HomeMy WebLinkAbout1000-74.-1-42HENRY E. RAYNOR, Jr., Chairman
JAMES WALL
BENNETT ORLOWSI~, Jr.
GEORGE RITCHIE LATHAM, Jr.
WILUAM F. MULLEN, Jr.
Southold, N.Y. 11971
December 2, 1982
TELEPHONE
765-1938
Mr. William Wickham
Wickham, wickham & Bressler
P.O. Box 1424
Mattituck, New York 11952
Re: John Simon Estate
Set-Off
Dear Mr. Wickham:
The following action was taken by the Southold Town Planning Board,
Monday, November 30, 1982.
RESOLVED that the Southold Town Planning Board approve a set-off
(106-13) as designated on the map of John Simon Estate, dated July 30,
1982, located at Peconic, subject to the filing of covenants and
restrictions stating no further subdivision will be made on the lot
designated as lot #1 in the future.
Upon receipt of four (4) copies of the above mentioned map and a
copy of the filed covenants and restrictions stating no further sub-
division will be made, the Chairman will endorse approval.
Very truly yours,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Susan E. Long, Secretary
)ist.
~ 0 O0
~c.
~73.00
~.0o
ot
01. 000
DECIARATI_C1N OF C015ENANSS
AND RESTRICTIONS
THIS INDENTURE mede this 12th day of October , 1982, by
ARTHUR P. SI512N, SARAH JEAN~ri'E SimON, ~qANCES E. SIWON and LECNE HAYES,
all residing at (no #) North Road, Peconic, Suffolk County, I.~w York and. '.
MARE ~AUSCHFR, residing at 97-09 72nd Erive, Forest Hills, New York.
~H~]~AS, Decl~rants are owners of a homestead parcel of land situate
at Pecc~ic, ~bwn of Southold, Suffolk County, Ne~ York, being part of the
premises designated on the Suffolk County Tax Map as District 1000,
Section 073.00, Block 03.00 and Lot 001.000 and further described as
follows:
ALL that certain plot, piece or parcel of land with the buildings
and i~provem~ts thereon erected, situate, lying and being at
Peoonic, Town of Southold, County of Suffolk and State of New
York, bounded and described as follows:
BEG/NNING at a point on the northerly line of M~ddle Road (C.R.27)
at the southeast corner of the ~remi~es herein described adjoining
land of the ~tate of Charles Simon cn the East from said point
of b~ginning; furring thence along the northerly line of
Road (C.R. 27) the following t~o (2) courses and distances:
(1) South 68° 04' 00" West, 20.0 feet; thence (2) South 69° 17'
50" West, 20.22 feet; running thence along other land of the John
Simcn ~tate the following ~chree (3) courses and distances: (1)
North 29° 12' West, 315.78 feet; thence (2) North 60° 48' Fast,
274.74 feet; thence (3) South 26° 28' 20" East, 138.56 feet to
said land of the Estate of Charles Simon; running thence along
said land the following Bo (2) courses ~nd distascas;~ (1) South
68° 11' West, 40.07 feet; thence (2) South 26° 25' 20" East,
211.45 feet to the point or place of BEGINNING.
WHEREAS, Declarants ha%m applied to the Planning Board of the ~
of Southold for approval of a set-off for the premises.
NCW, THF~RE~O~E, the Declarants heret~y ~ ~mmpcse the follewing Covenants
said premises which shall rm with the land:
1) Said p~emises shall not be further subdivided
without the approval of th~ Southold T~wn
Plan~ing Board.
~ WI~/~%~q WHE~OF, this indenture has been executed the day and
year first above written.
S~TE OF NE~ YOP~<)
COLNTf OF SUFFOLK) ss:
Arthur p. Sim~
Sarah Jeanette Sinon
, 1982, before me personally cam~
ARSHUR P. S/_~fl~, SAR~q JEANE'i'i'E S~N, ~RANCES E. S/~2N and LEf/~E HAYS,
to me known to be the individuals described in and who executed the fore-
going instrument, and acknowledged that they executed the same.
Notar~ Public
ANNA-MAE E-VANS
S~ATE OF N~4~YORK) SS:
COU~f
OF
day of ~-~, 1982,-- before me personally came
the
~4AR~ DAUSC~ER, to me kncwn to be the indiv/dual described in and who
execu%ed th~ foregoing instrument, and acknowledged that s~e ¢×ecuted the
~ / z~otary Public
30SE~M T.
i',;cta y ?ub!ic - State of New Yorl~
No. (4'--249,-400) Queens Count~
Term expires March 31 19 o
DECLARATIC~ ~OF (I)V~NANTS
AND ~ESTRICTIf~S
n~de
AR~TJR P. SIM2N
SARAH JEANg'i'LE SIMiN
FRANf~S E. SIMON
October , ]982
WICKHAM, WICKHAM & BRESSLER, P.C.
MAIN ROAD
MA'I'TITUCK, LONG ISLAND
NEW YORK !1952
John Simon Estate located at Peconic
AS per Royal R. Reynolds, the following actions transpired
between the Suffolk County Department of Health Services (SCDOHS)
and the applicant, for the above mentioned subdivision.
applicant submitted maps November 11, 1982 to the SCDOHS
SCDOHS sent letter t~ ~pplicant in November 1982 stating
they required a test ~_11 and hole.
applicant notified SCDOHS in May 1983 that the well was in
SCDOHS made a field inspection and noted problems with high
levels of nitrates and pesticides
SCDOHS sent a rejection letter to the applicant in June 1983
and there has been no response from the applicant to date
Hodor/Staller; East Marion Woods~ located at East Marion
As per Royal R. Renolds, the following actions transpired
between the Suffolk County Department of Health Services (SCDOHS)
and the applicant, for the above mentioned subdivision.
applicant submitted maps in January 1981
SCDOHS did work for applicant such as location of test wells and
holes in February 1981
actual application to SCDOHS submitted July 1983
SCDOHS approved application August 1983
/
'! APPLICATI~ FOR APPROVAL OF PLAT
To tile Planning Board of the Town of Southold:
The undersigned applicant hereby applies /or Itentative) (final) approval (~i a subdivision plat
accordance witl~ Article 16 of the Town Law and the Rules and Regulations of the Sonthold Town
Pianning Board. and represents and states as follows:
1. The applicant is the owner of record oi the land under application. (If the applicant is not thc
owner of record oi the land Under application, the applicant shall state his interest in said
land under application.)
2. The name of the sub,vision is to be . .~L~0f~ ~O~.J~ .$~h .~.p~..~..
$~ng ~ ~q~ A-106-13
3. The entire land under application is described in Schedule "A" hereto annexed. (Copy of
deed suggested.)
4. The land is held by the applicant under deeds recorded in Suffolk County Clerk's office as
follows:
Liber ........................ Page ...................... On ........................ ;
Liber ........................ Page ...................... On ........................ ;
Liber ........................ Page ...................... On ........................ ;
Liber ........................ Page ...................... On ........................ ;
Liber ........................ Page ...................... On ........................ :
as devised under the ~st Will and Testament of . ..J~ .Si~.~e~.,~.~p~.~ .~8,
~ ~37,. me. ~v~. ~. ~?~. ~,.. ~732 .~. ~. ~ ~.~...
........ ~s~ .~. Z~. 1962,..~a &et~..~t~ Xep~. 5,..l~ ~2 .......................
5. The area of the land is ~75. ~..~..~.
6. Ail t&xes which are liens on the land at the date hereof have been paid.~ ..........
7. The land is encumbered by N0
mortgage. ~: ..............................................................
(a) Mortgage recorded in Liber ............ Page .................... in original amount
of $ ................ unpaid amount $ ................ held by ..........................
.......................... address ......................................................
(b) Mortgage recorded in Liber ............ Page .................... in original amount
of $ ................ unpaid amount $ ................ held by ...........................
.......................... address .................. j ...................................
(C) ~fr.~r:~a~{ recorded in '[.;her ............ P:~,c .................... ;~ or[.~i.M amoun:
of S ................ unpMd ~I:,M ~ ............... ],cid h, .... I ...................
.......................... address ......................................................
S. There are no oti~er encumhrances or liens a~ainst ihe tand.~ ........................
9. Ti~c land lies in the following zoning nsc distr~cts ...... aT~fl~.~~...
.................... i .... L..2 ................. i .................................. : .......
I0. No part oi the land lies under water whether t;de water, stream, pond water or otherwise, ~
11. The applicant shall at his expense install all required public improvements.
12_ The land ~ (does not) lie in a ~Va~er District or ~ater Supply Dist~ct. Name of Dis-
trict, ii within a District, is ..............................................................
13. Water mains will be Iald by ...O~& .......................................................
and (a) {no) charffe will be made for installing said mains.
14_ Electric lines and standards will be installed by . .~. ............................
.................................... and ~ (no) charge ix-ill be made ~or installing said
lines.
13.
16.
17.
18.
· 19.
20.
Gas mains will be installed by n/a '
and (a) (no) charge will be made for installing said mains.
Ii streets shown on the plat are claimed by the applicant to be existing public streets in the
Snffolk County Highway system, annex Schedule "B" hereto, to show same.
If streets shown on'the plat are claimed by the applicant to be existing public streets in the
Town o£ Southold Highway system, annex Schedule "C" hereto to shiny same.
There .are nO existing buildings or structures on the land which are not located and shown
on the plat.
Where the plat shows proposed streets which are extensions of streets on adioining sub-
division maps heretofore filed, there are ho.reserve strips at the end of the streets on said
existing maps at their conjunctions with .the proposed streets.
In the course of these proceedings, the applicant will offer proof ~f title as required .by Sec.
335 ot: the Real Property Laxv.
Submit a copy, of pro3osed deed for lots showing all restrictions, covenants, etc. Annex
Schedule "D". -. '
22. Thc applicant estimates that oi grafting- aml required public ]lll~provements will hc
$ .......... as itemized in Schedule "E" hereto annexed and requests that the matur ty of
tile Per[ormance Bond be fixed at ............ years. The Periormance Bond will be written
by a licensed surety compan3 unless otherwise shown on Schedule "F".
DATE
(Name of Applicant)
(Signature and Title)
(Address)
STATE OF NEW YORK, COUNTY OF ....... .C!t.E..I'~J.R.G .................... ss:
Ou the ....... 21ll;h ...... day of ..... .!v/AZ ............... , 19.82..., before me personally came
...... &E~r. hC!r..E., .Si.ra~ .................... to me known to be the indi~iidttal described in and wh,.
executed the foregoing' instrument, and ackuowledged that .... .HE. ....... executed the same.
MARY ,EI'H M,IgCHIN .~. ~_~/ ~ ~
Notary Public. Stot~ of New YorJt
No. 4659066 Chem~ng Counlr¥ '
Commission E~pires March 30, i~ ~ .,Notary ~dic,
STATE OF NEW YORK, COUNT~ OF .................................. ss:
On the .................. clay .............. of .......... , 19 ...... , before me personally came
................................................ to me known, who being by me duly sworn did de-
pose and say that ............ resides at No .....................................................
................................................ that .......................... is the ..........
the corporation described in and which executed the foregoing instrument; that ............ knows
the seal o~ said corporation; that the seal affixed by order of_ the board of directors of said corpor-
ation, and that ............ signed ............ name thereto by llke order.
Notary Public
APPLICATION FOR SET-OFF
Arthur P. Simon
Middle Road- Pec~nic, N.Y.
ALL that certain plot, piece or parcel of land with the buildings and improve-
ments thereon erected, situate, lying and being at Peccmic, Tcwn of Southold,
Go~nty of Suffolk and State of New York, bonded and described as follows:
BEG~X~ING at a point cn the northerly line of Middle Road (C.R. 27) at
the southeast corner of the premises herein described adjoining land of the
Estate of Charles Sin~n ~n the East. from said point of beginning;
RL~N/NG THENCE alcng the northerly line of Middle Road (C.R. 27) the
follcwing t~o (2) courses and distances:
(1) Sou~]n 68° 04' 00" West, 200 feet; thence
(2) South 69° 17' 50" Wear, 20.22 feet;
RL~NING 5H~NCE along other land of the John Simc~ Estate the following
three (3) courses and distances:
(1) North 29° 12' West, 315.78 feet; thence
(2) Nozth 60° 48' East 274.74 feet; thence
(3) Sound% 26° 28' 20" F~st, 138.56 feet to said /and of the Estate
of fharlea S~;
RENNING TH~CE alcng said land the following ~o (2) courses and distances
(1) South 68° 11' West, 40.07 feet; thence
(2) Sout~h 26° 25' 20" East, 211.45 feet to the point or place of
BI,GINNING
APPLICATION FOR SET-OFF
Az'thur P. Simcn
M~ddle Road- Peccnic, N.Y.
ALL that certain plot, piece or parcel of land with the b~ldings and improve-
ments thereon erected, situate, lying and beJ~g at Pecceic, Tc~n of Sout]~old,
go%mty of Suffolk and State of New York, bounded and described as follcws:
BEGINNING at a point un the northerly line of ~{iddle Road (C.R. 27) at
the southeast corner of the premises herein described adjoining land of the
~state of Charles Simcn on the East. from said point of beginning;
RL~]iqG THZNCE alung the northerly line of Middle Road (C.R. 27) the
following ~o (2) courses and distances:
(1) Sour]% 68° 04' 00~ West, 200 feet; thence
(2) South 69° 17' 50" West, 20.22 feet;
RUNNING ~H~NCE alc~g other land of the John Sin~n Estate the following
three (3) courses and distances:
(1) North 29° 12' West, 315.78 feet; thence
(2) Nozth 60° 48' F~st 274.74 feet; t~ence
(3) South 26° 28' 20" E~st, 138.56 feet to said land of the Estate
of fharles Sinm~;
RL~NING TH~/qCE alceg said land the following ~o (2) courses ~d distances
(1) South 68° 11' West, 40.07 feet; thence
(2) Sou~ 26° 25' 20" East, 211.45 feet to the point or place of
BEG~qNING
WICKHAM~ WICKHAM & BRESSLER, P.c.
MAIN ~OAD~ P,O. BOX 1424
MATTITUCK LONG ISLAND
NEW YORK 11952
5L6 -298-8353
AugUSt 2, 1982
AUG5
REC'O
Southold Town Planning Board
Town Hall
Main Road
Southold, NY 11971
Re: John Simon Estate
C~n tlemsn:
In accordance with your letter of J~e 9, I enclose six copies for a set-
off for the residence property.
I regret very much that these were not included in my letter of May 24.
My notes, hcwever, on the conference at your office on 5~y 4 indicate that,
in the first instance at least, the copies you have in the office would
suffice.
Very c~ially ~ours,
WW:l~
Sarah (¢ June 14,
1/3
JOHN AND SARAH SI~{ON ESTATES
John Simon (d) September 28, 1937
1962
Charlie (d) April 15, 1956 ~4ar¥ Leone Frances Sarah
Arthur
(Arthur conveyed out
by deed dated 12/19/64)
Arthur
Elizabeth John Robert
1/3 1/6 1/6
1/~ 1/9 1/9 1/9 1/9
1/15 1/15 1/15 1/15 1/15
Elizabeth
Virginia
1/6 1/6
1/27 1/54 1/54 1/54 1/54
HENRY E. RAYNOR. Jr.. Chairing.,
JAMES WALL
BENNETT ORLOWSKI, ,Ir.
GEORGE RITCHIE LATHAM. Jr.
William F. Mullen, Jr.
TELEPHONE
765- 1938
June 9, 1982
Mr. William Wickham
Wickham, Wickham & Bressler
P.O. Box 1424
Mattituck, Long Island NY 11952
Re: John Simon Estate
Dear Mr. Wickham:
We are in receipt of your application for a set-off for the
above captioned property. Unfortunately, the maps submitted
prior to this request do not reflect a set-off of land.
The lots numbered one, two, and three should be removed from
the map, and that parcel which is being set-off should be
designated as such.
Please submit six (6) copies of the amended map to this office
and we will place it on our agenda for the next available
meeting.
If you have any questions concerning the above revisions, please
do not hesitate to contact this office.
Yours very truly,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Susan E. Long, Secretary
pg. (9)
8/30/82
Mr. Raynor: Part of public record, sure.
Mr. Tashkin: Thank you.
Mr. Raynor: Is there anyone else present this evening that ~s some-
thing nice they would like to say about the subdivision? (Negative)
Is there anyone present this evening that has some information that
should come before this board that may be neither pro nor con with
regard to the subject but would help this board in making a determination?
(Negative) Hearing none, Mr. Orlowski do you have any questions?
(Negative) Mr. Latham? (Negative) Mr. Mullen? (Negative) Alright,
there being no further questions then we will deem this hearing closed
and thank everybody for coming down.
Nalbantian Brothers - William Salahian, Esq., Charles Nalbantian and
Howard Yound met with the board to discuss this proposed major subdiv-
ision. Mr. Raynor stated the property contained many large trees that
somehow survived the 1938 hurricane and stated the board would like
them retained on site. The board also noted no allowance for park and
playground area within this subdivision. Mr. Raynor stated the ap-
plicant has the option of designating 5% of the total area or the Town
will accept money in lieu of park and playground area. The board re-
quested revisions on the configuration of the rear lot lines. Mr.
Sulahian and the applicant stated they would work with the Town in re-
taining the trees to satisfaction of the board and at a later date
would submit alternate plans of the site for Planning Board review.
The applicant stated his agreement to have covenants placed on the
property to protect the trees.
ohn Simon Estate - Ms. Abigail Wickham, Esq. was requested to inf
~--~..W~m~a'm, attorney for the applicant, to revise the maps to
designate lot number one and lot number two for this proposed set-off
and to supply the board with a voluntary covenant stating no further
~bdivision will be made in th~ future on lot number one.
Richard J. Cron - Mr. Richard Cron, Esq. met with the board to discuss
this minor subdivision located near East Marion. Mr. Cron stated there
was no fee title on the designated right-of-way; the right-of-way is
to provide access to the utilities and to lots one and four. It was
the concensus of the board to field inspect this property prior to the
next Planning Board meeting.
HENRY E. RAYNOR. Jr., Chairman
JAMES WALL
BENNETT ORLOWSKI, Jr.
GEORGE RITCHIE LATHAM. Jr.
William F. Mullen,
Jr.
Southold, N.Y. 11971
TELEPHONE
765-19~
April 14, 1982
Mr. William Wickham
Wickham, Wickham, & Bressler
P.O. Box 1424
Mattituck, New York 11952
Re: John Simon Estate
Dear Mr. Wickham:
After a review of the above captioned maps, it was noted the
proposal consists of six parcels which, therefore, would re-
quire the filing for a major subdivision.
Kindly advise this office on how you wish to proceed with
this proposal. If you would like to discuss this matter with
me, please contact my secretary for an appointment date.
Yours very truly,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Susan E. Long, Secretary
WICKHAM, WICKHAM ~ BRESSLER, P.C.
MAI N rOAD, P.O. BOX 1424
MATT~TUCK LONG ISLAND
NEW YORK II95~
May 24, 1982
Southold Town Planning Board
Main Road
Southold, NY 11971
Re: John sinDn Estate
Gentl~m~n:
I enclose application for a set-off for the residence property on Middle
Road, Pecenic.
You have the surveys in your office in connection with the application
minor subdivision dated March 27, 1982, which is her~ith withdrawn.
WW:ljw
WICKHAM~ WICKHAM & BRESSLER, P,C.
MAIN ROAD, P.O, BOX 1424
mAttlTUCK LONG ISLAND
NEW YORK 119S2
516-298-8353
October 20~ 1982
OOT 2J,
Southold Town Planning Board
Main R~ad
Southold, NY 11971
Re: Simon Homestead Set-Off
Gentlemen:
I am enclosing a copy of the Declaration of Covenants and Restrictions
in accordance with your requirements. The original is being recorded in the
Suffolk Co~ty Clerk's Office. f~ its return, I will forward you a xerox
copy sh~wing recording informatice.
Very cc~ial.ly yours,
William Wickham
W~:ljw
Enc.
APPLICATION FOR APPROVAL OF PLAT
To the Planning Board of the Tmvn of Southold:
The undersigned applicant hereby applies for {tentative) (final) approval (Jr a subdivision plat
in accordance with Article 16 of the To~vn Law and the Rules and Regulations c*f the Southold Toxvn
Planning Board, and represents and states as foiloxvs:
1. The applicant is the owner of record of the land under application. (If the applicant is not the
owner of record of the land under application, the applicant shall state his interest in said
land under application.)
2. The name of the subdivision is to be . .$o.t-r0ff..fOr. Jchrl .$iI%o. rl ./~.t~'c~.pD~.s. uajg...t...to....
........ .Z .q:x~.' .n.g...Cc2~... S..eg.tci.'..(~...AT 10 6-13
3. The entire land under application is described in Schedule "A" hereto annexed. (Copy of
deed suggested.)
4. The land is held by the applicant under deeds recorded in Suffolk County Clerk's office as
follows:
Liber ........................ Page ...................... On .............
Liber ........................ Page ...................... On ........................ ;
Liber ........................ Page ...................... On ......................... ·
Liber ........................ Page ...................... On ........................ ;
Liber ........................ Page ...................... On ........................ :
as devised under the Last Will and Testament of . ..Johtx.Silrc~.de~q~¢t. $.e. pt.o.4fl%e.r..2.8,
~ ~9.37,.~e.l~.t.t~....d.a.t.~.Q2.t~...e~.. 8~ 1937 and Sarah J. Simon,
........ daceas~d .May. 2 ~. 196~ .the. l~tt~r~..darnel ~epke~qe~. ~..19. ~... ....................
5. The area of the land is 2~¢5. scl..ft .........
6. All taxes which are liens on the land at the date hereof have been paid.~ ..........
7. The land is encumbered by NO
mortgage. (~)=:a~lt~a~: ..............................................................
(a) Mortgage recorded in Liber ............ Page .................... in original amount
of $ ................ unpaid amount $ ................ held by ..........................
.......................... address ......................................................
(b) Mortgage recorded in Liber ............ Page .................... in original amount
of $ ................ unpaid amount $ ................ held by ...........................
.......................... address .................. : ...................................
(c) -~ort.tage recorded in I.i ............ Pa.,..,e ................ in ori.~i~ml amonnt
of S ................ unpaid ~-mount S ......... held ~t
.......................... address
8. There are no other encumbrances or liens against lhe land.~ ........................
9_ Ti;e land ties in the following zoning ust- distric{s ...... ~.-Pxe~j.c]o,.15.'c~.'_~.]...~:~'..~.o~1~.~...~.~...
......................... ~..i ................. i .................................. : .......
10. No part of the land lies under water whether tide water, stream, pond water or otherwise, t~
1 I. The applicant shall at his expense install all reqnired public improvements.
12. The land (dc_~) (does not) lie in a Water District or Wrater Supply District. Name of Dis-
trict, ii within a District, is ..............................................................
15. \Vater mains will be laid by ...~./'ill .....
and (a) (no) charge will be made for installing said mains_
14. Electric lines and standards will be installed by ..ap~.l±cant
.................................... and ~=) (no) charge ix'ill be made for installing said
lines.
15. Gas mains xvill be installed by .n/a.
and (a) (no) charge will be made for installing said mains.
16. If streets shown on the plat are claimed by the applicant to be existing public streets in the
Suffolk County Highway system, annex Schedule "B" hereto, to show same.
17. ti streets shown on'the plat are claimed by the applicant to be existing public streets in the
Town of Southold Highway system, annex Schedule "C" hereto to shoxv same.
15. There .are n6 existing buildings or structures on the land which are not located and shown
on the plat.
19. \Vhere the plat shows proposed streets which are extensions of streets on adjoining sub-
division maps bereto£ore filed, there are no .reserve strips at the end of the streets on said
existing maps at their conjunctions witb .the proposed Streets
20. In the course of these proceedings, the applicant will offer proof ~)f title as required by Sec.
335 of the Real Property Law.
21. Submit a copy. of pro3osed deed for lots showing all restrictions, covenants, etc. Annex
Schedule "D". -.
22. Thc applicant estimates that the cost of grading and required public ir.~provements will be
$ .......... as itemized in Schednle "E" hereto annexed and requests that the maturity of
the Performance Bond be fixed at ............ years. The Performance Bond will be written
by a licensed surety company unless otI~erwise shown on Schedule "F".
DATE ........ I'IAX .20,..1.~82 .........
(Name of Applicant)
(Signature and Title)
.....
(Address)
STATE OF NEW YORK, COUNTY OF ....... .C.H~.I~.IJ.I'(G .................... ss:
On the ....... 20.t,h ...... day of ..... .lqlY ............... , 19.82..., before me personally came
...... Alrthtlr. ~., .S~ .................... to me koown to be the individual described in and who
executed the foregoing instrument, and acknowl~dged that .... .H.E. ....... executed the same.
MARY BETH MI.CH'N ~,~.. ~~. ;..~...~
Notary Public, Stc~to ~,f New Yor~
No, 4659066 Chempng County . ~...~,ic) "
Commission Expires March 30, 19 ~ ~otary'
STATE OF NEW YORK, COUNTY OF .................................. ss:
On the .................. (5ay .............. of .......... , 19 ...... , before me personally came
................................................ to me known, who being by me duly sworn did de-
pose and say that ............ resides at No .....................................................
................................................ that .......................... is the ..........
................ of
the corporation described in and which executed the foregoing instrument; that ............ knows
the seal of said corporation; that the seal affLxed by order of the board of directors of said corpor-
ation, and that ............ signed ............ name thereto by like order.
Xotary ....... ']3~ii~ ...................................
-no ~
/
/
RECEIVED BY
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