southold by Tax Deed on May 14, 1987, from the County of Suffolk, New York, and
recorded on May 14, 1987 in Liber 10318, Page 541.
PROVIDED, however, that the party of the second part, will be restricted in its
use of the subject premises and will use said premises solely and exclusively
for affordable housing purposes; all right, title, and interest will revert to
the party of the first part, at the sole option of the party of the first part,
in the event that the party of the second part, at any time uses or attempts to
use said subject premises for other than affordable housing purposes, in
accordance with the approved plan submitted by the party of the second part.
The reverter clauses contained herein shall apply to the grantee, or any
transferee from the grantee formed pursuant to Article XIX - Affordable Home
Ownership Development Program of the Private Housing Finance Law of the State of
New York, or a not-far-profit corporation formed under 5402 of the
Not-for-Profit Corporation Law for affordable housing purposes.
Additionally, if anyone or more of the following occurs, the property secured
by this deed shall revert as hereinbefore set forth:
1. If the party of the second part fails to construct or complete construction
of affordable housing unit or units on said property within three (3) years from
the date of this deed;
2. If the party of the second part sells or otherwise transfers an affordable
housing unit or units to a purchaser or purchasers whose total annual household
income, from all sources, is above the maximum income limits for non-targeted
areas in the State of New York Mortgage Agency's Affordable Housing Program for
Suffolk County;
114:Jt:iri:5tl7
3. If the party of the second part permits the affordable housing unit or units to be aceu
by a family whose total annual income, frow all sources, is above the maximum income limits
non-targeted areas of the State of ~ew YorK Mortgage Agency's Affordable Housing Program fa
Sut folk County;
4. If the party of the second part allows the total purchase price of each affordable hous
unit to exceed the sum of One Hundred Thousand Dollars ($100,000.00);
5. If the party of the second part fails to certify to the Suffolk County Department of
Community Development prior to closing of title with any affordable housing grantee;
a) the dates of completion and occupancy for any affordable housing unit or units
constructed or rehabilitated on said property;
b) the total houshold income, from all sources, of the purchaser or purchasers of the
property and his or her family; and
c) the total purchase price of the affordable housing unit or units sold or otherwise
transferred.
It is intended and agreed that the agreements and covenants herein shall be covenants runni
with the land and that they shall, in any event, and without regard to technical classifica
or designation, legal or otherwise, and except only as specifically provided herein, be to
full extent permitted by law, binding for the benefit and in favor of, and enforceable by,
party of the first part. If is further understood that such agreements and covenants shall
binding only upon the party of the second part, if it be a municipality or any assignee of
party of the second part, formed under Article XIX of the Private Housing Finance Law of th
Stat of New York, or any affordable housing corporation created under Articles 15A and 15B
the General Municipal Law of the State of New York, or any not-for profit corporation forme
under ~402 of the Not-far-Profit Corporation Law for affordable housing purposes, respectiv
only for such period as they shall have title to or an interest in or possession of the
property or part hereof.
11436PC588
TOGETHER with all right. title aad iDlctCSt, if uY. of the put)' of the firlt part in and to any .trecta aad
road. abuttiag the above deac:ribed p1'emisu to the ceotu lim:s thereof,
TOGE11JER with the appurtefta11CCl and aU the eotate and rights of the party of the fiM part in aad to
Aid p1'emiIeI.
TO HA VB AND TO HOW the prcmiaes herein granted unto the party of the _d part, the bein or
successors and assign. of the party of the second part forever.
AND the puty of the lint part, ill compliaau witb Smion 13 of the Lieu Law, hereby CO_Db that the part)' of
the first part will receive the conaidcration for this ClIIVeylUIce aDd WIll hDId the right to receive IUch conaId-
eration II a lruIt fund to be applied first for the purpose of paying the cost of the improyemeot and will apply
the IamC first to the payment of the co.t of the improvement before using any part of the total of the lame for
any other parpose.
The wocd "party" shaU be construed II if it read "parties" whenever the senae of this indenture 10 requlrea.
IN WITNESS WHEREOF, the party of the first part has duly c><ccuted thu doed the day and year first above
writteD.
IN n&U1fc:a: 07:
'IDWN OF SOUTHOLD, NEW YORK
BY:~~ &....~
Scott L. is, Supervisor
~
11436PG589
STATE OF NEW YORK, COUNTY OF SUFFOLK, ss.:
On the 11ILday of #4/C'~'" ,1992., before me personally came
BEVERLY J. HALLOCK, to me known, who, being by me duly sworn, did
depose and say that she resides at No. 18 South Street, Greenport,
New York 11944, that she is the president of the NORTH FORK
HOUSING ALLIANCE, the corporation described in and which executed
the foregoing isntrument; that she knows the seal of said
corporation; that the seal affixed to said instrument is such
corporate seal; that it was so affixed by order of the board of
directors of said corporation, and that she signed her name
thereto by like order.
a~~~~~~.
Notary Pu lic
ARLENE B. LOMBARDI
NoIarY Public. Stat. at New yQftL
No. 7587450
QuaIHIed in Suffolk county _ 1.
Commisslon Expires Sept 30. 19.sr'
'.
11436PL590
.,
ITllTl OF _ '1'-' ~ 01
On the day of
pel'lonally CIJDC
19
... ITATII 'OF _ '1'-' =-rY 01'
, bdore me Oa the clay of
pcl'lOl:l&llycame
19
, before IDII
10 m~ known 10 be th~ individual
executec.l the forqoing instrument,
executed the same.
descn1Jcd in and who
and acknowledged that
ITAn o. _ YOM. COUNTY 01' Suffolk ""
011 the II t\.. day of Oe,,"],~L fu(l\AJ... 19 9J/, bdore me
(lCl'sonaIly CUM! SCOTT L. HARRIS
to me known. who. being by me duly sworn, did depose and
sar that he resides at No. 53095 MAIN ROAD, SOUTHOLD.
NY 11971,
th:t he i. the
of THE TOWN OF
Supervisor
SOUTHOLD. NEW YORK
, the corporation dacnOed
in and whieh executed the foregoing instrument; that h.
knows the seal of laid corporalion: lhal Ihe seal affixed
10 said instrument is IUCh corporate seal; that it was .0
affixed by order of the board of directon of said corpora-
tWn, and 7'1 ~isG:e k~=r.
IMTTHEwCUlIEIlNAH
,.., ~ ....IINN VIllI
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euitdaim :mull
TITLE No.
TOWN OF SOUTHOLD, NEW YORK
1'0
NOETH FORK HOUSING ALLIANCE
SY....AIlD FOIM Of IIIW YO_II: .oAID O. TInt ~DI.wal""
IHn,i..fIfI .,
'fIlE 'fITLE GUA.RA.NTEE COftfPANY
II
...
10 me known 10 be the indiYidual dacn'bed in ud who
executed the forq:oiDg instrument. and acknowledged that
tlXl!CUled the SlIIIlC.
sTAn os _ YOM. COUNTY Of ...
On the day of 19 . bdore me
pcnona1Iy CIJDC
the subscnDing lritn... to the foregoing itIJtrument, with
w'- I am penonally orquainled. who, being by m. duly
sWOJ'n. did dopooe and lay that he resides at No.
that he know.
to be the individual
dclaibed in and who ex_led the foregoing instrument;
that he. said subleribing witaesl, w.. p.......m and saw
execute the tame; and that he. aid wilness.
at the oame time sublcnbed h DIIIIle U witn.... thereto.
lliCnON
BLOCK
LOT
COUNTY UI. TOWN
aceonlell &1 ....... .. TIle 'l'1I1e e......." ea.p.a,
UTU.". .Y',JlA1L TO:
P. EDWARD REALE
TWOMEY. LATHAM, SHEA & KELLEY
33 WEST SECOND STREET, PO BOX 398
RIVERHEAD. NY 11901
z;p No.
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TP-S84 (4/89)
New York Stale
t@;t'Departmentof
~ Taxalion
'.~' and Finance
New York State
Combined
Real Property Transfer Gains Tax Affidavit
Real Estate Transfer Tax Return
Credit Line Mortgage Certificate
For depertment u.. only
See Instructions (TP-S84-J) before completinq this form
Schedule A - Information Relatina to Convevance
Please print or type Name Social security number
(Transferor/grantor) TOWN OF SOUTHOLD I I I
""~3'095 MAl N ZIP code Federal emPIOrr ~en~fic~9 number
ROAD, SOUTHOLD, NEW YORK 11971
Name Social security number
(Transferee/grantee) NORTHFORK HOUSING ALLIANCE I I I
""~8"SOUTH STREET, GREEN PORT , ZIP code Fed1;' ~P~2i~7~"6'''' numbe,
NEW YORK 11944
Location and description of property conveyed
Tax map designation Address CityNillage Town County
1000-48-2-24 Flint Street Greenport Southold Suffolk
Type of property conveyed
(Check applicable box)
1 0 1 - 3 family house
2 0 Residential cooperative
3 0 Residential condominium
4 i:iI Vacant land .
SOOther
Date of conveyance
I 04
month
04
day
91
Percentage of real property
conveyed which is residential
real property %
Condition of conveyance (Check all that apply)
8. _ Conveyance of fee interest f.
b. _ Acq\Jisilion of a controlling interesl (state
percentage acquired %)
ye..
c. _ Transflfr of a controlling interest (state
percentage transferred
d. ....xConveyance to cooperative housing
corporation
e. _ Conveyance pursuant to or in lieu of
foreclosure (Attach Form TP-5S4.1, Schedul9 E)
%)
_ Conveyance which consists of a mere
change of identity or form of ownership or
organization
(Attach Form TP-584.1. Schedule F)
g. - Conveyance for which credit for tax
previously paid will be claimed
(Attach Form TP-S84.1. Schedule G)
h. _ Conveyance of air rights or development
rights
_ Contract assignment
j. _ Option assignment or surrender
i.
k. _ Leasehold assignment or surrender
I. _ leasehold grant
m. _ Conveyance of an easement
n. _ Conveyance for which exemption from
transfer tax is claimed. (Complete
Schedul. C, Part III)
o. _ Conveyance by gift
p. - Conveyance of property partly within and
partly without the state
q. _ Other (Describe)
Schedule B - Real Property Transfer Gains Tax Affidavit (Article 31-B of the Tax Law)
o Check this box if a Tentative Assessment and Return is being filed with respect to your current transfer, and proceed to Schedule C
without completing the following affidavit. Also, enter the assessment number shown on the Tentative Assessment:
I (we) certify that: (check appropriat8 box)
o The transfer of real property consists of the execution of a contract to sell real property without the use or occupancy of such property or the
granting of an option to purchase real property without the use or occupancy of such property.
2 0 The transfer is a transfer of real property where the consideration is less than $500.000 and which is neither (A) pursuant to a cooperative or
condominium plan. nor (B) a partial or successive transfer pursuant to an agreement or plan 10 effectuate by partial or Successive transfers a
transfer which would otherwise be included in the coverage of Article 31-8 of the Tax Law.
3 0 The transfer is a transfer of real property by tenants in common, joint tenants or tenants by the entirety where the aggregate consideration is
less than $500.000. (All such transferors must sign this form.)
4 [l The conveyance is not a transfer of real property within the meaning of section 1440.7 of Article 31-8 of the Tax Law. (Attach documents
supporting such claim. and sign on back as required.)
5 0 The transfer of real property consists of premises wholly occupied and used by the transferor exclusively as his residence, including a
cooperative apartment or condominium occupied by the transferor exclusively as a residence. (This exemption may only be claimed by an
individual, es~ate or trust.)
6 XJ The governmental entity (transferor) is the State of New York. or any of its agencies, instrumentalities, political subdivisions, or public
corporations, including a public corporation created pursuant to an agreement or compact with another state or Canada.
7 0 The governmental entity (transferor) is the United Nations or any other international organization of which the United States is a member, the
United States of America or any of its agencies or instrumentalities.
Schedule C -Real Estate Transfer Tax Return (Article 31 of the Tax Law)
Part I - Computation of Tax Due
1 Enter amount of consideration for conveyance. (If you are claiming a total exemption from tax. enter consideration
and proceed to Part III) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Continuing lien deduction (See instructions if property is taken subject to mortgage or lien) .
3 Taxable consideration (Subtract line 2 from line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Tax due: $2 for each $500, or fractional part thereof, of consideration on line 3. .
5 Amount of credit claimed (See instructions and attach Form TP-584.1. Schedule G).
6 Total tax due. (Subtract line 5 from line 4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part II - Computation of Additional Tax Due on the Conveyance of Residential Real Property for $1 Million or More
1 Enter amount of consideration for conveyance (same as amount in Part I, line 1) . . . . . . . . . . . . . . . . . . . . . . . . ~
2 Taxable c~nsideratjon (Multiply f;n~ 1 by the, percentage of the premises which is r~~id~:tial r~~/,~roP~7Y) (see instructions) 2
3 Total additional transfer tax due (1% of Ime 2) . . . . .. ................ .... " ._... ,.,._.'......,. . . . . . . . .. 3 -0-
..' .., -... ~ 1. ~:',.'v.t
* Please make check(s) payable to the county clerk where the recording is to take place or-'theJJepartment of Taxation and Finance if
payment is being made directly to the Tax Department. '._.....,._,....
For recording oNicer"s use Amount ...... Part I $ Date received
received ,.. Part II S
1 -0-
2 )
3
4
5 1
6
f~
'-=:~umba'
TP-584 (4/89) (back)
Schedule C - (continued)
Part III - Explanation 01 Exemption Claimed in Part I. line 1. (check any boxes that apply)
The conveyance of real property is exempt from the real estate transfer tax for the following reason:
a. Conveyance is to the United Nations. the United States of America. the State of New York or any of their instrumentalities,
agencies or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or
compact with another state or Canada) . . . . . . . . . . . . . . . . . . . . . . . . . . . a D
b. Conveyance is to secure a debt or other obligation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b 0
c. Conveyance is without additional consideration to confirm, correct. modify or supplement a prior conveyance. . . . . . . . . . . . . c 0
d. Conveyance of real property without consideration and otherwise than in connection with a sale, including conveyances conveying
realty as bona fide gilts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ _ . . . . . . . . d iii
e. Conveyance is given in connection with a tax sale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . eO
2 IX]
3 0
f. Conveyance is a mere change of identity or form of ownership or organization where there is no change in beneficial ownership.
(This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the
cooperative dwelling or dweilings.) . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . I 0
g. Conveyance consists of deed of partition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . gO
h. Conveyance is given pursuant to the federal bankruptcy act. . . . . . . . . . . . . . . . . . . . . . . . " ... h 0
i. Conveyance consists of the execution of a contract to sell real property without the use or occupancy of such property or the
granting of an option to purchase real property without the use or occupancy of such property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i 0
j. Conveyance of an option or contract to purchase real property with the use or occupancy of such property where the
consideration is less than $200.000 and such property was used safely by the grantor as his personal residence and consists of a
1, 2, or 3 family house. a residential individual condominium unit, or the sale of stock in a cooperative housing corporation in
connection with the grant or transfer of a proprietary leasehold covering an individual residential cooperative unit. . . . . . . .
k. Other (attach explanation) . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule 0 - Credit Line Mortgage Certificate (Article 11 of the Tax Law)
Complete the following only if the interest being transferred is a fee simple interest.
I (we) certify Ihat: (Check appropriate box)
o The real property being sold or transferred is not principally improved nor will it be improved by a one-to six-family owner-
occupied residence or dwelling.
The real property being sold or transferred is not subject to an outstanding credit line mortgage.
The real property being sold or transferred is subject to an outstanding credit line mortgage. However, an exemption from the tax
is claimed for the following reason:
o The transfer of real property is a transfer of a fee simple interest to a person or persons who held a fee simple interest in
the real property (whether as a joint tenant, a tenant in common or otherwise) immediately prior to the transfer;
n The transfer of real property is (A) to a person or persons related by blood, marriage or adoption to the original obligor or
:0 one or more of the original .'Jbligors or (B) to a person or entity where'a maJority of the beneficial interest in such real
;:>roperty after the transfer IS held by the transferor or such related person or persons;
C The ::ransfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee or other officer of a court:
...)0
...kO
"
~
Other (attach detalied explanation).
4" The real property being transferred is presently subject to an outstanding credit line mortgage, however, no tax is due for the
following reason:
o A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed; or
o A check has been drawn payable for transmission to the credit line mortgagee or his agent for the balance due and a
satisfaction of such mortgage will be recorded as soon as it is available.
5 0 The real property being transferred is SUbject to an outstanding credit Hne mortgage on record at
(insert liber and page or reel or other identification of the mortgage). The maximum principal amount expressed in the mortgage
is . No exemption from tax is claimed and the tax of is
being paid herewith. (Make check payable to county clerk where deed will be recorded.}
Signature and Affirmation (Both the transferor(s)/grantor(s) and transferee(s)/grantee(s) must sign).
The undersigned, being duly sworn, depose and say under penalty of perjury that the above return. including any affidavit, certification,
schedule or attachment. has been examined by the undersigned, and is. to the best of his/her knowledge, true and complete and made
in good faith pursuant to A cles 11, 31 nd 31-8 of the New York State Tax Law.
.
Tille
Transferee/grantee
Title
Scott L. Harris
Supervisor
Beverly J. Hallock
President
Town of SOllthold
Northfork Housing Alliance
Subscribed to and sworn before me
l~iS th Y day of April.. .19~.
\, ,c.<r...) C. K""A Vl""'1--
.
Slaf. of --HelV York ~L~Yaot
c:."~f Ik - ..&~county
County of _...u.u 0 (:!.),..,.miaion Expires MClfl.:h O. '90 County of
Reminder Oid rOu complC!te all of the required information in Schedules A and 8? Were you required to complete Schedules C and 01
If yuu checked ~. f and 9 in Schedule A, did you complete TP.S84.1? Have you attached your check(s) made payable to the
COLJllly clerk ",here recording will take place or the Department of Taxation and Finance if payment is being made directly to
the Tax Department? .
Subscribed 10 and sworn before me
this
day of
,19_.
State of
. TP-&'a4 (4189)
New York Slate
~~' Department of
lil , Taxation
"J and Finance
New York 'State
Combined
Real Property Transfer Gains Tax Affidavit
Real Estate Transfer Tax Return
Credit Line Mortgage Certificate
For deplll't"*" u.. only
See Instructions (TP.S84-IJ before completina this form
S hie
c edu e A - Information Relatino to onvevance
Please print or type Name Social security number
(Transferor/grantor) TOWN OF SOUTHOLD I I I
Address ZIP code Federal employer identilic800n number
53095 MAIN ROAD, SOUTHOLD, NEW YORK 11971
Name Social security number
(Transferee/grantee) NORTH FORK HOUSING ALLIANCE I I I
Address ZIP code Federat employer identification number
18 SOUTH STREET, GREENPORT, NEW YORK 1191111
Location and description of property conveyed
Tax map designation Address CityNillage Town County
1000-118-2-26 Flint Street Greenport Southold Suffolk
Type of property conveyed
(Check applicable box)
1 0 1 - 3 family house
2 0 Residential cooperative
3 0 Residential condominium
4 50 Vacant land
5 0 Other
Date of conveyance
I 011
day
month
Condition of conveyance (Check all that apply)
8. _ Conveyance of fee interest f.
b. _ AcquiSition of a controlling interest (state
percentage acquired %)
c. _ Transfm' of a controlling interest (state
percentage transferred
d. -XConveyance to cooperative housing
corporation
e. _ Conveyance pursuant to or in lieu of
foreclosure (AnBch Form TP.584.1, SchedufB E)
_ Conveyance which consists of a mere
change of identity or form of ownership or
organization
(Attach Form TP.S84.1, Schedule F)
g. _ Conveyance for which credit for lax
previously paid will be claimed
(Attach Form Tp.S84.1, Schedule G)
h. _ Conveyance of air rights or development
rights
_ Contract assignment
_ Option assignment or surrender
'AI)
i.
j.
011
191
YO"
Percentage 01 real property
conveyed which is residential
real property %
k. _ Leasehold assignment or surrender
l. _ Leasehold grant
m. _ Conveyance of an easement
n. _ Conveyance for which exemption from
transfer tax is claimed. (Complete
Schedule C. Part III)
o. _ Conveyance by gift
p. _ Conveyance of property partly within and
partly without the state
q. _ Other (Describe)
Schedule B - Real Property Transfer Gains Tax Affidavit (Article 31-B of the Tax Law)
o Check this box if a Tentati.... Assessment and Return Is being filed with respect to your current trlnsfer, and proceed to Schedule C
without completing the following affidavit. Also, enter the assessment number shown on the Tentative Assessment:
I (we) certify that: (check appropriate box)
o The transfer of real property consists of the execution of a contract 10 sell real property without the use or occupancy of such property or the
granting of an option to purchase real property without the use or occupancy of such property.
2 0 The transfer is a transfer of real property where the consideration is less than $500,000 and which is neither (A) pursuant to a cooperative or
condominium plan, nor (8) a partial or successive transler pursuant to an agreement or plan to effectuate by partial or successive transfers a
transfer which would otherwise be included in the coverage of Article 31-8 of the Tax Law.
3 0 The transfer is a transfer of real property by tenants in common, joint tenants or tenants by the entirety where the aggregate consideration is
less than $500.000. (All such transferors must sign this form.)
4 0 The conveyance is not a transfer of real property within the meaning of section 1440.7 of Article 31.8 of the Tax Law. (Attach documents
supporting such claim, and sign on back as required.)
5 0 The transfer of real property consists of premises wholly occupied and used by the transferor exclusively as his residence. including a
cooperative apartment or condominium occupied by the transferor exclusively as a residence. (This exemption may only be claimed by an
individual. estate or trust.)
6 GG The governmental entity (transferor) is the Slate of New York. or any of its agencies. instrumentalities. political subdivisions. or public
corporations. including a public corporation created pursuant to an agreement or compact with another state or Canada.
7 0 The governmental entity (transferor) is the United Nations or any other international organization of which the United Stales is a member. the
United States of America or any of its agencies or instrumentalities. .
Schedule C -Real Estate Transfer Tax Return (Article 31 of the Tax Law)
Part I . Computation of Tax Due
1 Enter amount of consideration for conveyance. (If you are claiming a totaf exemption from tax. enter consideration
and proceed to Part Ill) . . . . . . . . . . . . . . . . . . . _ . . . . . . . .
2 Continuing lien deduction (See instructions if property is taken subject to mortgage or fien) . . .
3 Taxable consideration (Subtract line 2 from fine 1) . . . . . . . . .
4 Tax due: $2 for each $500. or fractional part thereof, of consideration on line 3. .
5 Amount of credit claimed (See instructions and attach Form TP.584.1, Schedule G).
6 Total tax due* (Subtract line 5 from line 4). . . . . . . . .
Part II . Computation of Additional Tax Due on the Conveyance of Residential Real Property for $1 Million or More
1 Enter amount of consideration for conveyance (same as amount in Part I. line 1) . . . . . . . . . . . . . . . . . . . . . . . . [B ~
2 Taxable consideration IMultiply line 1 by the percemage of the premises which is resldentiat 'eat property) Isee instroc/ions) 2
3 Total additional transfer tax due* (1% of fine 2) . . . . .. .............................................. 3, -0- ,
. Please make check(s) payable to the county clerk where the recording is to take place or the Department of Taxation and Finance if
payment is being made directly to the Tax Department.
FOf recording officer's use Amount ... Part IS' Dale received [rransaclI_on__n_"_mbe_'
received ".. Part 11 S ,
1 -0-
2 I
3
4
5 J
6
Tp.584 (4189) (back)
Schedule C - (continued)
Part III . Explanation of Exemption Claimed in Part I, line 1. (check any boxes that apply)
The conveyance of real property is exempt from the real estate transfer tax for the following reason:
a. Conveyance is to the United Nations, the United States of America, the State of New York or any of their instrumentalities,
agencies or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or
compact with another stale or Canada) . . . . . . . . . . . . . . .. . . . a 0
b. Conveyance is to secure a debt or other obligation.. ............ ...................... .bD
c. Conveyance is without additional consideration to confirm, correct. modify or supplement a prior conveyance. . . . . . . . . . . . . c 0
d. Conveyance of real property without consideration and otherwise than in connection with a sale. including conveyances conveying
realty as bona fide gifts.... .......... ...... dIU
e. Conveyance is given in connection with a tax sale.. ................ ... eO
f. Conveyance is a mere change of identity or form of ownership or. organization where there is no change in beneficial ownership.
(This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the
cooperative dwelling or dwellings.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f 0
g. Conveyance consists of deed of panition. ............ ....... gO
h. Conveyance is given pursuant to the federal bankruptcy act. .......................... .... hO
i. Conveyance consists of the execution of a contract to sell real property without the use or occupancy of such property or the
granting of an option to purchase real propeny without the use or occupancy of such propeny. .... . . . . . . . . . . . . . . . . . . . . . . . i 0
j. Conveyance of an option or contract to purchase real property with the use or occupancy of such property where the
consideration is less than $200.000 and such property was used solely by the grantor as his personal residence and consists of a
1, 2, or 3 family house, a residential individual condominium unit, or the sale of stock in a cooperative housing corporation in
connection with the grant or transfer of a proprietary leasehold covering an individual residential cooperative unit. . . . . . . . . . J 0
k. Other (attach explanationl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k 0
Schedule D . Credit Line Mortgage Certificate (Article 11 of the Tax Law)
Complete the following only If the Interest being transferred Is a lee simple Interest.
I (we) cenify that: (Check appropriate box)
1 0 The real property being sold or transferred is not principally improved nor will it be improved by a on9-to six-family owner-
occupied residence or dwelling.
The real property being sold or transferred is not subject to an outstanding credit line mortgage.
The real property being sold or transferred is subject to an outstanding credit line mortgage. However, an exemption from the tax
is claimed for the following reason:
o The transfer of real property is a transfer of a fee simple interest to a person or persons who held a fee simple interest in
the real property (whether as a joint tenant, a tenant in common or otherwise) immediately prior to the transfer;
n The transfer of real property is (A) to a person or persons related by blood. marriage or adoPtion to the original obligor or
to one or more of the original .')bligors or (B) to a person or entIty where a majority of tho beneficial interest in such real
;>roperty after the transfer is held by the transferor or such related person or persons;
C The ~ransfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee or other officer of a court;
2 KJ
3 0
C Other (attach detailed expianation).
4"" The real property being transferred is presently subject to an outstanding credit line mortgage, however. no tax is due for the
following reason:
o A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed: or
o A check has been drawn payable for transmission to the credit line mortgagee or his agent for the balance due and a
satisfaction at such mortgage will be recorded as soon as it is available.
5 0 The real property being transferred is subject to an outstanding credit line mortgage on record at
(insen Jiber and page or reel or other identification of the mongage). The maximum principal amount expressed in the mongage
is . No exemption from tax is claimed and the tax of is
being paid herewith. (Make check payable to county clerk where deed will be recorded.)
Signature and Affirmation (Both the transferor(s)/grantor(s) and transferee(s)/grantee(s) must sign).
The undersigned, being duly sworn, depose and say under penalty of perjury that the above return, including any affidavit, certification,
schedule or attachment. has been examined by the undersigned. and is, to the best of hislher knowledge. true and complete and made
in good faith pursua to Articies 11, 31 and 31.8 of the New York State Tax Law.
Title
Transfereelgrantee
Title
Scott L. Harris
Supervisor
Beverly J. Hallock
Nortfork Housing Alliance
President
Town of Southold
Subscribed 10 and sworn before me
Subscribed 10 and sworn belore me
t4~~aY~ (;,il
. 19 91
i!-
\!?.'\~.
.
this
day of
.19_.
Slate 01 -blew Ynr"k MA1"'THEWG. KIERNAN Slate of
NCJFARY~~_Yadl
County o,__Suffolk ClueUfledln.......Countv County 01
- c." 1.................'_
Reminder Did yOU compl~te all of the required information in Schedules A and B1 Were you required to complete Schedules C and 01
If yuu checked _. 1 and g in Schedule A, did you complete TP.584.1? Have you allached your check(s) made peysble to the
cOUllly clerk where recording will take place or the Department of Taxation and Finance if payment is being made directly to
the Tax D~parlment?