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Home My WebLink AboutDeer Run MARTIN D. FINNEGAN TOWN ATTORNEY martin.finnegan@town.southold.ny.us JENNIFER ANDALORO ASSISTANT TOWN ATTORNEY j ennifer.andaloro@town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hulse@town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 To: From: Date: Subject: OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD MEMORANDUM Ms. Elizabeth A. Neville, Town Clerk Lynne Krauza Secretary to the Town Attorney May 19, 2010 Zoumas at Deer Run/Dedication For your records, I am enclosing the original, recorded Bargain & Sale Deed and Dedication and Release documents in connection with the referenced matter. I am also enclosing a copy of the resolution authorizing this dedication. If you have any questions, please do not hesitate to call me. Thank you for your attention. Ilk Enclosures IIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEED N~m~er of Pages: 4 Receipt N~m~er : 10-0041534 TRANS~'~'.R TAX NUMBER: 09-20495 District: 1000 Deed Amount: Section: Block: 079.00 04.00 EXAMINED AND CHARGED AS FOLLOWS $0.00 Recorded: At: LIBER: PAGE: Lot: Received the Following Fees For Above Instrument Exempt Page/Filing $20.00 NO Handling COE $5.00 NO NYS SRCHG EA-CTY $5.00 NO EA-STATE TP-584 $5.00 NO Notation Cert. Copies $5.00 NO RPT Transfer tax $0.00 NO Comm. Pres Fees Paid TRANSFER TAX NUMBER: 09-20495 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL J~JDITH A. PASCALE County Clerk, Suffolk County 04/08/2010 10:33:58 ~ D00012621 368 017.023 Exempt $20.00 NO $15.00 NO $250.00 NO $0.00 NO $30.00 NO $0.00 NO $355.00 Number of pages ~ This document will be public record. Please remove all Social Security Numbers prior to recording. Deed / Mortgage Instrument Deed / Mortgage Tax Stamp RECOF.:DED 20i0 ~pr O:S~ ~0:33:58 · )'UDiTH R. Pizt'_:;CFtLE CLERK OF SUFFOLK C:OUHT? L D000i2~,2 ~ F' 369 [>'T~ 09-2049.'5 Recording / Filing Stamps 31 Page / Filing Fee Handling TP-S84 Notation EA-52 17 (County) EA-5217 (State) R.P.T.S.A. Comm. of Ed. 20. O0 5. 00 FEES Sub Total Mortgage Amt. 1. Basic Tax 2. Additional Tax Sub Total Spec./Assit. or Spec./Add. TOT. MTG. TAX Dual Town __ Dual County __ Held for Appoint~..~t. Transfer Tax (,~ Mansion Tax The property covered by this mortgage is or will be improved by a one or two NYS Surcharge Other 41c Real P Tax Se Age Verifi( 1S. O0 familydwelling only. SubTotal /~ ~-,-/ YES or NO GrandTotal (,~/~(~"-~ ( \~'l/If NO, see appropriate tax clause on -- U I page# oft~instru/nent. . I 10007224 1000 07goo 0400 017023 $ I CommunityPreservationFund Consideration Amount I ,~, CPF Tax Due $ 8 Satisfactions/Discharges/Releases List Property Owners Mailing Address RECORD & RETURN TO: MARTIN D FINNEGAN ESQ TOWN ATTORNEY; TOWN OF SOUTHOLD PO BOX 1179 SOUTHOLDNY 11971 Mail to: Judith A. Pascale, Suffolk County Clerk 310 Center Drive, Riverhead, NY 11901 www.suffolkcou ntyny.gov/clerk Improved__ TD /L~/ TD TD 71 Title Company Information Co. Name I Title # Suffolk County Recording & Endorsement Page made This page forms part of the attached BARGAIN & SALE DEED by: (SPECIFY TYPE OF INSTRUMENT) ZOUMAS CONTRACTING CORP. AND FREEFROM BUILDING PARTNERS LLC The premises herein is situated in SUFFOLK COUNTY, NEW YORK. TO In theTOWN of SOUTHOLD TOWN OF SOUTHOLD In the VILLAGE or HAMLETof SOUTHOLD BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. (over) IMPORTANT NOTICE If the document you've just recorded is your SATISFACTION OF MORTGAGE, please be aware of the following: If a portion of your monthly mortgage payment included your property taxes, *you will now need to contact your local Town T ax Receiver so that you may be billed dir ectl¥ for all future property tax statements. Local property taxes are payable twice a year: on or before January lO,h and on or before May 31,,. Failure to make payments in a timely fashion could result in a penalty. Please contact your local Town Tax Receiver with any questions regarding property tax payment. Babylon Town Receiver of Taxes 200 East Sunrise Highway North Lindenhurst, N.Y. 11757 (631) 957-3004 Riverhead Town Receiver of Taxes 200 Howell Avenue Riverhead, N.Y. 11901 (631) 727-3200 Brookhaven Town Receiver of Taxes One Independence Hill Farmingville, N.Y. 11738 (631 ) 451-9009 Shelter Island Town Receiver of Taxes Shelter Island Town Hall Shelter Island, N.Y. 11964 (631) 749-3338 East Hampton Town Receiver of Taxes 300 Pantigo Place East Hampton, N.Y. 11937 (631) 324-2770 Smithtown Town Receiver of Taxes 99 West Main Street Smithtown, N.Y. 11787 (631 ) 360-7610 Huntington Town Receiver of Taxes 100 Main Street Huntington, N.Y. 11743 (631) 351-3217 Southampton Town Receiver of Taxes 116 Hampton Road Southampton, N.Y. 11968 (631) 283-6514 Islip Town Receiver of Taxes 40 Nassau Avenue Islip, N.Y. 11751 (631) 224-5580 Southold Town Receiver of Taxes 5309S Main Street Southold, N.Y. 11971 (631) 765-1803 dw 2/99 Sincerely, Judith A. Pascale Suffolk County Clerk BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S ACTS (INDIVIDUAL OR CORPORATION) STANDARD NYBTU FORM 8007 CAUTION: THIS AGREEMENT SHOULD BE PREPARED BY AN ATTORNEY AND REVIEWED BY ATTORNEYS FOR SELLER AND PURCHASER BEFORE SIGNING THIS INDENTURE, made the ~ ~ day of~y, 2010 between ZOUMAS CONTRACTING CORI~_., a New York Corporation having its principal place of business located at (no#) North Country Road, (PO Box 361), Wading River, New York 11792 AND FREEFORM BUILDING PARTNERS, LLC, a domestic Limited Liability Company having its principal place of business located at 142 Mineola Avenue, Roslyn Heights, New York party of the first part, and TOWN OF SOUTHOLD, a New York municipality having, its.pJ'iRcipal place of business located 53095 Main Road, Southold, New York 11971 party of the second part WITNESSETH, that the party of the first part, in consideration ofTen Dollars and other valuable consideration, paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the SEE SCHEDULE A ATTACHED (DESCRIPTION OF PREMISES) BEING AND INTENDED TO BE part of the same premises as conveyed to Zoumas by deed dated 8/9/01, recorded 8/28/01 in L iber 12138 page 389 and part of the same premises as conveyed to Freeform by deed dated 9/21/05 recorded 11/3/05 in Liber 12418 page 357 and by a deed dated 9/21/05 recorded 11/3/05 in Liber 12418 page 446. 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, TOHA VEAND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of the party of the second part forever. AND the party of the first part, covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever, except as aforesaid. AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word "party" shall be construed as if it read "parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: ZOUMAS C]O/TRACTNG CORP. NYSBA Residential Real Estate Forms on HotDocs (9,00) F~~J~_g~ RTNERS LLC Copyright Capsofi Devclopmenl State of New York ) ~l,b.~_ ~ ss: County of ~ ) On this ;Z~day of February, 2010, before, the undersigned, personally appeared personally known to me or proved to me on the basis of satisfactory evidence to the be 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. Notary Public State of New York ) SS; County of_~ ~5~'~ ) On this ! day of-Febrtrary, 2010, before, the undersigned, personally appeared personally known to me or proved to me on the basis of satisfactory evidence to the be 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. Notary Public NYSBA Residential Real Estate Forms on HotDocs (9/00) Copyright Capsofla Development ALL that certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being at Bayview, Town of Southold, County of Suffolk, and State of New York, known and designated as Deer Run shown on Subdivision, "Zoumas Contracting Corp.", more particularly bounded and described as follows: BEGINNING at a point on the northerly side of North Bayview Road at the southeasterly corner of Lot 5, Subdivision, "Zoumas Contracting Corp.", said point being situate the following three (3) courses and distances as measured along the northerly side of North Bayview Road from the intersection of the easterly side of North Road to Bayview and the northerly side of North Bayview Road: South 73 deg. 51 min. 20 sec. East 240.67 feet, South 72 deg. 56 min. O0 sec. East 180.22 feet, South 73 deg. 05 min. 20 sec. East 502.79 feet; RUNNING thence from said point of beginning along Lot 5, Lot 4, Lot 3, Lot 2, and Lot 1, Subdivision, "Zoumas Contracting Corp." the following seven (7) courses and distances: 2. 3. 4. 5. 6. 7. On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet, North 16 deg. 54 min. 40 sec. East 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, On the arc of a curve to the right having a radius of 85.00 feet for a distance of 453.85 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, South 16 deg. 54 min. 40 sec. West 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet to the northerly side of North Bayview Road; RUNNING thence North 73 deg. 05 min. 20 sec. West along the northerly side of North Bayview ROad 100.00 feet to the point or place of Beginning. SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEDICATION & RELEASE N~m~er of Pages: 5 Receipt Number : 10-0045900 TRANSFER TAX NUMBER: 09-21213 District: 1000 Deed Amount: Recorded: At: LIBER: PAGE: Section: Block: 079.00 04.00 EXAMINED AND CHARGED AS FOLLOWS $0.00 Received the Following Fees For Above Instrument Exempt Page/Filing $25.00 NO Handling COE $5.00 NO NYS SRCHG TP-584 $10.00 NO Notation Cert. Copies $5.20 NO RPT Transfer tax $0.00 NO Co=~.Pres Fees Paid TRANSFER TAX NUMBER: 09-21213 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JITDITH A. PASCALE County Clerk, Suffolk County 04/19/2010 10:35:52 AM D00012622 285 Lot: 017.022 Exempt $20.00 NO $15.00 NO $0.00 NO $50.00 NO $0.00 NO $130.20 Number of pages This document will be public record. Please remove all Social Security Numbers prior to recording. 31 Deed / Mortgage Instrument Deed / Mortgage Tax Stamp Page / Filing Fee ,;::~J H a n/,dlhff~'~ '--~ 20. 00 ~ -584 ~ Nota 5. 00 Sub Total EA-52.,. ].7-(C-o r.m~) .s.^. Affidavit NY5 Surcharge 15. 00 Other 4 J Dist./6r~ Real Property Tax Service Agency Verification 8 Sub Total FEES 75 Grand Total 1000 07900 0400 017022 1000 07900 0400 017021 Recording / Filing Stamps Mortgage Amt. 1. Basic Tax 2. Additional Tax Sub Total Spec./Assit. or Spec./Add. TOT. MTG. TAX Dual Town __ Dual County __ T r aHnei~e fr °.~a~ P P ° i n t m e n~--- Mansion Tax The property covered by this mortgage is or will be improved by a one or two family dwelling only. YES or NO j "~. ,,~0 I If NO, see appropriate tax clause on ~,~ J page # of this ins[rpment. I -- 5 I Community Preservation Fungi Consideration Amount $ ¢ Satisfactions/Discharges/Releases List Property Owners Mailing Address RECORD & RETURN TO: MARTIN D FINNEGAN ESQ TOWN ATTORNEY; TOWN OF SOUTHOLD PO BOX 1179 SOUTHOLD NY 11971 CPF Tax Due $ made Improved Vacant Land ID TD Mail to: Judith A. Pascale, Suffolk County Clerk Title Company Information 310 Center Drive, Riverhead, NY 11901 Co. Name www.suffolkcountyny.gov/clerk Title # 6 Suffolk County Recording & Endorsement Page This page forms part of the attached DEDICATION AND RELEASE by: (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in SUFFOLK COUNTY, NEW YORK. ZOUMAS CONTRACTING CORP. AND FREEFROM BUILDING PARTNERS LLC TO In theTOWN of SOUTHOLD TOWN OF SOUTHOLD In the VILLAGE or HAMLETof SOUTHOLD BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. (over) IMPORTANT NOTICE If the document you've just recorded is your SATISFACTION OF MORTGAGE. please be aware of the following: If a portion of your monthly mortgage payment included your property taxes, *you will now need to contact your local Town T ax Receiver so that you may be billed directly for all future property tax statements. Local property taxes are payable twice a year: on or before January 10,h and on or before May 31,. Failure to make payments in a timely fashion could result in a penalty. Please contact your local Town Tax Receiver with any questions regarding property tax payment. Babylon Town Receiver of Taxes 200 East Sunrise Highway North Lindenhurst, N.Y, 11757 (631) 957-3004 Riverhead Town Receiver of Taxes 200 Howell Avenue Riverhead, N.Y. 11901 (631) 727-3200 Brookhaven Town Receiver of Taxes One Independence Hill Farmingville, N.Y. 11738 (631 ) 451-9009 Shelter Island Town Receiver of Taxes Shelter island Town Hall Shelter Island, N.Y. 11964 (631) 749-3338 East Hampton Town Receiver of Taxes 300 Pantigo Place East Hampton, N.Y. 11937 (631) 324-2770 Smithtown Town Receiver of Taxes 99 West Main Street Smithtown, N.Y. 11787 (631 ) 360-7610 Huntington Town Receiver of Taxes 100 Main Street Huntington, N.Y. 11743 (631) 351-3217 Southampton Town Receiver of Taxes 116 Hampton Road Southampton, N.Y. 11968 (631) 283-6514 Islip Town Receiver of Taxes 40 Nassau Avenue Islip, N.Y. 11751 (631) 224-5580 Southold Town Receiver of Taxes 53095 Main Street Southold, N.Y. 11971 (631) 765-1803 dw 2/99 Sincerely, Judith A. Pascale Suffolk County Clerk TOWN OF SOUTHOLD: STATE OF NEW YORK In the Matter of the Application of ZOUMAS CONTRACTING CORP. and FREEFORM BUILDING PARTNERS, LLC, for the Laying Out of DEDICATION AND New Highways and Drainage Easement at RELEASE Southold, Town of Southold, Suffolk County, New York, to be known as: DEER RUN and DRAINAGE EASEMENT. We, ZOUMAS CONTRACTING CORP., having its principal place of business at no # Route 25A, P.O. Box 361, Wading River, New York, and FREEFORM BUILDING PARTNERS, LLC, having its principal place of business at 142 Mineola Avenue, Roslyn Heights, New York, being the owners of certain land in Southold, Town of Southold, County of Suffolk and State of New York, and included within which land are proposed highways known as DEER RUN and DRAINAGE EASEMENT, described in the above-entitled matter dated NOW, THEREFORE, in consideration of Ten Dollars ($10.00) to us in hand paid by Peter Harris, Superintendent of Highways of said Town of Southold, and in further consideration of laying out of the new highways known as DEER RUN and DRAINAGE EASEMENT, do hereby release and dedicate to the Town of Southold all the land heretofore owned by us within said proposed highways as follows: The highways known as DEER RUN and DRAINAGE EASEMENT, as shown and designated on a certain map entitled "Subdivision Map of ZOUMAS CONTRACTING CORP.", situate at Southold, in the Town of Southold, County of Suffolk and State of New York, filed in the Office of the Clerk of the County of Suffolk on October 1, 2004, as Map No. 11166. And we do release the said Town of Southold from all damages by reason of the laying out of the said highways. FR~O~/~~ PARTNERS, LLC By:~-,-~//'~ ' Ke~ill~,;/Managing Member STATE OF NEW YORK ) ) SS.: COUNTY OF SUFFOLK ) On the ~ day of 014~uP/¢-, '*~,0~, before me personally appeared John Zoumas, personally known to me or proved to me on the basis of satisfactory .evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed same in his capacity and that by his signature on the instrument, the individual, or the person on behalf of which the individual acted, executed the instrument. Notary 5~1~ O. I~mu~zl, Jr. Notary Pul?., SWte of New York 02 RE2S1MS STATE OF NEW YORK ) ) SS.: COUNTY OF SUFFOLK ) On the/~ day of~?~'~L ~..;.~;fied in suffolk County (,~;,~l,,;~;$ion Expires July ,~0¢2-, before me personally appeared Kevin Miller, 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 he executed same in his capacity and that by his signature on the instrument, the individual, or the person on behalf of which the individual acted, executed the instrument. LORA GRILLO Notary Public, State of New York Suffolk County, GR.4982888 ,. '* Commi~eion Explree June 10, 20 ~ 04/09/2016 11:23 FAX 631 765 4643 MOORE LAW OFFICES ~]002 Zoumas Contracting Corp. at Bayview, Town of Southold, Suffollk County, New York Surveyor's Description 30' Drainage Easement Subdivision, "Zoumas Contracting Corp." ALL that certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being at Bayview, Town of Southold, County of Suffolk, and State of New York, known and designated as a 30' ]Drainage Easement as shown on Subdivision, "Zoumas Contracting Corp.", more particularly bounded and described as follows: BEGINNING at a point at the division line between Lot 4 & Lot 5, Subdivision, "Zoumas Contracting Corp.", said point being situate the following four (4) courses and distances as measured along the westerly side of Deer Run from the northerly side of North Bayview Road: 2. 3. 4. On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet, North 16 deg. 54 min. 40 sec. East 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, On the arc of a curve to the right having a radius of 85.00 feet for a distance of 71.75 feet; RUNNING thence from said point of beginning on the art: of a curve to the left having a radius of 85.00 feet along Lot 5, Subdivision, "Zoumas Contracting Corp." for a distance of 15.08 feet to a point; RUNNING thence North 87 deg. 41 min. 29 sec. West through Lot 5, Subdivision, "Zoumas Contracting Corp." 302.45 feet to Lot 7, Subdivision, "Zoumas Contracting Corp."; RUNNING thence North 12 deg. 43 min. 46 sec. East along Lot 7, Subdivision, "Zoumas Contracting Corp." 30.50 feet to a point; RUNNING thence South 87 deg. 41 min. 29 sec. East through Lot 4, Subdivision, "Zoumas Contracting Corp." 296.93 feet to the westerly side of Deer Run; RUNNING thence on the arc of a curve to the left having a radius of 85.00 feet along the westerly side of Deer Run for a distance of 15.08 feet to the point or place of Beginning. 04/09/2010 11:23 FAX 931 765 4643 MOORE LAW OFFICES [~003 ALL tl~at certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being at Bayview, Town of Southold, County of Suffolk, and State of New York, known and designated as Deer Run shown on Subdivision, "Zoumas Contracting Corp.", more particularly bounded and described as follows: BEGINNING at a point on the northerly side of North Bayview Road at the southeasterly corner of Lot 5, Subdivision, "Zoumas Contracting Corp.", said point being situate the following three (3) courses and distances as measured along the northerly side of North Bayview Road from the intersection of the easterly side of North Road to Bayview and the northerly side of Nort~h Bayview Road: South 73 deg. 51 min. 20 sec. East 240.67 feet, South 72 deg. 56 min. 00 sec. East 180.22 feet, South 73 deg. 05 min. 20 sec. East 502.79 feet; RUNNING thence from said poini of beginning along Lot 5, Loi 4, Lot 3, Lot 2, and Lot 1, Subdivision, "Zoumas Contracting Corp." the following seven (7) co,urses and distances: 2. 3. 4. 5. 6. 7. On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet, North 16 deg. 54 min. 40 sec. East 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet fc~r a distance of 27.47 feet, On the arc of a curve to the right having a radius of 85.00 feet for a distance of 453.85 feet, On the arc of a curve to the left having a radius ot 25.00 feet far a distance of 27.47 feet, South 16 deg. 54 min. 40 sec. West 183.84 feet, ~gn the arc of a curve to the left having a radius of 25.00 feet ftyr a distance of 39.27 feet to the northerly side of North Bayview Road; RUNNING thence North 73 deg. 05 min. 20 sec. West along the north~ly side of North Bayview ROad 100.00 feet to the point or place of Beg~m,tng. MARTIN D. FINNEGAN TOWN ATTORNEY martin.finnegan@town.southold.ny.us JENNIFER ANDALORO ASSISTANT TOWN ATTORNEY jennifer.andaloro@town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hulse@town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD RECEIVED MEMORANDUM 2010 To: From: Date: Subject: Ms. Elizabeth A. Neville, Town Clerk Lynne Kmuza Secretary to the Town Attorney April 30, 2010 Zoumas Contracting Corp. at Deer Run Road Dedication For your records, I am enclosing certified copies of the recorded Deed and Dedication and Release documents in connection with the referenced matter. I am also enclosing a copy of the resolution authorizing this dedication. If you have any questions, please do not hesitate to call me. Thank you for your attention. /Ik Enclosures COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK CC #: C10-12992 I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DEED recorded in my office on04108/2010 under Liber D000t2621 and Page 368 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 0410812010 SUFFOLK COUNTY CLERK JUDITH A. PA$CALE SEAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE T~pe of Instrument: DEED Number of Pages: 4 Receipt ~mBer : 10-0041534 TRANSFER TAX NUMBER: 09-20495 District: 1000 Deed Amount: Recorded: At: LIBER: PAGE: Section: Block: 079.00 04.00 EXAMINED AND CHARGED AS FOLLOWS $0.00 04/08/2010 10:33:58 ~vl D00012621 368 Lot: 017. 023 Received the Following Fees For Above Instrument Exempt Page/Filing COE EA-CTY TP-584 Cert. Copies Transfer tax TRANSFER TAX NUMBER: $20 $5 $5 85 $5 00 $0 00 00 NO Handling 00 NO NYS SRCHG 00 NO EA-STATE 00 NO Notation NO RPT NO Comm. Pres Fees Paid 09-20495 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL $20.00 $15.00 $250.00 $0.00 $30.00 $o.oo $355.00 Exempt NO NO NO NO NO NO JUDITH A. PASCALE County Clerk, Suffolk County Number of pages This document will be public record. Please remove all Social Security Numbers prior to recording. Deed / Mortgage Instrument Deed / Mortgage Tax Stamp FEES RECORDED 2010 Apr O~ J0:33:5~ JUDITH ~. PASCALE CLERK OF SUFFOLK COU~F? L D000!262i P ~,]~ 09-20495 Recording / Filing Stamps Page / Filing Fee Handling 20. O0 TP-584 Notation CA-52 17 (County) EA-5217 (State) Comm. of Ed. 5. 00 Affidavit Certified Copy NYS Surcharge 15. 00 Other Sub Total Sub Total Grand Total 41 Dist. Real Prope Tax Service Agency Verificatio 1000 07900 0400 017023 6 8 Satisfactions/Discharges/Releases List Property Owners Mailing Address RECORD & RETURN TO: MARTIN D FINNEGAN ESQ TOWN ATTORNEY; TOWN OF SOUTHOLD PO BOX 1179 SOUTHOLDNY 11971 Mortgage Amt. 1. Basic Tax 2. Additional Tax Sub Total Spec,/Assit. or Spec./Add. TOT. MTG. TAX Dual Town __. Dual County __ Held for Appointmerl,t,-, Transfer Tax C Mansion Tax The property covered by this mortgage is or will be improved by a one or two family dwelling only. YES or NO If NO, see appropriate tax clause on page # __ of this instrument. 5 Community Preservation Fund Consideration Amount $ (% CPF Tax Due /$ Improved Vacant Land TD TD TD Mail to: Judith310 CenterA' Pascale,Drive,SUffOlkRiverhead,County NyClerk11901CoT.blame Title Company Information www.suffolkcountyny.gov/clerk Tit e # Suffolk County Recording & Endorsement Page ZOUMAS CONTRACTING CORP. AND FREEFROM BUILDING PARTNERS LLC This page forms part of the attached BARGAIN & SALE DEED by: (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in SUFFOLK COUNTY, NEW YORK. made TO In theTOWN of SOUTHOLD TOWN OF SOUTHOLD In the VILLAGE or HAMLETof SOUTHOLD BOXES 6 THRU 8 MUST BE TYPED OR PRINTED iN BLACK INK ONLY PRIOR TO RECORDING OR FILING. (over) IMPORTANT NOTICE If the document you've just recorded is your SATISFACTION OF MORTGAGE, please be aware of the following: If a portion of your monthly mortgage payment included your properb/taxes, *you will now need to contact your local Town Tax Receiver so that you may be billed directly for all future property tax statements. Local property taxes are payable twice a year: on or before January 10,, and on or before May 31,~. Failure to make payments in a timely fashion could result in a penalty. Please contact your local Town Tax Receiver with any questions regarding property tax payment. Babylon Town Re~:eiver of Taxes 200 East Sunrise Highway North Lindenhurst, N.Y. 11757 (631 ) 957~3004 Riverhead Town Receiver of Taxes 200 Howell Avenue Riverhead, N.Y. 11901 (631) 727~3200 Brookhaven Town Receiver of Taxes One Independence Hill Farmingville, N.Y. 11738 (631 ) 451-9009 Shelter Island Town Receiver of Taxes Shelter Island Town Hall Shelter Island, N.Y. 11964 (631) 749-3338 East Hampton Town Receiver of Taxes 300 Pantigo Place East Hampton, N.Y. 11937 (631) 324-2770 Smithtown Town Receiver of Taxes 99 West Main Street Smithtown, N.Y. 11787 (631 ) 360-7610 Huntington Town Receiver of Taxes 100 Main Street Huntington, N.Y. 11743 (631) 351-3217 Southampton Town Receiver of Taxes 116 Hampton Road Southampton, N.Y. 11968 (631) 283-6514 Islip Town Receiver of Taxes 40 Nassau Avenue Islip, N.Y. 11751 (631) 224-5580 Southold Town Receiver of Taxes 53095 Main Street Southold, N.Y. 11971 (631) 765-1803 dw 2/99 Sincerely, Judith A. Pascale Suffolk County Clerk BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S ACTS (INDIVIDUAL OR CORPORATION) STANDARD NYBTU FORM 8007 CAUTION; THIS AGREEMENT SHOULD BE PREPARED BY AN ATTORNEY AND REVIEWED BY ATTORNEYS FOR SELLER AND PURCHASER BEFORE SIGNING THIS INDENTURE, made the ~ day of ~a~, 2010 between ZOUMAS CONTRACTING CORP., a New York Corporation having its principal place of business located at (nog) North Country Road, (PO Box 361 ), Wading River, New York 11792 AND FREEFORM BUILDING PARTNERS, LLC, a domestic Limited Liability Company having its principal place of business located at 142 Mineola Avenue, Roslyn Heights, New York party of the first part, and TOWN OF SOUTHOLD, a New York municipality ,havip$ its:pj-in, c~al place of business located 53095 Main Road, Southold, New York 11971 ~ : ~. ,,.. party of the second part WITNESSETH, that the party of the first part, in consideration of Ten Dollars and other valuable consideration, paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the SEE SCHEDULE A ATTACHED (DESCRIPTION OF PREMISES) BEING AND INTENDED TO BE part of the same premises as conveyed to Zoumas by deed dated 8/9/01, recorded 8/28/01 in Liber 12138 page 389 and part of the same premises as conveyed to Freeform by deed dated 9/21/05 recorded 11/3/05 in Liber 12418 page 357 and by a deed dated 9/21/05 recorded 11/3/05 in Liber 12418 page 446. 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 HA VEAND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of the party of the second part forever. AND the party of the first part, covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever, except as aforesaid. AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word "party" shall be construed as if it read "parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: ZOUMAS CtOJ/TRACTNG CORP. NYSBA Residential Real Estate Forms on HotDocs' (9/00) F~RTNERS LLC BY:~'~ Copyright Cap$oflI Development State of New York ) ~.~_ ,J ss: County of ~ ) On this 2,~day of February, 2010, before, the undersigned, personally appeared personally known to me or proved to me on the basis of satisfactory evidence to the be 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. {3ual~o, 0,~KA4~3841 Comrnba ~ExDire~ln Nassau Co~n ~on r~,brumry,~,.;~/5/~ Notary Public State of New York ) County of_~' ~- ~) ss: On this / day of.C-ebma~y, 2010, before, the undersigned, personally appeared personally known to me or proved to me on the basis of satisfactory evidence to the be 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. Notary Public NYSBA Residential Real Estate Forms on HotDocs~' (9/00) Copyright Capsoff~ Development ALL that certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being at Bayview, Town of Southold, County of Suffolk, and State of New York, known and designated as Deer Run shown on Subdivision, "Zoumas Contracting Corp.", more particularly bounded and described as follows: BEGINNING at a point on the northerly side of North Bayview Road at the southeasterly corner of Lot 5, Subdivision, "Zoumas Contracting Corp.", said point being situate the following three (3) courses and distances as measured along the northerly side of North Bayview Road from the intersection of the easterly side of North Road to Bayview and the northerly side of North Bayview Road: South 73 deg. 51 min. 20 sec. East 240.67 feet, South 72 deg. 56 min. 00 sec. East 180.22 feet, South 73 deg. 05 min. 20 sec. East 502.79 feet; RUNNING thence from said poin~ of beginning along Lot 5, Lot 4, Lot 3, Lot 2, and Lot 1, Subdivision, "Zoumas Contracting Corp." the following seven (7) courses and distances: 2. 3. 4. 5. 6. 7. On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet, North 16 deg. 54 min. 40 sec. Ease 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet f~r a distance of 27.47 feet, On the arc of a curve to the right having a radius of 85.00 feet for a distance of 453.85 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, South 16 deg. 54 min. 40 sec. West 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet to the northerly side of North Bayview Road; RUNNING thence North 73 deg. 05 min. 20 sec. West along the northerly side of North Bayview ROad 100.00 feet to the point or place of Begi~n4n, g. COUNTY CLERK'S OFFICE STATE OF NEW YORK COUNTY OF SUFFOLK CC #: C10-14267 I, JUDITH A. PASCALE, Clerk of the County of Suffolk and the Court of Record thereof do hereby certify that I have compared the annexed with the original DEDICATION & RELEASE recorded in my office on0411912010 under Liber D000'12622 and Page 285 and, that the same is a true copy thereof, and of the whole of such original. In Testimony Whereof, I have hereunto set my hand and affixed the seal of said County and Court this 04/1912010 SUFFOLK COUNTY CLERK JUDITH A. PASCALE SEAL Number of pages This document will be public record. Please remove all Social Security Numbers prior to recordin9. Deed / Mortgage Instrument 31 Page / Filing Fee Ha~ndiing ~"~_ EA ~)17(State) ~ Comm. of Ed. Affidavit Q~i~-~rcharge Other 20. 00 5. O0 15. O0 41 Dist. Real Property Tax Service Agency Verification Deed / Mortgage Tax Stamp FEES Sub Total Sub Total Grand Total /'}O,~0 1000 07900 0400 017022 1000 07900 0400 017021 Satisfactions/Discharges/ReleasesListPropertyOwnersMailingAddress RECORD & RETURN TO: MARTIN D FINNEGAN ESQ TOWN ATTORNEY; TOWN OF SOUTHOLD PO BOX 1179 SOUTHOLD NY 11971 ',_-:LE F:E OF SLiFFL]LK ...... Ir',, ', L ['OOC i2622 E:,T~ Recording / Filing Stamps Mortgage Amt. 1. Basic Tax 2. Additional Tax Sub Total Spec./Assit or Spec./Add. TOT. MTG. TAX Dual Town __ Dual County __ Held for Appointment/~z~ Transfer Tax Mansion Tax The property covered by this mortgage is or will be improved by a one or two family dwelling only. YES or NO If NO, see appropriate tax clause on page # __ of this ~n,~. S Community Preservation Consideration Amount $ CPF Tax Due $ TD Improved Vacant Land TD /C) ID made Mail to: Judith A. Pascale, Suffolk County Clerk 171 Title Company Information 310 Center Drive, Riverhead, NY 11901[Co. Name www.suffolkcountyny.gov/clerk I Title # Suffolk County Recording & Endorsement Page This page forms part of the attached DEDICATION AND RELEASE by: (SPECIFY TYPE OF INSTRUMENT) The premises herein is situated in SUFFOLK COUNTY, NEW YORK. ZOUMAS CONTRACTING CORP. AND FREEFROM BUILDING PARTNERS LLC TO In theTOWN of SOUTHOLD TOWN OF SOUTHOLD In the VILLAGE or HAMLETof SOUTHOLD BOXES ii THRU $ MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. (over) IMPORTANT NOTICE If the document you've just recorded is your SATISFACTION OF MORTGAGE, please be aware of the following: If a portion of your monthly mortgage payment included your property taxes, *you will now need to contact your local Town T ax Receiver so that you may be billed dir ectl¥ for all future property tax statements. Local property taxes are payable twice a year: on or before January lO,h and on or before May 31,, Failure to make payments in a timely fashion could result in a penalty. Please contact your local Town Tax Receiver with any questions regarding property tax payment. Babylon Town Receiver of Taxes 200 East Sunrise Highway North Lindenhurst, N.Y. 117S7 (631) 957-3004 Riverhead Town Receiver of Taxes 200 Howell Avenue Riverhead, N.Y. 11901 (631) 727-3200 Brookhaven Town Receiver of Taxes One Independence Hill Farmingville, N.Y. 11738 (631) 451-9009 Shelter Island Town Receiver of Taxes Shelter Island Town Hall Shelter Island, N.Y. 11964 (631) 749-3338 East Hampton Town Receiver of Taxes 300 Pantigo Place East Hampton, N.Y. 11937 (631) 324-2770 Smithtown Town Receiver of Taxes 99 West Main Street Smithtown, N.Y. 11787 (631) 360-7610 Huntington Town Receiver of Taxes 100 Main Street Huntington, N.Y. 11743 (631) 3S1-3217 Southampton Town Receiver of Taxes 116 Hampton Road Southampton, N.Y. 11968 (631 ) 283-6514 Islip Town Receiver of Taxes 40 Nassau Avenue Islip, N.Y. 11751 (631) 224-5580 Southold Town Receiver of Taxes 53095 Main Street Southold, N.Y. 11971 (631) 765-1803 dw 2/99 Sincerely, Judith A. Pascale Suffolk County Clerk 12-0104.06/06kd SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Ty~e of Instrument: DEDICATION & RELEASE N~mBer of Pages: 5 Receipt Number : 10-0045900 TRANSFER TAX NUMBER: 09-21213 District: Section: 1000 079.00 Deed Amount: Recorded: At: LIBER: PAGE: Block: 04.00 EXAMINED AND CHARGED AS FOLLOWS $0.00 Received the Following Fees For Above Instrument Exempt Page/Filing $25.00 NO Handling COE $5.00 NO NYS SRCHG TP-584 $10.00 NO Notation Cert. Copies $5.20 NO RPT Transfer tax $0.00 NO Comm. Pres Fees Paid TRANSFER TAX NL~MBER: 09-21213 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County 04/19/2010 10:35:52 AM D00012622 285 Lot: 017. 022 Exempt $2O.00 NO $15.00 NO $0.00 NO $50.00 NO $0.00 NO $130.20 TOWN O¢ SOUTHOLD: STATE OF NEW YORK In the Matter of the Application of ZOUMAS CONTRACTING CORP. and FREEFORM BUILDING PARTNERS, LLC, for the Laying Out of DEDICATION AND New Highways and Drainage Easement at RELEASE Southold, Town of Southold, Suffolk County, New York, to be known as: DEER RUN and DRAINAGE EASEMENT. We, ZOUMAS CONTRACTING CORP., having its principal place of business at ne # Route 25A, P.O. Box 361, Wading River, New York, and FREEFORM BUILDING PARTNERS, LLC, having its principal place of business at 142 Mineola Avenue, Roslyn Heights, New York, being the owners of certain land in Southold, Town of Southold, County of Suffolk and State of New York, and included within which land are proposed highways known as DEER RUN and DRAINAGE EASEMENT, described in the above-entitled matter dated NOW, THEREFORE, in consideration ofTen Dollars ($10.00)to us in hand paid by Peter Harris, Superintendent of Highways of said Town of Southold, and in further consideration of laying out of the new highways known as DEER RUN and DRAINAGE EASEMENT, do hereby release and dedicate to the Town of Southold all the land heretofore owned by us within said proposed highways as follows: The highways known as DEER RUN and DRAINAGE EASEMENT, as shown and designated on a certain map entitled "Subdivision Map of ZOUMAS CONTRACTING CORP.", situate at Southold, in the Town of Southold, County of Suffolk and State of New York, filed in the Office of the Clerk of the County of Suffolk on October 1,2004, as Map No. 11166. And we do release the said Town of Southold from all damages by reason of the laying out of the said highways. 7 CO,T% :~:~ PAR~.~N~RS, LLC Ken. Slide.Managing Member STATE OF NEW YORK ) ) SS.: COUNTY OF SUFFOLK ) On the ~¢ day of ~/H~//-¢'~-, '~, before me personally appeared John Zoumas, personally known to me or proved to me on the basis of satisfactory .evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed same in his capacity and that by his signature on the instrument, the individual, or the person on behalf of which the individual acted, executed the instrument. Notary PubJic st~pnen ~. I~IIIUZZI, Jr. . Notary Public, StYe of New YOrK 02-RE2SI~eS ) ~,-;4;¢?d in suffoll~ County . ) SS.: C..~:ir~i.~,~S$~on Expires July ~ ) Kevin Miller, 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 he executed same in his capacity and that by his signature on the instrument, the individual, or the person on behalf of which the individual acted, executed the instrument. STATE OF NEW YORK COUNTY OF SUFFOLK / ' Rotary PL LORA GRILLO Notary Public, State of New York Suffolk County, GRo4982888 ,. commission Expires June 10, 20 04/09/2010 11:23 FAX 631 766 4643 MOORE LAW OFFICES Zoumas Contracting Corp. at Bay'view, Town of Southold, Suffollk County, New York Surveyor's Description 30' Drainage Easement Subdivision, "Zoumas Contracting Corp." ALL that certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being at Bayview, Town of Southold, County of Suffolk, and State of New York, known and designated as a 30' Drainage Easement as shown on Subdivision, "Zoumas Contracting Corp.", more particularly bounded and described as follows: BEGINNING at a point at the division line between Lot 4 & Lot 5, Subdivision, "Zoumas Contracting Corp.", said point being situate the following four (4) courses and distances as measured along the westerly side of Deer Run from the northerly side of North Bayview Road: 2. 3. 4. On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet, North 16 deg. 54 min. 40 sec. East 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, On the arc of a curve to the right having a radius of 85.00 feet for a distance of 71.75 feet; RUNNING thence from said point of beginning on the arc of a curve to the left having a radius of 85.00 feet along Lot 5, Subdivision, "Zoumas Contracting Corp." for a distance of 15.08 feet to a point; RUNNING thence North 87 deg. 41 min. 29 sec. West through Lot 5, Subdivision, "Zoumas Contracting Corp." 302.45 feet to Lot 7, Subdivision, "Zoumas Contracting Corp."; RUNNING thence North 12 deg. 43 min. 46 sec. East along Lot 7, Subdivision, "Zoumas Contracting Corp." 30.50 feet to a point; RUNNING thence South 87 deg. 41 min. 29 sec. East through Lot 4, Subdivision, "Zoumas Contracting Corp." 296.93 feet to the westerly side of Deer iRun; RUNNING thence on the arc of a curve to the left having a radius of 85.00 feet along the westerly side of Deer Run for a distance of 15.08 feet to the point or place of Beginning. 04/09/2010 11:23 FAX 631 765 4643 MOORE LAW OFFICES ALL that certain plot, piece or parcel of land with the buildings axed improvements thereon erected, situate, lying and being at Bayview, Town o~ Southold, County of Suffolk, and. State of New York, known and designated as Deer Run s~own on Subdivision, "Zoumas Contracting Corp.", more particularly bounded and described as follows: BEGINNING at a point on the northerly side of North Bayview P, oad at the southeasterly corner of Lot 5, Subdivision, "ZoUmas Contracting Corp.", said point being situate the following three (3) courses and distances as measured along the northerly side of North Bayview Road from the intersection, of the easterly side of North Road to Bayview and the nqrtherly side of North Bayview Road: South 73 deg. 51 min. 20 sec. East 240.67 feet, South 72 deg. 56 min. 00 sec. East 180.22 feet, South 73 deg. 05 min. 20 sec. East 502.79 feet; RUNNING thence from said poin( of beginning along Lot 5, Lot 4, Lot Lot 2, and Lot 1, Subdivision, "Zoumas Contracting Corp." the following seven (7) co,urses and distances: 2. 3. 4. 5. 6. 7. On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet, North 16 deg. 54 min. 40 sec. Eas~ 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, On the arc of a curve to the right having a radius of 85.00 feet for a distance of 453.85 feet, On the arc of a curve to the left having a radius of 25.00 feet far a distance of 27.47 feet, :South 16 deg. 54 min. 40 sec. West 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet fo~ a ,distance of 39.27 feet to the northerly side of North Bayviaw Road; RUNNING thence North 73 deg. 05 min. 20 sec. West along the north~;1y side of North Bayview Road 100.00 feet to the point or place of RESOLUTION 2010-109 ADOPTED DOC ID: 5660 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2010-109 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JANUARY 19, 2010: WHEREAS, Zoumas Contracting Corp. and Freeform Building Partners, LLC have made application to the Town Board of the Town of Southold to dedicate a certain road in Southold, New York, to be known as "DEER RUN", and a "DRAINAGE EASEMENT", as shown on the map entitled "Subdivision Map of Zoumas Contracting Corp.", filed in the Office of the Clerk of the County of Suffolk on October 1, 2004 as Map No. 11166, together with the release executed by the owner thereof; and WHEREAS, the Southold Town Superintendent of Highways has inspected the said highways and has advised the Town Board that said proposed highways comply in all respects with the specifications for the dedication of highways in the Town of Southold; now, therefore, be it RESOLVED, that in accordance with Section 171 of the Highway Law of the State of New York, consem be, and the same hereby is, given to the Superintendent of Highways to make an order laying out the aforesaid highways, to consist of lands described in said application as shown on certain maps attached to said application; and be it FURTHER RESOLVED, that the Town Clerk be, and she hereby is, authorized and directed to forthwith cause the dedication~ release~ and deed to be recorded in the Office of the Clerk of the County of Suffolk~ New York. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Christopher Talbot, Councilman SECONDER: Louisa P. Evans, Justice AYES: Ruland, Orlando, Talbot, Krupski Jr., Evans ABSENT: Scott Russell MA~. TIN D~. FINNEGAN TOWN ATTORNEY martin.finnegan@town.southold.ny.us JENNIFER ANDALORO ASSISTANT TOWN ATTORNEY jennifer.andaloro@ town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hu]se@town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD March 25, 2010 R~CEIVED Patricia C. Moore, Esq. 51020 Main Road $outhold, NY 11971 Re: Zoumas Contracting Corp. at Deer Run/Dedication Dear Ms. Moore: I am pleased to enclose the following original road dedication papers in connection with the referenced matter, which are now ready for recording with the Suffolk County Clerk, and which have been signed by Supervisor Russell. 2. 3. 4. Combined Real Estate Transfer Tax Return (Form TP-584)(please insert the conveyance date); Peconic Bay Region Community Preservation Fund (please insert the conveyance date); Real Property Transfer Report (Form RP-5217)(please insert the date of transfer); and Dedication and Release. With respect to the odginal Bargain and Sale Deed, we were provided a copy only. The original deed should be in your file. Please make certain that the "Record and Return to" section on the cover sheet reflects Martin D. Finnegan, Esq., Town Attorney, Town of Southold, P.O. Box 1179, Southold, New York 11971-0959. Finally, I am enclosing copies of the resolution and consent authorizing this dedication for your records. · Patricia C. Moore, Esq. March 25, 2010 Page 2 If you have any questions regarding this matter, please do not hesitate to call me. Thank you for your assistance. JNIk Enclosures cc: Members of the Town Board (w/o encls.) Elizabeth A. Neville, Town Clerk (w/encls.) ~' Peter Harris, Superintendent of Highways (w/o encls.) James Richter, Town Engineer (w/o encls.) TP-5~4 (3/07) Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax Recording office t/me stamp See Form TP.5844, Instructions for Form TP-584, before completin9 this form. Please print or type. Schedule A ~ Information relating to conveyance Grantor/Transferor [] Individual [] Corporation [] Parlnership [] Estate/Trust [] Other Grantee/Transferee [] Individual [] Corporation [] Partnership [] Estate/Trust [] Other ZOUMAS CONRACTING CORP & FREEFORM BUILDING PARTNERS LLC Mailing address PO BOX 361 & 142 Mineola Ave. City state ZIP code Wading River NY 11792 Roslyn Heights, NY ;octal security number TOWN OF SOUTHOLD Mailing address Social security number PO BOX 1179 City Slate ZIP code SOUTHOLD NY 11971 Location and description of property conveyed Federal employer idenl, number i -q-3 ,-//'vD Social security number Tax map designation Address City/village Town County Section Block Lot DEER RUN SOUTHOLD SOUTHOLD SUFFOLK 79 4 Type of property conveyed (check applicable box) I [] One- to three-family house 5 E~] Commercial/Industrial Date of conveyance 2 [] Residential cooperative 6 [] Apartment building 3 [] Residential condominium 7 [] Office building I 4 [] Vacant land 8 [] Other ~ o ~.y,o,th ~, Percentage of real property conveyed which is residential real property % (see instructions) Condition of conveyance (check all that apply) a, [] Conveyance of fee interest b. [] Acquisition of a controlling interest (state percentage acquired. %) c. r~ Transfer of a controlling interest (state percentage transferred %) d. I-~ Conveyance to cooperative housing corporation f. [] Conveyance which consists of a mere change of identify or form of ownership or organization (attach Form TP.584. I, Schedule F) g. rq conveyance for which credit for tax previously paid will be claimed (attach Form TP-584. I, Schedule G) h. I"l Conveyance of cooperative apartment(s) i. [] Syndication e, [-I Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest (attach Form TP-584.1, Schedule E) j. [] Conveyance of air rights or development rights k. [] Contract assignment For recording officer's use Amount received Schedule B,, Part I $ Schedule B., Part n $ Date received I. r'"l option assignment or surrender m. ~ Leasehold assignment or surrender n. [] Leasehold granl o. [] Conveyance of an easement p. E] Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part 111) q. [] Conveyance of property partly within and partly outside.~the state r. [~] Other (describe) ~-t_'Yf~ ~ ~: r) l E,R' Transaction number Page'2 of 4 TP-584 (3/07) Schedule B -- Real estate transfer tax return (Tax Law, Article 31 ) Part ! - Computation of tax due I Enter amount of consideration for the conveyance (ilyou are claiming a total exemption from tax, check the exemption claimed box, enter consideration and proceed to Part III) .............................. [] Exemption claimed 2 Continuing lien deduction (see instructions #property is taken subject to mortgage or lien) ......................................... 3 Taxable consideration (subtract line 2 from line 1) ................................................................................................... 4 Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ......................................................... 5 Amountof creditc~aimed (see instructions and attach Form TP*584,1, ScheduleG) ................................................... 6 Total tax due' (subtlact Ikre 5 from line 4) ................................................................................................................ Part I! - Computation of additional tax due on the conveyance of residential real property for $1 million or more 1 Enter amount of consideration for conveyance (from Part I, line I) ........................................................................ 1. 2 Taxable consideration (multiply line 1 by Ihe percentage of the premises which is residential real propert~ as shown in Schedule A) ,.. I 2. w . o 3 Total add tlonal transfer tax due (mu/tply line 2 by I ~ (.01)) .................................................................................. I 3. I Part !!1 - Explanation of exemption claimed on Part 1, 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 b. Conveyance is to secure a debt or other obligation ............................................................................................................................ b c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................... c d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts ....................................................................................................................................................................... d 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.) Attach Form TP-584.1, Schedule F .................................................................... f g. Conveyance consists of deed of partition ........................................................................................................................................ ~., g h, Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................. h i. Conveyance consists of the execution of a contract to sell real property, without lhe use or occupancy of such property, or the granting of an option to purchase real property, without the use or occupancy of such property ................................................. j. Conveyance of an option or contract 1o purchase real property with the use or occupancy of such property where the consideration is less lhan $200,000 and such property was used solely by the grantor as the grantor's personal residence and consists of a one-, two-, or three-family house, an individual residential condominium unit, or the sale of stock in a cooperative housing corporation in connection wilh the grant or transfer of a proprietary leasehold covering an individual residential cooperative apartment ....................................................................................................................................... k, Conveyance Js not a conveyance within the meaning of Tax Law, Article 31, section 1401(e) (attach documents supporting such claim) ........................................................................................................................................................................... k I. Other (attach explanation) ..................................................................................................................................................................... *Please make check(s) payable to the county clerk where the recording is to take place, if the recording is to take place in NewYork City, make check(s) payable to the NYC Department of Finance. It a recording is ecl required, send this return and your check(s) made payable to the NYS Departn~ent of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (3/07) Schedule C m Credit Line Mortgage Certificate (Tax Law, Article 11) Complete the following only If the Interest being transferred is a fee simple Interest. I (we) ced[fy that: (check the appropriate box) 1. [] The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. [] The mai property being sold or transferred is subject to an outstanding credit line mortgage. However, an exemption from the tax is claimed for the following mason: L~ 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 before the transfer. [] The transfer of mai 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 obligors or (B) to a person or entity where 50% or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer lo a trust for the benefit of the transferor). E~The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and 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 dwolling. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. [] Other (attach detailed explanation). The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: [] A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. [] 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. The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by 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 or, if the recording is to take place in New York City, make check payable to the NYC Department of Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, including any return, certification, schedule, or attachment, is to the best of his/her knowledge, true and complete, and authorize the person(s) submitting such form on their behalf to receive a copy for p~rl~ses of recording the dee¢ or g.ther instr~megt effecting the conveyance. ',,,~ ~ ,..~ . Grant~'r ~g~ Title ' r,~ ¢, ~/~_.rantee s~tnatu~¢~ ,. ~, ~.-~.. t Tille v ~ ~tf~lto¢ sigflature ~ Titf~ 4 Grantee signature Title Reminder: Did you complete ail of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you checked e, f, or g in Schedule A, did you complete Form TP-584.17 Have you attached your check(s} made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department of Finance? If no recording is required, send your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Pag~ 4 of 4 TP-584 (3/07) Schedule D - Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663) Complete the following only If a fee simple Interest or a cooperative unit is being transferred by an individual or estate or trust. Part t - New York State residents if you am a New York State resident transferor(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferors/sellers of the mai property or cooperative unil is a resident of New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferors/sellers. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) as signed below was a resident of I lew York State, and therefore is not required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer y or cooperative unit. , ~ Prinl full name KEVIN MILLER Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed, Part I] - Nonresidents of New York State If you are a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but are not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferor(s)/seller(s), that transferor(s)/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonresident transferors/sellers. If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated personal income tax, on page 1 of Form TP-584-1. Exemption for nonresident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) (grantor) of this real properly or cooperalive unit was s nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: [] The real property or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, seclion 121) from to (see instruchons). Dale eate [] The transferodseller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. [] The transferor or transferee is an agency or authority of the United States of America, an agency or aulhority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Peconic Bay Region Community Preservation Fund Proceeds of this transfer tax are disbursed to the Townships in which the transaction takes place for its acquisition of land, development rights, and other interests in property for conservation purposes. Townships: East Hampton 03 Riverhead 06 Shelter Island 07 Southampton 09 Southold 10 Please print or type. Schedule A Information Relating to Conveyance Grantor Name (individual; last, first, middle initial) [] Individual [] Corporation [] Partnership [] Other Grantee [] individual [] Corporation [] Partnership [] Other ZOUMAS CONTRACTING CORP. & FREEFORM BUILDING PARTNERS Mailing address PO BOX 361 & 142 MINEOLA AVE State ZIP code Ci~ADING RIVER ROSLYN HEIOH~ Name (individual; last, first, middle initial) TOWN OF SOUTHOLD Mailing address PO BOX l 179 C~UTHOLD State ziP code NY 11971 Social Security Number I Federal employer Idenl, number Social Security Number Federal employer IdenL number Location and description of property conveyed Tax map designation Address Village Town Dist Section Block Lot 1000 79 4 17.23 DEER RUN SOUTHOLD SOUTHOLD /pe of property conveyed (check applicable box) Date of conveyance [] Improved /~ . ~ ~ Dual Towns; Condition of conveyance (check all that apply) a. - Conveyance of fee interest b. - Acquisition of a controlling interest (state percentage acquired %) c. - Transfer of a controlling interest (state percentage transferred %) d. - Conveyance to cooperative housing corporation e. - Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest f. -Conveyance which consists ora mere change of identity or form of ownership or organization g. - Conveyance for which credit (or tax previously paid will be claimed h. - CDnveyar)£e of cooperative apartment(s) i. - 3ynalcarlon j. - Conveyance of air rights or development rights k. - Contract assignment I. - Option assignment or surrender m. * Leasehold assignment or surrender n. ~ Leasehold grant o. - Conveyance of an easement p. - Conveyance for which exemption is claimed (complete Schedule B. Part Il) q. - Conveyance of property partly within and j partly without th~ state Schedule B - Community Preservation Fund Part l - Computation of Tax Due 1. Enter amount &consideration for the conveyance (from line 1 TP584 Schedule B) 2. Allowance (see below) 3. Taxable consideration (subtract line 2 from line 1) 4, 2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK 5. Property not subject to CPF Tax (See Schedule C) ~i 0 O For recording officer's use Amount received Date received Allowance: East Hampton Shelter Island Southampton 5250,000.00 Improved 5250,000.00 Improved $250,000.00 Improved 5100,000.00 Vacant Land (Unimproved) 5100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) Riverhead $150,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) Southold $150,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) Schedule C (continued) Part II - 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 state or Canada) [] b. Conveyance is to secure a debt or other obligation [] c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance [] d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts [] e. Conveyance is given in connection with a tax sale [] fi Conveyance is 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.) [] g. Conveyance consists of deed of partition [] h. Conveyance is given pursuant to the federal bankruptcy act [] 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 [] j. Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) (j) or (k) of Article 31-D of the Tax Law. (See required Town approval, below) [] k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, environmental, or historic preservation purposes. [] I. Other list explanations in space below (Grandfather/Contract) [] m. Conveyance of real proper~ as a primary residence where the grantee is a first-time homebuyer (attached approved application) [] n. Conveyance of real property to a tax exempt, not-for-profit corporation for the purpose of providing affordable housing. [] o. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 3 I-D of the Tax law. (See j in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Interest Any grantor or grantee failing to file a return or to pay any tax within Daily compounded interest will be charged on the amount of the the time required shall be subject to a penalty of 10% of the amount tax due not paid within the time required. of tax due plus an interest penalty of 2% of such amount of each month of delay or fraction thereof after the expiration of the first month after such return was required to be filed or the tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Signature (both the grantor(s) and ,~rantee(s) must sign). The undersigned certify that the above return, including any certification, sched~eJor attachment, is to the best of his/her PLEASE TYPE oR PRESS FIRMLY wHEN WRITING ON FORM INSTRUCTIONS: hep://www.orps.state.ny.us or PHONE (518) 473-7222 c'1. swls Code I ~ ~ ~ ~ ~ [ REAL PROPERTY TRANSFER REPORT STATE OF NEW YORK C2. Date Deed Recorded I Month / Day / Year I STATE BOARD OF REAL PROPERTY SERVICES CB. Book ,,,, RP'5217 PROPEt~ ~ Y' iNFORMATiON ~ Location I STREET NUMBER STREET NAME CI~ TOWN ViL~AGE Zip CODE 3. Tax indicate where future Tax Bills are to be sent Billing if other than buyer address (at bottom of form) I I Address LAST NAME / COMPANY FIRST NAME 4. Indicate the number of Assessment Roil parcels transferred on the deed I I #of Parcels OR ~ Part of a Parcel 5. Deed S~ze FRONT FEET DEPTH IACRESI Name LAST I~AME I COMPANy . Fi/~ST NAME LAST NAME / COMPANy FIRST NAME 7. Check the box below which most accurately describes the use of the property at the time of sale: (Only if Part of a Parcell Check as they apply: 4A. Planning Board with Subdivision Authority Exists [] 4B. Subdivision Approval was Required for Transfer [] 4C. Pamel Approved for Subdivision with Map Provided [] Check the boxes below as they apply: ~ ~J 2 or 3 Family Residential C ~,~ Residential Vacant Land D [~ Non-Residential Vacant Land SALE INFORMATION I 11. Sale Contract Date 12. Date of Sale / Transfer Agricultural Commercial Apartment Enter~alnment / Amusement Month / Day '/ Year Month Day Year 8. Ownership Type is Condominium [] ~ LJ Community Service 9. New Construction on Vacant Land J ~ industrial 10A. Property Located within an Agricultural District [] r~.~ Public Service 10B, Buyer received a disclosure notice indicating [] LI I Forest that the property is in an Agricultural Distdct 15. Check one or more of these condB]ons as applicable to transfe~ A Sale Between Relatives or Former Relatives B Sale BeeNeen Related Companies or Partners in Business C One of the Buyers is also a Seller D Buyer or Seller is Government Agency or Lending Institution E Deed Type not Warranty or Bargain and Sale (Specify Below) F Sale of Fractional or Less than Fee Interest (Specify Below) 13. Fug Sale Price I , , , , , , , ,~, O, 01 (Full Sale Price is the total amount paid for the property including personal properb/, [ This payment may be in the form of cash, other property or goods, or the assumption of j mortgages or other obllgations.) Please round to the nearest whole dollar amount, 14.1ndicate tbe value of personal I ~ i i , , ,'~, 0 I 0 I property included in the sale ) ~ ._. · ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill 16. Year of Assessment Roll from ~, } 0l 17. Total Assessed Value Iof all parcels in transfer) I which information taken 18. .roperty Class [(~0,~ ~'~J-I I 19. Schoof District Name I ["~,'~2)~'~'~ Significant Change in Property Between Taxable Status and Sale Dates Sale of Business is rncluded in Sale Price Other Unusual Factors Affecting Sale Price (Specify Below) None 20. Tax Map Identifier{s) / Roll Identifier{s) (If more than four, attach sheet with additional identifierlsll I CE.,iFICATION I I certify that all of ~he items of information entered on this form are true and correct (to the best of my knowledge and belief) and I understand that file making of any willful false statement of material fact herein will subject me to the provisions of the penal law relative to the mal~ng and filing of false loz~umen~s. BUYER'S ATTORNEY NEW YORK STATE COPY TOWN OF SOUTHOLD: STATE OF NEW YORK In the Matter of the Application of ZOUMAS CONTRACTING CORP. and FREEFORM BUILDING PARTNERS, LLC, for the Laying Out of DEDICATION AND New Highways and Drainage Easement at RELEASE Southold, Town of Southold, Suffolk County, New York, to be known as: DEER RUN and DRAINAGE EASEMENT. We, ZOUMAS CONTRACTING CORP., having its principal place of business at no # Route 25A, P.O. Box 361, Wading River, New York, and FREEFORM BUILDING PARTNERS, LLC, having its principal place of business at 142 Mineola Avenue, Roslyn Heights, New York, being the owners of certain land in Southold, Town of Southold, County of Suffolk and State of New York, and included within which land are proposed highways known as DEER RUN and DRAINAGE EASEMENT, described in the above-entitled matter dated NOW, THEREFORE, in consideration of Ten Dollars ($10.00)to us in hand paid by Peter Harris, Superintendent of Highways of said Town of Southold, and in further consideration of laying out of the new highways known as DEER RUN and DRAINAGE EASEMENT, do hereby release and dedicate to the Town of Southold all the land heretofore owned by us within said proposed highways as follows: The highways known as DEER RUN and DRAINAGE EASEMENT, as shown and designated on a certain map entitled "Subdivision Map of ZOUMAS CONTRACTING CORP.", situate at Southold, in the Town of Southold, County of Suffolk and State of New York, filed in the Office of the Clerk of the County of Suffolk on October 1,2004, as Map No. 11166. And we do release the said Town of Southold from all damages by reason of the laying out of the said highways. F FR~..~ PARTNERS, By: ~r-'-/~f/ ./~ ~ Ke~il~anaging Member LLC STATE OF NEW YORK ) ) SS.: COUNTY OF SUFFOLK ) On the ~¢ day of ~)14~¢'¢'~, "//0~, before me perSonally appeared John ,¢Zoumas, 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 he executed same in his capacity and that by his signature on the instrument, the individual, or the person on behalf of which the individual acted, executed the instrument. '~ Notary_.Pu b. lic .... stepnen emuzzl, Jr. Notary Public, St.te of New YOrk 02-RE2 lee5 STATE OF NEW YORK ~.-gl;lied in Suffolk¢ounty COUNTY OF SUFFOLK ss.: f~O~tll.l$$iOI1 Expires July 31¢~/¢ 0 n t h e/~)~)')~ d a Y of ~.,c~'?L ,2o~--, before me personally appeared Kevin Miller, 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 he executed same in his capacity and that by his signature on the instrument, the individual, or the person on behalf of which the individual acted, executed the instrument. / ' Notary Public - LORA GRILLO Notary Public, St,,te of New York Suffolk County, aR.4962888 .. Commlsaion Explre~ Jutle 10, 20 ~ RESOLUTION 2010-109 ADOPTED DOC ID: 5660 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2010-109 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JANUARY 19, 2010: WHEREAS, Zoumas Contracting Corp. and Freeform Building Partners, LLC have made application to the Town Board of the Town of Southold to dedicate a certain road in Southold, New York, to be known as "DEER RUN", and a "DRAINAGE EASEMENT", as shown on the map entitled "Subdivision Map of Zoumas Contracting Corp.", filed in the Office of the Clerk of the County of Suffolk on October 1, 2004 as Map No. 11166, together with the release executed by the owner thereof; and WHEREAS, the Southold Town Superintendent of Highways has inspected fl~e said highways and has advised the Town Board that said proposed highways comply in all respects with the specifications for the dedication of highways in the Town of Southold; now, therefore, be it RESOLVED, that in accordance with Section 171 of the Itighway Law of the State of New York, consent be, and the same hereby is, given to the Superintendent of Highways to make an order laying out the aforesaid highways, to consist of lands described in said application as shown on certain maps attached to said application; and be it FURTHER RESOLVED, that the Town Clerk be, and she hereby is, authorized and directed to forthwith cause the dedication~ release, and deed to be recorded in the Office of the Clerk of the County of Suffolk~ New York. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Christopher Talbot, Councilman SECONDER: Louisa P. Evans, Justice AYES: Ruland, Orlando, Talbot, Krupski Jr., Evans ABSENT: Scott Russell TOWN OF SOUTHOLD: STATE Of NEW YORk COUNTY OF SUFFOLK I~the Matter of the Application of ZOUMAS CONTRACTING CORP. and FREEFORM BUILDING PARTNERS, LLC, for the Laying CONSENT. Out of New Highways and Drainage Easement at Southold, Town of Southold, Suffolk County, New York, to be known as "DEER RUN" and ".DRAINAGE EASEMENT" We, the undersigned, being a majority of the Town Board of the Town of 8outhold, in the County of Suffolk and State of New York, having duly met at a regular meeting of the said Town Board on the 19th day of January, 2010, and having duly considered the application of ZOUMAS CONTRACTING CORP. and FREEFORM BUILDING PARTNERS, LLC dated March 26, 2007, for the laying out of new highways at Southold, in the Town of Southold, to be known as DEER RUN and a DRAINAGE EASEMENT, do hereby consent that such laying out be made in a.~dance with said petition. Scott"A. Russell, ,~upervisor ~'f"~"' .''~'v~T~ p E'Z~~llwoman Vincent M. Orlando, Councilman Albert J. Kr~pski, Jr., C~)uncilm,~n Chr. isfopher M. 'l'albo, ' Eli~ A. Ne~il'l~, Town Clerk Peter Harris, Hwy. Super, .PATRICIA A. FINNEGAN TOWN ATTORNEY patricia.finnegan(~town.southold.ny.us KIEI~kN M. CORCORAN ASSISTANT TOWN ATTORNEY kieran.corcoran~)town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hulse~?town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD £~C£1VT. D Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 February 5, 2009 2009 RE: Zoumas Contracting Corp. at Deer Run Dedication of Deer Run and Drainage Easement Dear Ms. Moore: With respect to the referenced matter, enclosed please find a copy of James Richter's inspection report dated January 26, 2009. Regarding the second paragraph of Mr. Richter's letter report, I am also enclosing a copy of correspondence dated January 24, 2006, and its attachment, that the Planning Board sent to Thomas McCarthy. Please note that the Planning Board was never sent a copy of this recorded Declaration. In addition, our office has tried to obtain a copy of the recorded Declaration through Fidelity National Title Insurance Company but have been informed that this Declaration was never recorded. In this regard, kindly forward us a copy of the recorded Declaration pertaining to the center island for our records. We look forward to hearing from you regarding this matter. If you have any questions, please do not hesitate to call me. lie r"'~n/l~. CL~o r a n ~ ssA,.~ant Town Attorney KMC/Ik Enclosures ~ cc: Ms. Elizabeth Neville, Town Clerk (w/encls.) Mr. Jamie Richter, Engineering Inspector (w/o encls.) Mr. Peter Harris, Superintendent of Highways (w/o encls.) Patricia A. Finnegan, Esq., Town Attorney (w/encls.) SCOTT A. RUSSELL SUPERVISOR TOWN HALL - 53095 MAIN ROAD Fax (631)- 765 - 9015 JAMES A. RICHTER, R.A. ENGINEER TOWN OF SOUTHOLD, NEW YORK I 1971 Tel, (631) - 765 - 1560 JAMIE.RICHTER(~TOWN.SOUTHOLD.NY.US OFFICE OF THE ENGINEER TOWN OF SOUTHOLD Peter Harris Superintendent of Highways Peconic Lane Peconic, NewYork 11958 January 26,2009 Re: Zoumas @ Bayview- (DEER RUN) i ~:: -- ;,,~.; Five Lot Conservation Subdivision SGTM #: 1000-79-04-17.23 Dear Mr. Harris: As per a request from the Town Attorney's Office, I have conducted a final inspection for the above referenced subdivision. To Date, all of the required construction items have been completed in a satisfactory manner. The deed descriptions provided by the developer have been reviewed and are considered accurate. These descriptions accurately describe both the Road Right-of-Way for Deer Run and the Drainage Easement Area located between Lot Numbers 4 & 5. In addition to the above, you should remember that this roadway was designed with an oversized Cull-De-Sac. Our original objection to this design was the creation of a centralized landscaped area and who would be responsible for future maintenance. At the time of Planning Board Approval, it was determined that C&R's would be established to require a homeowners association. This association would then be responsible for maintenance and landscaping of this center island. I would confirm this matter with the Planning Board and the Town Attorney's Office to ensure that this item is in place and that the covenant, as written, meets the minimum requirements necessary to guarantee the outcome. Ultimately, we will need some assurance certifying that the Highway Department will not be responsible for landscaping and maintenance of this Center Island. If you have any questions concerning this Final Inspection, please contact myoffice. CC: Planning Board Town Attorney (.,/)~~Si?et ly, ,- PLANIqIIqG BOARD MEMBER~ JERILYN B, WOODItOUSE Chair KENNETH L, EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON JOSEPH L. TOWi~SEND PLANNING BOARD OFFICE TOWN OF SOUTHOLD MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 O~ICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. Main Rd. & Youngs Ave.) Southold, NY Telephone: 631 765-1938 Fax: 631 765-3138 VIA FACSIMILE January 24, 2006 Thomas McCarthy 46520 County Route 48 Southold, NY 11971 Re: Zoumas at Bayview SCTM#1000~79-4-17.14 & 17.17 Dear Mr. McCarthy: I have reviewed the draft Declaration regarding the maintenance of the landscaped island within the cul-de-sac for the above-referenced subdivision. With respect to the mad dedication, the entire mad may be dedicated 'to the Town even though the Homeowner's Association will be responsible for maintaining the landscaped island. The draft Declaration you submitted has been reviewed by the Town Attorney, the Town Engineer and Planning staff and has been found to be acceptable. Upon filing of the Declaration, please submit a copy to this office for our records. If you have any questions or need additional information, please feel free to contact this office. Senior Planner DECLARATI0~ This Declaration C'Declacation") is made this day of building Parmers, LLC, hereafter referred to as "Declarant" · 2005, by Freeform WHEREAS, the Declarant is the owner in fee simple of real property situate in thc Town of Southold, county of Suffolk, State of New York, known and designated on the Suffolk County Tax Map as District 1000, Section 75, Block 2, Lot 2 and WHEREAS, Declarant has acquired the rights to build a certain subdivison of real property consisting of five (5) lots, as shown on the Subdivision map of , annexed hereto and made a part hareof as Exhibit "A" and WHEREAS, Declarant desires to provide for maintenance and management of the certain culdusac "island consisting of a certain design as Annexed hereto and made a part hereof as Exhibit "A"; NOW, THEREFORE, for the purposes of carrying out the intentions above expressed and in consideration of the foregoing recitals, the Declarant hereby covenants and agrees that ail of the said Lots shall hemal~er be subject to the covenants and restrictions as herein cited. All the provisions of this Declaration shall operate as covenants running with the land and shall be binding upon all purchasers and holders of the Lots, their heirs, successors and assigns, to wit: A. ISLAND DESIGN AND CONSTRUCTION The subdivision road culdusac shall contain a certain Island consisting of decorative vegetation and design as set forth in Exhibit "B" and to be located s shown on the subdivision map and shall be of a kind and nature consistent with that approved by he municipality having said jurisdiction to approve same all to be constructed in accordance with Town of Southold specifications. Title to the culdusac land, vegetation and design shall be dedicated to the Town of Southold subject to this declaration which shall be a covenant and restriction running with the land of each and every of the Five homes constructed under the approvals given by the Town, and shall be equally divided amongst each and every one of the homeowners of said Five homes contained in this subdivision subject to this Declaration. Bo MAl3/TENANCE AND MANAGEMENT OF ROAD 1. The owners of each of the subdivision lots hereby covenant and agree that they shall manage, administer, maintain and operate the Islkand contained in thc said culdusac area in accordance with the provisions of this Declaration. The homeowners hereby agree to provide year-round management of thc culdusac island in accordance with normal, customary and responsible management practices, which practices include but are not limited to: The routine maintenance of the vegetation, plantings, decorative structures, and all other items placed within thc boundaries of said Island sUucture, including but not limited to, litter collection, pruning, replacement of deceased, dangerous or defective plantings or vegetation, and repair of the surface and or structures contained thereon and therein, including that of any electric or water supply as the case may be, and to generally and as necessary keep the Island in presentable appropriate order as defined by the Town of Sothold and or other Municipality having jurisdiction. The use and or retention of agents, subcontractors or employees deemed by Freeform Building PaCaters, LLC or its successors or assigns to be reasonably necessmy to ceny out the responsibilities under this Declaration. MANAGEMENT COSTS 1. Freeform Building partners, LLC, in its sole discretion, shall: Prepare a budget and apportion to the Lot Owners an equal share of the costs of managing the Island contained in the cuidusac (hereinafter referred to as "Maintenance Costs") including, but not limited to, the costs of administration, if any, taxes if any, insurance, maintenance and repair. In thc event that unforeseen cxtraordinary expenses arise and sufficient funds are not available the homeowners may recommend and require a special assessment to each of the homeowners which must be approved by a simple majority of ail Lot Owners so assessed. Subsequent to approval thereof the homeowners shall be obligated to promptly pay the amount of the Special Assessment to repair, replace and or maintain said culdusac Island. PERMITTED AND PROHIBITED USES 1, Declarant hereby declares that the Island Culdusac shall be not be used by the Lot Owners, their guests and invitees other than as a decorative parcel whci shai be maintained by the homeowners at all times· subject to the following restrictions: When installing, maintaining, or otherwise servicing utility and service lines, Lot Owners shall have their respective agents, employees, conWactors, and subcontractom, and other representatives (1) use reasonable care not to damage thc vegetation, plantings and or other structures contained thereon or therein.; (ii) minimize the disturbance of shrubbery or other vegetation within the boundaries of the Island within thc culdusac; and (iii) upon completion of any repair or maintenance, restore thc Island substantially to thc samc condition as it existed at the time of commencement of the work· The Island within the Culdusac shall not be used for the dumping or abandoning of any solid waste or debris on or along its boundaries. Co No construction or installation or substantial alteration of any smsctures of any kind, permanent or otherwise, or ~hc vegetation thereon (including, but not limited to, fences), may be made without prior written consent oftbe Town of Southold. No conslruction or installation of any structures and/or landscaping which serve to impede sight lines along, entering upon, or exiting from thc culdusac may be made. No alteration or modification of the Island, once constructed, will be permitted without prior wrilten consent of the Town of Southold Planning Board, the Buildings Department or eny other municipality having jurisdiction there over. TERMS OF PAYMENT All Maintenance Costs, Reserve Fund fees, and Special assessments as detailed above shall be billed to the lot Owners in their proportionate share and shall be required to be paid within thirty (30) days after the dale of the bill submitted for same. The Lot Owners shall comply with thc terms of this declaration. In the event that any Lot Owner fails to comply with thc tcrms set forth herein within thirty (30) days after notice of violation is given, the Town of Southold, or any other municipality having jurisdiction sludi have the right and power to enforce by any proceeding at law or in equity, all the terms of this Declaration. MISCELLANEOUS 1. Freeform Building Partners, LLC its successors and assigns hereby make a continuing offer of dedication of the Island within the culdusac to the Town of Southold which the Town may formally accept in the event one or more of the following events occurs: a. Thc conditions for acceptance of thc offer ofdedicadon of the mad set forth in the Resolution of Conditiunal Final Approval for the subdivision adopted by the Town of Southold Planning Board on That the Island within the Culdnsac is in a state of disrepair and remains in that state for a period of 120 days after receipt of written notice from the Town of Southold, That these covenants and restrictions contained herein shall be construed to bc in addition to and not in derogation or limitation upon any local, state or federal laws, ordinances, regulations or previsions in effect at the time of execution of this agreement, or at the time such laws, ordinances, regulations and/or provisions may hereafter be revised, emended or promulgated. If any section, subsection, paragraph, clause, phrase, or provision of these covenants and restrictions shall, by a court of competent jurisdiction, be adjudged illegal, unlawful, invalid or hcld to be unconstitutional thc same shall not affect the validity of these covenants as a wbolc, or any other part or provision hereof other than the part so adjudged to be illegal, unlawful, invalid, or unconstitutional. The within declaration is made subject to the provisions of all laws required by law or by their provisions to be incorporated herein, and they arc deemed to be incorporated herein and made a part hereof as though fully set forth. The within declaration shall nm with the land and shall be binding upon thc Declarant, his he/rs, successors and assigns, and upon all persons or entities claiming under them, and may not be annulled, waived, changed, modified, terminated, revoked, or emended by subsequent owners of the premises unless and until approved by a majority plus one vote of the Planning Board of the Town of Southold or its successors, following a public hearing. If Freeform Building Parmers, LLC or its successors or assigns falls to meet its obligations with regards to the terms of this Island and Maintenance Agreement, the Declaration may be enforced by the Town of Southold against Freeform Building Parmcrs LLC, its successors, assigns, or the individual lot owners. All notices required under this Declaration shall be mailed to the Lot Owners' addresses rather than to thc property addresses unless other arrangements have been made by the Lot Owner. Notice shall bc deemed effective when mailed. In the event that the Declarant is no longer in title to any portion of the subdivision, then, in that event, notice shall bc given to the then owners ofthc lands making up the subdivision by mailing said notice to their addresses shown on thc current Town tax mils. IN WITNESS WHEREOF, the Declarant has executed this Easement and Declaration the day and year first above written. Declarant: FREEFORM BUILDING PARTNERS, LLC: STATE OF NEW YORK) ) SS:. On the day of In the year 2005 before me, the undersigned, a Notary Public in and for said state, personally appeared , persenally known to mc or proved to me on the basis of satisfactory evidence to be the individual(s) whos~ name(s) is (arc) subscribed to the within instrument end acknowled§ed to mc that he executed the same in his capacity and that by his signaturc on the instrmnent, the individual(s), or thc person upon behalf of which the individual(s) acted, executed the instrument. NOTARY PUBLIC RESOLUTION 2009-67 ADOPTED DOC ID: 4577 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2009-67 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JANUARY 6, 2009: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute the Drainage Easements pertaining to the following tax parcels in connection with the dedication of the drainage area between Zoumas Contracting Corp. and the Town of Southold, subject to the approval of the Town Attorney. Suffolk County Tax Map Nos. 1000-79-4-17.21; and 1000-79-4-17.22 Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Louisa P. Evans, Justice SECONDER: Thomas H. Wickham, Councilman AYES: Ruland, Orlando, Krupski Jr., Wickham, Evans, Russell , PATRICIA A. FINNEGAN TOWN ATTORNEY patricia.finnegan@town.southold.ny.us KIERAN M. CORCORAN ASSISTANT TOWN ATTORNEY kieran.corcoran@town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lorL hulse@town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hail Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD Janua~ 26,2009 Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 RE: Zoumas Contracting Corp./Deer Run Dedication Drainage Easements Dear Ms. Moore: With respect to the referenced matter, I am enclosing the Drainage Easements for Lot Nos. 4 and 5, which have been executed by Supervisor Russell. Kindly provide us with certified copies of the recorded Easements. Please note that with respect to the Drainage Easement for Lot No. 5, page 4 of the TP-584 form must be signed by the property owner. If you have any questions regarding this matter, please do not hesitate to call me. Thank you. Assistant Town Attorney KMC/Ik ~ Enclosures cc: Ms. Elizabeth A. Neville, Town Clerk (w/encls.) DRAINAGE EASEMENT THIS AGREEMENT made thisD/~ay ot~/~V,'~, etween the J.& MJ Small Revocable Trust, c/o 165 Deer Run, Southold, New York, party of the first part, hereinafter referred to as the "Property Owner", and the Town of Southold, a municipal corporation having principal offices located at 53095 Main Road, Southold, New York, party of the second part, hereinafter referred to as the "Town". WHEREAS, the Property Owner herein is the owner in fee and simple of certain real property designated as Lot # 4 on a certain map entitled "Subdivision Map for Zoumas Contracting Corp." situate at Bayview, Town of Southold, Suffolk County, New York, surveyed by Young & Young Land Surveyors, and filed in the office of the Clerk of the County of Suffolk on October 1, 2004 as Map No. 11166. NOW, THEREFORE, in consideration of Ten Dollars ($10.00) and other good and valuable consideration, the receipt and sufficiency of which the parties hereby acknowledge, the property owner hereby grants unto the Town, it's successor and assigns, a thirty foot (30') drainage easement at the division line between lots 4 & 5 and as more fully described in attached description, as shown on the filed map, for the inspection, maintenance and repair and replacement of underground drainage structures and facilities within such easement area. Upon completion, the Town will restore the affected area with grading and seeding. The easement conveyed herein shall run with the land and shall be binding upon all purchasers and holders of said lot, their heirs, executors, legal representatives, distributees, successors and assigns, and that every purchaser by the acceptance of a deed thereto, covenants and agrees that the premises so purchased shall be held subject to the said easements. IN WITNESS WHEREOF, the parties hereto have caused these presents to be signed on the day and year first above written. J. & MJ SMALL REVOCABLE TRUST IOWN OF SOUTHOLD SCOTT A. RUSSELL SUPERVISOR State of New York ) County of ,~'(tess: On this ~day of,/~/~-- ,~'~'O~: be.~.fore, the undersigned, personally appeared personall~ known to me or proved to me on the'basis of satisfactory evidence to the be 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 capacity0es), 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, exe~strument. PATRICIA C. MOORE ~__._~--~ ~__ Notary Public, State of New Ymk Suffolk County - No. 4861668 Nota~Public Commission Expires June 16 State of New York ) SS: County of On this/~- day of ,~e~., 200~, before, the undersigned, personally appeared SCOTT A. RUSSELL, personally known to me or proved to me on the basis of satisfactory evidence to the be individual(~) whose name(~) is (cra) subscribed to the within instrument and acknowledged to me that he/~ executed the same in his/hcr!thc!r capacity~, and that by his/hm-/the~ signature('~) on the instrument, the individual(~), or the person upon behalf of which the individual(~) acted, executed the instrument. LINDA J COOPER NOTARy PUBLIC, State of New York NO. 01CO4822563, Suffolk Courtt3/ Term Expires December 31, 20./~ N o'ta~ry 'Publi~ ' Zoumas Contracting Corp. at Bayview, Town of Southold, Suffolk County, New York Surveyor's Description 30' Drainage Easement Subdivision, "Zoumas Contracting Corp." ALL that certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being at Bayview, Town of Southold, County of Suffolk, and State of New York, known and designated as a 30' Drainage Easement as shown on Subdivision, "Zoumas Contracting Corp.", more particularly bounded and described as follows: BEGINNING at a point at the division line between Lot 4 & Lot 5, Subdivision, "Zoumas Contracting Corp.", said point being situate the following four (4) courses and distances as measured along the westerly side of Deer Run from the northerly side of North Bayview Road: 2. 3. 4. On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet, North 16 deg. 54 min. 40 sec. East 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, On the arc of a curve to the right having a radius of 85.00 feet for a distance of 71.75 feet; RUNNING thence from said point of beginning on the arc of a curve to the left having a radius of 85.00 feet along Lot 5, Subdivision, "Zoumas Contracting Corp." for a distance of 15.08 feet to a point; RUNNING thence North 87 deg. 41 min. 29 sec. West through Lot 5, Subdivision, "Zoumas Contracting Corp." 302.45 feet to Lot 7, Subdivision, "Zoumas Contracting Corp."; RUNNING thence North 12 deg. 43 min. 46 sec. East along Lot 7, Subdivision, "Zoumas Contracting Corp." 30.50 feet to a point; RUNNING thence South 87 deg. 41 min. 29 sec. East through Lot 4, Subdivision, "Zoumas Contracting Corp." 296.93 feet to the westerly side of Deer Run; RUNNING thence on the arc of a curve to the left having a radius of 85.00 feet along the westerly side of Deer Run for a distance of 15.08 feet to the point or place of Beginning. P-584 (3/07) Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax Recording office time stamp See Form TP-584-1, Instructions for Form TP-584, before completing this form, Please print or type. Schedule A -- Information relating to conveyance Grantor/Transferor [] Individual r-I corporation [] Partnership [] Estate/Trust I--~ Other Grantee/Transfl~ree [] Individual [] Corporation [] Partnership [] Estate/Trust [] Other Name (# individual: last, first, mMdla initial) J & MJ SMALL REVOCABLE TRUST Mailing address 165 DEER RUN City State ZIP code SOUTHOLD NY 11971 TOWN OF SOUTHOLD Mailing address PO BOX 1179 City State ZIP code SOUTHOLD NY 11971 Social s~ecurity number Social security number Federal employer ident, number Social security number Social security number Federal employer ident, number Location and description of property conveyed Tax map designation Address City/village Town County Section Block Lot 165 DEER RUN SOUTHOLD SOUTHOLD SUFFOLK 79 4 17.21 Type of property conveyed (check applicable box) I [] One- to three-family house 5 [] Commercial/Industrial 2 [] Residential cooperative 6 [] Apartment building 3 [] Residential condominium 7 [] Office building 4 [] Vacant land 8 [] Other EASEMENT Date of conveyance Percentage of real property I 08 I conveyed which is residential real property .% month day year (see instructlcns) Condition of conveyance (check all that apply) a. [] Conveyance of fee interest b. [] Acquisition el a ccntrelling interest (state pe~w~ge acqUYed c. [] Transfer of a controlling interest (state percentage transferred d. I-I Conveyance to cooperative housing corporation e. [] Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest (attach Form TP-584.1, Schedule E) For recording officeFs use Amount received f. [] Conveyance which consists of a mere change of identity or form of ownership or organization (at~ach Fom~ TP-584.1, Schedule F) g. [] Conveyance for which credit for tax previously paid will be claimed (a~tach Form TP-584. t, Schedule G) h. i'-I Conveyance of cooperative apartment(s) i. [] Syndication j. [-I Conveyance of air rights or development rights k. [] Contract assignment Schedule B., Part ] $ Date received Schedule B., Part I! $ I. [] Option assignment or surrender m. [] Leasehold assignment or surrender n. [] Leasehold grant o. [] Conveyance of an easement p. [] Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part/i/) q. [] Conveyance of property partly within and partly outside the state r. [] Other (describe) Page 2 of 4 TP-584 (3/07) Schedule B -- Real estate transfer tax return (Tax Law, Article 31) Part ! - Computation of tax due I Enteram~unt~fc~nsiderati~nf~rthec~nveyance(ify~uarec~aimingat~ta~exempti~nfr~mtax~check~he I exemption clalmed box, enter consideration and pmceed to Part ill) .............................. [] Exemption claimed I 1. 2 C~ntinuing~iendeducti~n(seeinstructi~nsifpr~pertyisiakensubjectt~m~rtgage~r~ien) ......................................... I 2. 3 Taxable consideration (subfract line 2 from line 1) ................................................................................................... I 3. 4 Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ......................................................... I 4. 5 Amount of credit claimed (see instructions andattach Form TP-584. I. Schedule G) ................................................... I 5. 6 Tota tax due* (subtract line 5 from line 4) ................................................................................................................ I 6. 0.00 0.00 0.00 0.00 0.00 0.00 Part ]] - Computation of additional tax due on the conveyance of residential real property for $1 million or more I Enter amount of consideration for conveyance (from Part t, line 1) ........................................................................1. 2 TaxabJe consideration (mul~iyline 1 bythepercentageofthepremises whichisresidentialrealproper~ asshowninScheduleA) :: 3 Total additional transfer tax due* (multiply line 2 by t % (.01)) .................................................................................. 0 0 Part []! - Explanation of exemption claimed on Part t, line 1 (ch~ck 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 b. Conveyance is to secure a debt or other obligation ............................................................................................................................ b [] c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................... c [] d. Conveyance of real property is without consideration and not in connection with a sale. including conveyances conveying realty as bona fide gifts ....................................................................................................................................................................... d [] f. Conveyance is a mera change of identity or form of ownership or organization where thera 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.) Attach Form TP-584.1, Schedule F .................................................................... f g, Conveyance consists of deed of partition ........................................................................................................................................... g h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................. h 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 ................................................. [] [] [] 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 the grantors personal residence and consists of a one-, two-, or three-family house, an individual residential condominium unit, or the sate of stock in a cooperative housing corporation in connection with the grant or transfer of a proprieta,'y leasehold covering an individual residential cooperative apartment ....................................................................................................................................... k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401(e) (attach documents supporting such claim) ........................................................................................................................................................................... k I. Other (attach explanation) ..................................................................................................................................................................... I [] [] [] *Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in New York City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department, RE'I-r Return Processing, PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (3/07) Schedule C -- Credit Line Mortgage Certificate (Tax Law, Article 11) Complete the following only if the Interest being transferred Is a fee simple Interest. I (we) certify that: (check the appropriate box) 1. [] The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. [] 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: [] 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 before the transfer. [] The transfer of real property is lA) to a person or persons related by blood, marriage or adoption to the original obligor or to one or more of the original obligors or lB) to a person or entity where 50% or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). [] The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. [] The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and 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 dwelflng. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. [] Other (attach detailed explanation). The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: [] A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. [] 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. 4.1-1 The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by 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 or, if the recording is to take place in New York Ci~ make check payable to the NYC Department of Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undemigned certify that the above information contained in schedules A, B, and C, including any return, certification, schedule, or attachment, is to the best of his/her knowledge, true and complete, and authorize the person(s) submitting such,~orm on,their behalf to receive a copy for purposes of recording the deed or other instrument effecting the ~9.nveyance. G~'~igna uF, - - TI~ ~- ~.~ ~. G~anlee Si~l.nature' /9 J F~' f [ / /Grantor signature ~e Grantee signature Title Rerflihder: Did you complete all of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you checked e, f, or g in Schedule A, did you complete Form TP-584.1 ? Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department of Finance?. If no recording is required, send your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 4 of 4 TP-584 (3/07) Schedule D - Certification of exemption from the payment of estimated pemonal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit is being transferred by an individual or estate or trust. Part ! - New York State residents If you are a New York State resident transfemr(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferors/sellers of the real property or cooperstive unit is a rssident of New York Stale, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferors/sellers. Certification of resident transferor(s)/seller(s) This rs to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) as signed below was a res[dent of New York State, and therefore is not required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of this real property or cooperative unit. Sign~ ~0 Plinl full name Date S,gna~ ~.~ ~ Print full name Date Sign~ f Print full name Date Signature P~int ful~ name Date Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed. Part ]] - Nonresidents of New York State If you ara a nonrasident of New York State listed as a transferer/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but ara eot requirad to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferor(s)/seller(s), that transferar(s)/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonrasident transferors/sellers. If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated personalincome tax, on page 1 of Form TP-584-I. Exemption for nonresident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the raal property or cooperative unit, the transferor(s)/seller(s) (grantor) of this real property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: [] The real properly or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from to. (see instructions). Date Data [] The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. [] The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federsl National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signature Print full name Date Signature Print full name Dale Signature Print full name Date Sigr~ature Print full name Date Peconic Bay Region Community Preservation Fund Please print or type. Schedule A Information Relating to Conveyance [] Individual [] Corporation [] Partnership [] Other [] Individual [] Corporation [] Partnership [] Other Name (individual; last. first, middle initial) J & MJ SMALL RECOVACABLE TRUST Mailing address 165 DEER RUN ~g State ZIP code THOLD NY 11971 Name (individual; last, first, middle initial) TOWN OF SOUTHOLD Mailing address PO B-OX 1179 City State ZIP code SOUTHOLD NY 11971 Social Security Number So¢ia-'] Seeufity Number FedemI employer idenl, number I *deral employer ideM. nu~er Location and description of property conveyed Tax map designation Address Village Town Dist Section Block Lot 1000 79 4 17.21 165 DEER RUN SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box) Date of conveyance [] Improved [ I [ [] Vacant land Dual Towns: Condition of' conveyance (check all that apply) a. - Conveyance of fee interest b. - Aequisition of a controlling interest (state percentage acquired %) c. - Transfer of a controlling interest (state percentage transferred %) d. - Conveyance to cooperative housing corporation e. - Conveyance pursuant to or in lien of foraclosure or enforcement of' security interest f, - Conveyance which consists of a mere change of identity or form of ownership or organization g. - Conveyance for which credit (or tax previously paid will be claimed h. -Conveyancc of cooperative apartment(s) i. - Syndication j. - Conveyance of air right~ or development fights k. - Contract assignment 1. - Option assignment or surrender m. - Leasehold aasignment or surrender n, - Leasehold grant o. - Conveyance of an easement p. - Conveyance for which exemption is claimed (complete Schedule B. Part II) q. - Conveyance of property partly within and partly without the state r. - Other (describe) Schedule B - Community Preservation Fund Part 1 - Computation of Tax Due 1. Enter amount of consideration for the conveyance (from line ] TP584 Schedule B) ................................. 2. Allowance (see below) ......................................................................................................... 3. Taxable consideration (subtract line 2 from line 1) ........................................................................ 4. 2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK 5. Property not subject to CPF Tax (See Schedule C) ........................................................................ For recording officer's use Amount received Date received Transaction number Allowance: East Hampton Shelter Island Southampton $250,000.00 Improved $250,000.00 Improved $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) Riverhead $150,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) Southold $150,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) Schedule C - (continued) Part II - Explanation of Exemption Claimed in Part I, line 1 (check any boxes that apply) The conveyance of real property is exempt from the mai 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 pumuant to agreement or compact with another state or Canada) ............................................................................................................[] b. Conveyance is to secure a debt or other obligation ............................................................................................. [] c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance ..................... [] d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts .............................................................................................................................. [] e. Conveyance is given in connection with a tax sale ............................................................................................. [] f. Conveyance is mere change of identity or form of ownership or organization where them 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.) ............................................................................................................... [] g. Conveyance consists of deed of partition .........................................................................................................[] h. Conveyance is given pursuant to the federal bankruptcy act .................................................................................... [] L Conveyance conslsts of the execution of a contract to sell real property without the use or occupancy of such property or thc granting of an option to purchase real property without the use or occupancy of such property .......................................... [] j. Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) (j) or (k) of Article 31-D of the Tax Law. (See required Town approval, below) ............................................................................................................... [] k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, environmental, or historic preservation purposes ................................................. [] 1. Other list explanations in space below (Grandfather/Contract) ................................................................................. [] m. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 31 -D of the Tax law. (See j in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing to file a return or to pay any tax within the time required shall be subject to a penalty of 10% of the amount of tax due plus an interest penalty of 2% of such amount of each month of delay or fraction thereof after the expiration of the first month after such return was required to be filed or the tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Interest Daily compounded interest will be charged on the amount of the tax due not paid within the time required. Signature (both the grantor(s) and grantee(s) must sign). The undersigned certify that the above return, including any certification, schedut~or attachment, is to th~:~best of his/her DRAINAGE EASEMENT THIS AGREEMENT made this~' ~lay'~ ofJ~,t\~- 2GGS, between Freeform Building Partners, LLC, a domestic limited liability company having principal offices located at 142 Mineola Avenue, Roslyn Heights, New York, party of the first part, hereinafter referred to as the "Property Owner", and the Town of Southold, a municipal corporation having principal offices located at 53095 Main Road, Southold, New York, party of the second part, hereinafter referred to as the "Town". WHEREAS, the Property Owner herein is the owner in fee and simple of certain real property designated as Lot # 5 on a certain map entitled "Subdivision Map for Zoumas Contracting Corp." situate at Bayview, Town of Southold, Suffolk County, New York, surveyed by Young & Young Land Surveyors, and filed in the office of the Clerk of the County of Suffolk on October 1, 2004 as Map No. 11166. NOW, THEREFORE, in consideration of Ten Dollars ($10.00) and other good and valuable consideration, the receipt and sufficiency of which the parties hereby acknowledge, the property owner hereby grants unto the Town, it's successor and assigns, a thirty foot (30') drainage easement at the division line between lots 4 & 5 and as more fully described in attached description, as shown on the filed map, for the inspection, maintenance and repair and replacement of underground drainage structures and facilities within such easement area. Upon completion, the Town will restore the affected area with grading and seeding. The easement conveyed herein shall run with the land and shall be binding upon all purchasers and holders of said lot, their heirs, executors, legal representatives, distributees, successors and assigns, and that every purchaser by the acceptance of a deed thereto, covenants and agrees that the premises so purchased shall be held subject to the said easements. IN WITNESS WHEREOF, the parties hereto have caused these presents to be signed on the day and year first above written. NGRTNERS, LLC ~EMBER TOWN OF SOU./~OLD SCOTT A. RUSSELL SUPERVISOR State of New York ) SS; County of(~ ~ ~ O..F~.,.~- /~/' 'z'/~) ~'£~'/7 ? o ? _ n r nil rd ~ On this2 ~day of ~, ~ oefore, the undemig ed, pe so a y appea e KEVIN MILLER personally k~own to me or proved to me on the basis of satisfacto~ evidence to the be 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 capaci~(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. D~hi 8um~h M. /~~ N~ Publ~ ~. of N~ Yo~Nnf~n~ ~o. 01~1~9 ...... ~ Pub c Q~I~ in ~ ~u~ C~mlssi~ e~. May 12, ~12 State of New York ) Coun~ of J ~ ~ On this/aZ day of~'/~,t-~ , 200~', before, the undersigned, personally appeared SCOTT A. RUSSELL, personally known to me or proved to me on the basis of satisfactory evidence to the be individual(q) whose name(.~) is (e~e) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in hi~hcr/thc=,~ capacity(;~,~, and that by his~ signature(~) on the instrument, the individual(~), or the person upon behalf of which the individual(~)~ acted, executed the instrument. LINDA J CooPER NOTARY PUBLIC, State of New Y°rk ,'~./z,:~.~ ~-- ~ NO, 01CO4822563, Suffolk Cou?~.,Y Term Expires December 31, 20~--~* Notary'Public / ' Zoumas Contracting Corp. at Bayview, Town of Southold, Suffolk County, New York Surveyor's Description 30' Drainage Easement Subdivision, "Zoumas Contracting Corp." ALL that certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being at Bayview, Town of Southold, County of Suffolk, and State of New York, known and designated as a 30' Drainage Easement as shown on Subdivision, "Zoumas Contracting Corp.", more particularly bounded and described as follows: BEGINNING at a point at the division line between Lot 4 & Lot 5, Subdivision, "Zoumas Contracting Corp.", said point being situate the following four (4) courses and distances as measured along the westerly side of Deer Run from the northerly side of North Bayview Road: 2. 3. 4. On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet, North 16 deg. 54 min. 40 sec. East 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, On the arc of a curve to the right having a radius of 85.00 feet for a distance of 71.75 feet; RUNNING thence from said point of beginning on the arc of a curve to the left having a radius of 85.00 feet along Lot 5, Subdivision, "Zoumas Contracting Corp." for a distance of 15.08 feet to a point; RUNNING thence North 87 deg. 41 min. 29 sec. West through Lot 5, Subdivision, "Zoumas Contracting Corp." 302.45 feet to Lot 7, Subdivision, "Zoumas Contracting Corp."; RUNNING thence North 12 deg. 43 min. 46 sec. East along Lot 7, Subdivision, "Zoumas Contracting Corp." 30.50 feet to a point; RUNNING thence South 87 deg. 41 min. 29 sec. East through Lot 4, Subdivision, "Zoumas Contracting Corp." 296.93 feet to the westerly side of Deer Run; RUNNING thence on the arc of a curve to the left having a radius of 85.00 feet along the westerly side of Deer Run for a distance of 15.08 feet to the point or place of Beginning. P-584 (3/07) New York State Department of Taxation and Finance Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal IncomeTax See Form TP-584-/, Instructions for Form TP-584, before completing this form, P/ease print or ~pe. Schedule A -- Information relating to conveyance Recording office time stamp Grantor/Transferor [] Individual [] Corporation [] Partnership [] Estate/Trust [] Other Grantee/Transferee [] Individual [] Corporation [] Partnership [] Estate/Trust [] Other FREEFORM BUILDING PARTNERS, LLC Mailing address 142 MINEOLA AVE City State ZIP code ROSLYN HEIGHTS NY 11577 TOVVN OF SOUTHOLD Social security number Social security number Federal employer ident, number Social security number Mailing address Social security number PO BOX 1179 City State ZIP code Federal employer ident, number SOUTHOLD NY 11971 ?.//-- ~'~ ~' ?~-~ 7 Location and description of property conveyed Tax mapdesignation Address City/village Town County Section Block Lot DEER RUN SOUTHOLD SOUTHOLD SUFFOLK 79 4 17.22 Type of property conveyed (check applicable box) I [] One- to three-family house 5 [] Commercial/Industrial 2 [] Residential cooperative 6 [] Apartment building 3 [] Residential condominium 7 [] Office building 4 [] Vacant land 8 [] Other EASEMENT Date of conveyance Percentage of real property 08 ] conveyed which is residential real property. % monlh day yea~ (see instructions) Condition of conveyance (check all that apply) a. I--I Conveyance of fee interest b. [] Acquisition of a controlling interest (state percentage acquired %) c. [] Transfer of a controlling interest (state percentage transferred %) d. I--J Conveyance to cooperative housing corporation e. D Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest (attach Form TP-584.1, Schedule E) For recording officeFs use Amount received f. [] Conveyance which consists of a mere change of identify 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-584.1, Schedule G) h. D Conveyance of cooperative apartment(s) i. [] Syndication · [] Conveyance of air rights or development rights k. [] Contract assignment Schedule B., Part t $ Date received Schedule B., Part ti $ I. [] Option assignment or surrender m. [] Leasehold assignment or surrender n. [] Leasehold grant o. [] Conveyance of an easement p. [] Conveyance for which exempt[on from transfer tax claimed (complete Schedule B, Part/i/) q, [] Conveyance of property partly within and partly outside the state r. [] Other (describe) Page 2 of 4 TP-584 (3/07) Schedule B -- Real estate transfer tax return (Tax Law, Article 31 ) Part ! - Computation of tax due 1 Enter amount of consideration for the conveyance (if you are claiming a total exemption from tax, check the exemption claimed box, enter consideration and proceed to Part lll) .............................. [] Exemption claimed 2 Continuing lien deduction (see instructions if property is taken subject to mortgage or lien) ......................................... 3 Taxable consideration (subtract line 2 from line I) ................................................................................................... 3. 4 Tax: $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) ................................................... r 5. 6 Tote tax due* (subtract line 5 from line 4) ................................................................................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0 0 0 Part [I - Computation of additional tax due on the conveyance of residential real property for $1 million or more I Enter amount of consideration for conveyance (from Part ], line I) ........................................................................ I 1. I 2 Taxab~ec~nsiderati~n(mui~p~yline1bythepercentage~fthepremiseswh~chisresident~a~rea~pr~per~assh~wninS¢hedu~eA)~` 2. 3 Tota add t onal transfer tax due* (mulliioly line 2 by1% (,01)) .................................................................................. 3. Part [[! - Explanation of exemption claimed on Part [, line 1 (check anyboxes thatapply) 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 NewYork, or any of their instrumentalities, agencies, or political subdivisions (or any public corporation, including a public corporation created pumuant to agreement or compact with another state or Canada) .............................................................................................................................................. a b. Conveyance is to secure e debt or other obligation ............................................................................................................................ b c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................... c d. Conveyance of real property is without consideration and not in cennection with a sale, including conveyances conveying realty as bona fide gifts ....................................................................................................................................................................... d f. Conveyance is a mere change of identity or form of ownereship or organization where there is no change in beneficial ownership. (This exemption cennot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) Attach Form TP-584.1, Schedule F .................................................................... f g. Conveyance consists of deed of partition ........................................................................................................................................... g h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................. h i. Conveyance consists of the execution of a centract to sell real property, without the use or occupancy of such preperty, or the granting of an option to pumhase real property, without the use or occupancy of such property ................................................. Conveyance of an option or contract to purchase real properfy 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 the grantors personal residence and consists of a one-, two-, or three-family house, an individual residential condominium unit, or the sale of stock in a cooperative housing cerporetion in connection with the grant or transfer of a proprietary leasehold covering an individual residential cooperative apartment ....................................................................................................................................... k, Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401 (e) (attach documents supporting such claim) ........................................................................................................................................................................... k [] I. Other (attach explanation) ..................................................................................................................................................................... I [] *Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in New York City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Schedule C -- Credit Line Mortgage Certificate (Tax Law, Article 11) Page 3 of 4 TP-584 (3/07) Complete the following only if the interest being transferred ia a fee simple interest. I (we) certify that: (check the appropriate box) 1. [] The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. [] 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: [] The transfer of real property is a transfer of a fee simple interest to a pemon or pemons who held a fee simple interest in the real property (whether as a joint tenant, a tenant in common or othenvise) immediately before the transfer. [] 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 obligors or (B) to a person or entity where 50% or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). [] The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. [] The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and 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. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. [] Other (attach detailed explanation). 3. [] The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: [] A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. [] 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. 4. [] The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by 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 or, if the recording is to take place in New York Ci~ make check payable to the NYC Department of Finance.) Signature (~c,[h the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, including any return, certification, schedule, er attachment, is to the best of his/her knowledge, true and complete, and authorize the person(s) subrrjj~tting such form on their behalf to receive a copy for purposes of recording the deed or other instrument effecting the conveyance. // Grantor signature Title Grantee signature Title Reminder: Did you complete all of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you checked e, f, or g in Schedule A, did you complete Form TP-584.17 Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department of Finance? If no recording is required, send your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 4 of 4 TP-584 (3/07) Schedule D - Certification of exemption from the payment of estimated pemonal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit is being transferred by an Individual or estate or trust. Part ! - New York State residents If you are a New York State resident transferor(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferors/sellers of the real property or cooperative unit is a resident of New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferors/seHem. Certification of resident transfemr(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transfemr(s)/sel;er(s) as signed below was a resident of New York State, and therefore is not required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of this real property or cooperative unit. Signature Print full name Date Signature Print full name Date Signature Print full name Date Signature Print ful; name Date No. te: .A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a cendition of recording Part H - Nonresidents of New York State If you are a nonresident of New York State listed as a transferal/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but are not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferor(s)/seller(s), that transferor(s}/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space provided. If mom space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonresident transferors/sellers. If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated personalincome tax, on page 1 of Form TP-584-I. Exemption for i~o~,esident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) (grantor) of this reaP property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: [] The real property or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from Date to (see instructions), Date [] The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. [] The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signature Print full name Date Signature Print full name Date Signature Print full name Date Signature Print full name Date Peconic Bay Region Community Preservation Fund Please print or type. Schedule A Information Relatinl~ to Conveyance [] Individual [] Corporation [] Partnership [] Other [] Individual [] Corporation [] Partnership [] Other Name (individual; last. first, middle initial) FREEFORM BUILDING PARTNERS LLC Mailing address 142 MINEOLA AVE. City State ROSLYN HEIGHTS NY ZIP code 11577 Name (individual; last, first, middle initial) TOWN OF SOUTItOLD Mailing address PO BOX 1179 sCiy THOLDOU state ZIP code NY 11971 Location and description of property conveyed Social Security Number I I Social Secu Num7 Federal employer idenl, number I Social Secuity Numier Social Secuity Numier Federal employer idenl, number ( Tax map designation Address Village Town Dist Section Block Lot 1000 79 4 17.22 [}EER RUN SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box) Date of conveyance [] Improved [ I I [] Vacant land Dual Towns: Condition of conveyance (check all that apply) a, - Conveyance offee interest b. - Acquisition of a controlling interest (state percentage acquired %) c. - Transfer of a controlling interest (state percentage transferred %) d, - Conveyance to cooperative housing corporation e, - Conveyance pursuant to or in lleu of foreclosure or enforcement of security interest f. - Conveyance which consists of a mere change of identity or form of ownership or organization g. - Conveyance for which credit (or tax previously paid will be claimed h. - Conveyanceofcooperafiveapartment(s) i. - Syndication j. - Conveyance of air rights or development rights k. Contract assignment 1. Option assignment or surrender m. Leasehold assignment or surrender n, Leasehold grant o. Conveyance of an easement p. Conveyance for which exemption is claimed (complete Schedule B. Part II) q. - Conveyance of property partly within and partly without the state r, - Other (describe) Schedule B - Community Preservation Fund Part I - Computation of Tax Duo 1. Enter amount of consideration for the conveyance (from line 1 TP584 Schedule B) ................................. 2. Allowance (see below) ......................................................................................................... 3. Taxable consideration (subtract line 2 from line 1) ........................................................................ 4. 2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK 5, Property not subject to CPF Tax (See Schedule C) ........................................................................ 1 2 3 4 For recording officer's use Amount received Date received Allowance: East Hampton Shelter Island Southampton $250,000.00 Improved $250,000.00 Improved $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) Riverhead $150,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) Southold $150,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) Schedule C - (continued) Part II - Explanation of Exemption Claimed in Part I, line I (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) ............................................................................................................[] b. Conveyance is to secure a debt or other obligation ............................................................................................. [] c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance ..................... [] d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts .............................................................................................................................. [] e. Conveyance is given in connection with a tax sale ............................................................................................. f. Conveyance is 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.) ............................................................................................................... [] g. Conveyance consists of deed of partition .........................................................................................................[] h. Conveyance is given pursuant to the federal bankruptcy act .................................................................................... [] 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 .......................................... [] j. Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) (j) or (k) of Article 31-D of the Tax Law. (See required Town approval, below) ............................................................................................................... [] k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, environmental, or historic preservation purposes ................................................. [] 1. Other list explanations in space below (Grandfather/Contract) .................... ~ ............................................................ m. The conveyance is approved for an exemption from the Community Presetwation Transfer Tax, under Section 1449-ee of Article 31-D of the Tax law. (Seej in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing to file a return or to pay any tax within the time required shall be subject to a penalty of 10% of the amount of tax due plus an interest penalty of 2% of such amount of each month of delay or fraction thereof after the expiration of the first month after such return was required to be filed or thc tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Interest Daily compounded interest will be charged on the amount of the tax due not paid within the time required. Signature (both the grantor(s) and grantee(s) must sign). The undersigned certify that the above return, including any certification, schedule or attachment, is to the best of his/bet Grantor Grantee PATRICIA A. FINNEGAN TOWN ATTORNEY patricia.finnegan@town.southold.ny.us KIERAN M. CORCORAN ASSISTANT TOWN ATTORNEY kieran.corcoran@town.southold.ny.us LORI HULSE MONTEFUSCO ASSISTANT TOWN ATTORNEY lori.montefusco@town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD March 1,2007 Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 RE: Zoumas Contracting Corp. at Deer Run Dedication of Deer Run and Drainage Easement Dear Ms. Moore: With respect to the referenced matter, I enclose a copy of my letter to you dated August 31,2006. Please note that we are in receipt of copies of the mortgage documents that we requested. However, the dedication search must be certified to the Town Board of the Town of Southold. In addition, item nos. 2, 3, 4, 5, 6 and 7 are still outstanding. We look forward to hearing from you regarding this matter. If you have any questions, please do not hesitate to call me. Very truly yours, moran ~istant Town ^ttomey KMC/Ik Enclosure cc: Ms. Elizabeth Neville, Town Clerk (w/encl.) Mr. Jamie Richter, Engineering Inspector (w/encl.) Mr. Peter Harris, Superintendent of Highways (w/encl.) Patricia A. Finnegan, Esq., Town Attorney (w/encl.) PATRICIA A. FINNEGAN TOWN ATTORNEY patricia, finnegan@ town.southold.ny.us KIERAN M. CORCORAN ASSISTANT TOWN ATTORNEY kieran.corcoran@town.southold.ny.us LORI HULSE MONTEFUSCO ASSISTANT TOWN ATTORNEY lori.monte£usco@town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD August 31,2006 Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 RE: Zoumas Contracting Corp. at Deer Run Dedication of Deer Run and Drainage Easement Dear Ms. Moore: I have reviewed the dedication papers in connection with the referenced matter. Please note the following: 1. The dedication search must be certified to the Town Board of the Town of Southold. In addition, the search refers to a mortgage recorded on 11/3/05 in Liber 21165 at page 178, however, a copy of the mortgage must be included in the dedication search. In addition, we will need to see a copy of the deeds into Freeform Building Partners. Please ask the title company to address these issues and forward us the revised search. 2. Please be advised that the recharge area to be included with this dedication is actually a 30' drainage easement as referred to in the Road and Drainage plans. Therefore, the papers should reflect drainage easement and not recharge area. In this regard, I am enclosing revised forms of the Application and Dedication and Release documents which must be executed before a Notary Public using black ink and returned to me. 3. With respect to Lots 4 and 5 (SCTM Nos. 1000-79-4-17.21 and 17.22), the Town will require a recorded drainage easement from each lot owner. 4. Please note that the Town will require a legal description for Deer Run and the drainage easement, which descriptions must be approved by Jamie Richter. Please submit these descriptions as soon as possible. Patricia C. Moore, Esq. August31,2006 Page 2 5. Please provide us with an additional set of road and drainage plans. We received one set of plans with your papers. For your information, we normally require six sets of these plans, however, in this instance an additional set will suffice. 6. Please provide us with a copy of the filed Subdivision Map. 7. If there are any covenants and restrictions pertaining to this subdivision, kindly forward us copies for review. If you have any questions, please do not hesitate to call me. KMC/Ik Enclosures ~ cc: Ms. Elizabeth Neville, Town Clerk (w/encls.) Mr. Jamie Richter, Engineering Inspector (w/encls.) Mr. Peter Harris, Superintendent of Highways (w/encls.) Patricia A. Finnegan, Esq., Town Attorney (w/encls.) TOWN OF SOUTHOLD: STATE OF NEW YORK In the Matter of the Application of ZOUMAS CONTRACTING CORP. and FREEFORM BUILDING PARTNERS, LLC, for the Laying Out of New Highways and Drainage Easement in Southold, Town of Southold, Suffolk County, New York, to be known as: DEER RUN and DRAINAGE EASEMENT. APPLICATION To the Town Superintendent of Highways of the Town of Southold, in the County of Suffolk and State of New York: The undersigned petitioner, ZOUMAS CONTRACTING CORP., having its principal place of business at no # Route 25A, P.O. Box 361, Wading River, New York, and FREEFORM BUILDING PARTNERS, LLC, having its principal place of business at 142 Mineola Avenue, Roslyn Heights, New York, as owners of DEER RUN and DRAINAGE EASEMENT, liable to be assessed for highway taxes hereby apply to the Superintendent of Highways to lay out new highways and drainage easement at Southold, in the Town of Southold, County of Suffolk and State of New York, as follows: 1. The highways known as DEER RUN and DRAINAGE EASEMENT, as shown and designated on a certain map entitled "Subdivision Map of Zoumas Contracting Corp.", situate at Southold, in the Town of Southold, County of Suffolk and State of New York, filed in the Office of the Clerk of the County of Suffolk on October 1,2004, as Map No. 11166. 2. Maps of said proposed highways are annexed hereto and made a part of the application, together with a release and application to the Dated: Town of Southold by petitioner herein, over whose property said highways are to run. ,2006 ZOUMAS CONTRACTING CORP. By: John Zoumas, President FREEFORM BUILDING PARTNERS, LLC By:. Kevin Miller, Managing Member STATE OF NEW YORK ) COUNTY OF SUFFOLK ) On the __ day of ,2006, before me, the undersigned, personally appeared John Zoumas, 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 he executed same in his capacity and that by his signature on the instrument, the individual, or the person on behalf of which the individual acted, executed the instrument. Notary Public STATE OF NEW YORK ) ) SS.: COUNTY OF SUFFOLK ) On the __ day of ,2006, before me, the undersigned, personally appeared Kevin Miller, 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 he executed same in his capacity and that by his signature on the instrument, the individual, or the person on behalf of which the individual acted, executed the instrument. Notary Public TOWN OF SOUTHOLD: STATE OF NEW YORK In the Matter of the Application of ZOUMAS CONTRACTING CORP. and FREEFORM BUILDING PARTNERS, LLC, for the Laying Out of DEDICATION AND New Highways and Drainage Easement at RELEASE Southold, Town of Southold, Suffolk County, New York, to be known as: DEER RUN and DRAINAGE EASEMENT. We, ZOUMAS CONTRACTING CORP., having its principal place of business at no # Route 25A, P.O. Box 361, Wading River, New York, and FREEFORM BUILDING PARTNERS, LLC, having its principal place of business at 142 Mineola Avenue, Roslyn Heights, New York, being the owners of certain land in Southold, Town of Southold, County of Suffolk and State of New York, and included within which land are proposed highways known as DEER RUN and DRAINAGE EASEMENT, described in the above-entitled matter dated ,2006. NOW, THEREFORE, in consideration of Ten Dollars ($10.00) to us in hand paid by Peter Harris, Superintendent of Highways of said Town of Southold, and in further consideration of laying out of the new highways known as DEER RUN and DRAINAGE EASEMENT, do hereby release and dedicate to the Town of Southold all the land heretofore owned by us within said proposed highways as follows: The highways known as DEER RUN and DRAINAGE EASEMENT, as shown and designated on a certain map entitled "Subdivision Map of ZOUMAS CONTRACTING CORP.", situate at Southold, in the Town of Southold, County of Suffolk and State of New York, filed in the Office of the Clerk of the County of Suffolk on October 1,2004, as Map No. 11166. And we do release the said Town of Southold from all damages by reason of the laying out of the said highways. ZOUMAS CONTRACTING CORP. By: John Zoumas, President FREEFORM BUILDING PARTNERS, LLC By: Kevin Miller, Managing Member STATE OF NEW YORK ) ) SS,: COUNTY OF SUFFOLK ) On the __ day of ,2006, before me personally appeared John Zoumas, 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 he executed same in his capacity and that by his signature on the instrument, the individual, or the person on behalf of which the individual acted, executed the instrument. Notary Public STATE OF NEW YORK ) ) SS.; COUNTY OF SUFFOLK ) On the day of ,2006, before me personally appeared Kevin Miller, 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 he executed same in his capacity and that by his signature on the instrument, the individual, or the person on behalf of which the individual acted, executed the instrument. Notary Public PATRICIA A. FINNEGAN TOWN ATTORNEY patricia.finnegan(~vtown.southold.ny.us KIERAN M. CORCOP. AN ASSISTANT TOWN ATTORNEY kieran.corcoran~:town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hulse~town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD MEMO RA ND UM To: Jamie Richter, Town Engineer .j From: Kieran M. Corcoran, Esq. Assistant Town Attorney $c October 8, 2008 Zoumas & Gendot/Deer Run Dedication Road (1000-79-4-17,23) and Drainage Easement Date: Subject: I am enclosing copies of the legal descriptions sent to us by Patricia Moore, Esq. in connection with the referenced matter. Kindly review the attached descriptions and advise if they are accurate. In addition, I am also enclosing a road and drainage map for your information. Finally, please advise as to whether this dedication is acceptable so that I can have Pete Harris sign the Order Laying Out Highways. Thank you for your attention. KMC/Ik Enclosures cc: Patricia A. Finnegan, Esq., Town Attorney (w/encls.) Ms. Elizabeth Neville, Town Clerk (w/encls.) / Zoumas Contracting Corp. at Bayview, Town of Southold, Suffolk County, New York Surveyor's Description Deer Run Subdivision, "Zoumas Contracting Corp." ALL that certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being at Bayview, Town of Southold, County of Suffolk, and State of New York, known and designated as Deer Run shown on Subdivision, "Zoumas Contracting Corp.", more particularly bounded and described as follows: BEGINNING at a point on the northerly side of North Bayview Road at the southeasterly corner of Lot 5, Subdivision, "Zoumas Contracting Corp.", said point being situate the following three (3) courses and distances as measured along the northerly side of North Bayview Road from the intersection of the easterly side of North Road to Bayview and the northerly side of North Bayview Road: South 73 deg. 51 min. 20 sec. East 240.67 feet, South 72 deg. 56 min. 00 sec. East 180.22 feet, South 73 deg. 05 min. 20 sec. East 502.79 feet; RUNNING thence from said point of beginning along Lot 2, and Lot 1, Subdivision, "Zoumas Contracting Corp." seven (7) courses and distances: Lot 5, Lot 4, Lot 3, the following 2. 3. 4. 5. 6. 7. On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet, North 16 deg. 54 min. 40 sec. East 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, On the arc of a curve to the right having a radius of 85.00 feet for a distance of 453.85 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, South 16 deg. 54 min. 40 sec. West 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet to the northerly side of North Bayview Road; RUNNING thence North 73 deg. 05 min. 20 sec. West along the northerly side of North Bayview Road 100.00 feet to the point or place of Beginning. Zoumas Contracting Corp. at Bayview, Town of Southold, Suffolk County, New York Surveyor's Description 30' Drainage Easement Subdivision, "Zoumas Contracting Corp." ALL that certain plot, piece or parcel of land with the buildings and improvements thereon erected, situate, lying and being at Bayview, Town of Southold, County of Suffolk, and State of New York, known and designated as a 30' Drainage Easement as shown on Subdivision, "Zoumas Contracting Corp.", more particularly bounded and described as follows: BEGINNING at a point at the division line between Lot 4 & Lot 5, Subdivision, "Zoumas Contracting Corp.", said point being situate the following four (4) courses and distances as measured along the westerly side of Deer Run from the northerly side of North Bayview Road: 2. 3. 4. On the arc of a curve to the left having a radius of 25.00 feet for a distance of 39.27 feet, North 16 deg. 54 min. 40 sec. East 183.84 feet, On the arc of a curve to the left having a radius of 25.00 feet for a distance of 27.47 feet, On the arc of a curve to the right having a radius of 85.00 feet for a distance of 71.75 feet; RUNNING thence from said point of beginning on the arc of a curve to the left having a radius of 85.00 feet along Lot 5, Subdivision, "Zoumas Contracting Corp." for a distance of 15.08 feet to a point; RUNNING thence North 87 deg. 41 min. 29 sec. West through Lot 5, Subdivision, "Zoumas Contracting Corp." 302.45 feet to Lot 7, Subdivision, "Zoumas Contracting Corp."; RUNNING thence North 12 deg. 43 min. 46 sec. East along Lot 7, Subdivision, "Zoumas Contracting Corp." 30.50 feet to a point; RUNNING thence South 87 deg. 41 min. 29 sec. East through Lot 4, Subdivision, "Zoumas Contracting Corp." 296.93 feet to the westerly side of Deer Run; RUNNING thence on the arc of a curve to the left having a radius of 85.00 feet along the westerly side of Deer Run for a distance of 15.08 feet to the point or place of Beginning. PATRICIA A. FINNEGAN TOWN ATTORNEY patricia.fin negan~:town.southold.ny.us KIERAN M. CORCORAN ASSISTANT TOWN ATTORNEY kieran.corcoran(cetown.southold.ny.us LORI M. HUL~E ASSISTANT TOWN ATTORNEY lori.hulse~i~town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD October 14, 2008 RECEIVED VIA FACSIMILE and FIRST CLASS MAIL OCT Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 RE: Zoumas Contracting Corp. at Deer Run Dedication of Deer Run and Drainage Easement Dear Ms. Moore: With respect to the referenced matter, please be advised that we have completed our review of the Drainage Easement documents that you submitted for Lot Nos. 4 and 5. These documents are acceptable in form, however, according to our records, the owner of Lot No. 4 (SCTM #1000-79-4-17.21) has changed. I am enclosing a printout that reflects the current owner information. Therefore, we will require a Drainage Easement from the current owner of Lot No. 4. Upon our receipt of the executed and notarized Drainage Easements, we will obtain Supervisor Russell's signature. We will submit a resolution for the 10/21/08 Town Board meeting authorizing Supervisor Russell to sign both Easements. Please note that we will require copies of the recorded Easements prior to concluding this matter. In addition, we will require a Release in connection with the mortgage of record with Keybank National Association as it pertains to the road (SCTM #1000-79-4-17.23). This Release will need to be recorded prior to concluding this matter. Finally, Jamie Richter is in the process of reviewing the legal descriptions and reviewing the road and drainage plan. Patricia C. Moore, Esq. October 14, 2008 Page 2 We look forward to hearing from you regarding this matter. any questions, please do not hesitate to call me. kieran M. Corcoran Assistant Town Attorney KMC/Ik Enclosure cc: Ms. Elizabeth Neville, Town Clerk (w/encl.) / Mr. Jamie Richter, Engineering Inspector (w/encl.) Mr. Peter Harris, Superintendent of Highways (w/encl.) Patricia A. Finnegan, Esq., Town Attorney (w/encl.) If you have 79 4 17 21 473889 Southold A~tive Spec [ Description mage$ Site (1) Re~ Sa eOB?lO/O~ ,Site (1) SaleOD?21/O Sale09/21/85 IDeed Book. [Deed'Page:, >el~onaI Prop: Net Sale Ricer ~,900,000 Isable: i- OR' Part of a Parcel: Sale 'SelesBtatus: IT' Tmansm,ited J, · ;I F",¢. ~'d~t Vie,,., Toolbar Wndow Help Small J & NJ 2004 Revoc T~ustRollYear 2009 Next Y[ I Famil~ Res 1~5 Deer Run Land Size: 1.90 eClel Ownm ' laxBl M~IngAddre~ 3rd PaftyAdd~e~ Bank' J, Pa;col 79,-4-17.21 E:,:ernptL~ ~ ! SpecDk DescriDt~OP Site [1 ] R es Sate08/10/07 , -Site [11R S al e09/21 z~ 0E S ale09/21/0~ School: Southold School Land AV: 2.100 T otalAV: 20.800 ;treat No: Prefix D~r: Street / Rural Raut¢: St Suffix: Post Bit: Uni Name: Unit No: Po Box No: City/To.n: State: ' ZiP Code: Country; eneHfnot USA BarCd. O~nersh~p,e~.L~feUs Ow?r~ype: i', 7 ...... ...... ~eady · 'i File Edit View Toolba~ Windnw Help /9 -4 17 21 473889 Southold Active R/S:1 School: Southold School Small J & MJ 2004 Revoc T~uatRollYear: I~O'~ Next Yr I FamiJy Res ~' LandAV: 2.100 Land Size: TotalS: 165 I)ee~ Bun Parcel 79..4-17.21 A~sessment E~emptls) Spec Distl D escriptior 0 wnerJsl images Bis S ale08/10/07 I .Site [1) R ~i' Sale09/21/05 Sale09/21/05 Sale Additional Sales Info/Attorney Info ~ OwneI{~] 1 )eed Date: 11103/200~ Deed Book: 12418 Deed Page 44G Centred Date: 00/00/0000 Sale Date: 09/21/2005 Date Last Phy tnsp: :,00/00/0000 Full S ale Price: 1.8~*0.000 Personal Prop Net Sale Pnce: ' 840.000 Valuation Usable: ,./ Deed Type Sales Status: 'Co~lection~ Data Veri~y; Condition Code Sale Date Sale Price or Pelsonal Propelty :tar E~cluded Not Residential Cod E~cluded: Ye~ No. Parcels: .... 4 OR Pelt of a Parcel.. Arms Length: Yes F~eeJorm B uildine Partnel 09121,/2005 M: JrStec P ~.= d y F~I¥ Emt ew [cc, lbat VCJndow Held Small J & M3 2004 Revoc Tru~[Rol!~ea~: ~20~9 Next Y[ I Family Re~ ' L~ndAV: 2.i00 _ 165 Deer Run Land'Size To[alAV~ 20.800 I - ; Pmme179.-4-17,21 5 ~ DescriDliOn Si~e(l~ Res Sale08/10/07 :', -S ell}R, S ate09/21/05 ~ SaleO~/2~/05 D~ed P~ge k~4~ I Conbac Date! ;0010O./O000 Price: ':1 ~ 5 OR Paffof a Pa~ce]: Viev,~ Cond Codes F Io pATRICIA A. FINNEGAN TOWN ATTORNEY patricia.finnegan(~)town.southold.ny.us KIERAN M. CORCORAN ASSISTANT TOWN ATTORNEY kieran.cor coran(q/town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hulse(Wtown.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD October 14, 2008 RECEIVED OCT 1 5 2008 Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 RE: Zoumas Contracting Corp. and Gendot Homes, Inc. Dedication of Drainage Area and Recharge Basin Dear Ms. Moore: With respect to the referenced transaction, I am enclosing the Drainage Easement for Lot No. 3, which has been executed by Supervisor Russell. Kindly provide us with a certified copy of the recorded Easement. Upon our receipt of this recorded Easement, we will be in a position to finalize this dedication. If you have any questions regarding this matter, please do not hesitate to call me. Thank you. ssistant Town Attorney KMC/Ik Enclosure / cc: Ms. Elizabeth A. Neville, Town Clerk (w/encl.) Number of pages TORRENS Serial # Certificate # Prior Ctf. # Deed. Mortgage Instrument Deed / Mortgage Tax Stamp Recording / Filing Stamps FEES Page / Fihng Fee Handling TP-584 Notation EA-5217 (County) EA-5217 (State) R.ETS.A. Comm. of Ed. Affidavit Certified Copy Reg. Copy Other 1000 070.00 4 District Section Real Property Tax Service Agency Verification 5. 00 5. 00 Sub Total Sub Total Grand Total [ {~13o~2 0 [LOo~2.003 Satisfaction/Discharges/Release List Property Owners Mailing Address RECORD & RETURN TO: PATRICIA A. FINNEGAN, ESQ. TOWN OF SOUTHOLD, OFFICE OF TOWN ATTORNEY P.O. BOX 1179 SOUTHOLD, NY 11971-0959 o.[ Name Title # 8 5 Mortgage Amt. 1. Basic Tax 2. Additional Tax Sub Total Spec. / Assit. or Spec. / Add. TOT. MTG. TAX Dual Town __ Dual County __ Held for Appointment __ Transfer Tax Mansion Tax The property covered by this motgage is or will be improved by a one or two family dwelling only. YES or NO If NO, see appropriate tax clause on page # of this instrument. Community Preservation Fund Consideration Amount $ 0 CPF Tax Due $_ 0 Improved X Vacant Land TD TD TD Title Company In_formation Sunrise Abstract LLC 622-S-2171-SS Suffolk County Recording & Endorsement Page This page forms part of the attached DRAIlXlAa~ ~ASEMENT made by: (SPECIFY TYPE OF INSTRUMENT) The premisis herein is situated in MICHAEL INNAMORATO & LILLIAN DIAZ SUFFOLK COUNTY, NEW YORK. TO In the Township of SOUTHOLD In the VILLAGE TOWN OF $OUTHOLD or HAMLET of SOUTHOLD BOXES 6 THROUGH 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING (avar~ DRAINAGE EASEMENT THIS AGREEMENT made this ~O day of~ , 2008, between MICHAEL INNAMORATO AND/ILLIAN DIAZ residing at 2145 Oaklawn Avenue, Southold, New York, party of the first part, hereinafter referred to as the "Property Owner", and the Town of Southold, a municipal corporation having principal offices located at 53095 Main Road, Southold, New York, party of the second part, hereinafter referred to as the "Town". WHEREAS, the Property Owner herein is the owner in fee and simple of certain real property designated as Lot #3 on a certain map entitled "Map of Peconic Development Corp." situate at Southold, Town of Southold, Suffolk County, New York, surveyed by Peconic Surveyors, PC and filed in the office of the Clerk of the county of Suffolk on December 27, 2001 as Map No. 10723. NOW, THEREFORE, in consideration of Ten Dollars ($10.00) and other good and valuable consideration, the receipt and sufficiency of which the parties hereby acknowledge, the property owner hereby grants unto the Town, it's successor and assigns, a drainage easement over the southwesterly twenty (20) feet along Oaklawn Avenue, as shown on the filed map, and as more fully described in attached description, for the inspection, maintenance and repair and replacement of underground drainage structures and facilities within such easement area. Upon completion, the Town will restore the affected area with grading and seeding. The easement conveyed herein shall run with the land and shall be binding upon all purchasers and holders of said lot, their heirs, executors, legal representatives, distributees, successors and assigns, and that every purchaser by the acceptance of a deed thereto, covenants and agrees that the premises so Peconic Abstract, Inc. Title No.: PAC-3895 D Schedule A Description ALL that certain plot, piece or parcel of land, situate, lying and being at Southold, Town of Southold, County of Suffolk and State of New York, known and designated as and by the lot number 3 on a certain map entitled, "Subdivision Map of Peconic Development Corp. at Southold, Town of Southold, Suffolk County, N.Y., April 3, Peconic Surveyors, P.C.", and flied in the Office of the Clerk of the County of Suffolk on December 27, 2001 as Map Number 10723, which said lot is more particularly bounded and described as follows: BEGINNING at a point on the easterly side of Oaklawn Avenue distant 375.00 feet southerly, when measured along the easterly side of Oaklawn Avenue from the corner formed by the intersection of the easterly side of Oaklawn Avenue and the southerly side of Jernick Lane; RUNNING THENCE North 66 degrees 36 minutes 10 seconds East, 350.00 feet; THENCE South 36 degrees 53 minutes 40 seconds East, 128.55 feet; THENCE South 66 degrees 36 minutes 10 seconds West, 380.00 feet to the easterly side of Oaklawn Avenue; THENCE North 23 degrees 23 minutes 50 seconds West along the easterly side of Oaklawn Avenue, 125.00 feet to the point or place of BEGINNING. purchased shall be held subject to the said easements. IN WITNESS WHEREOF, the parties hereto have caused these presents to be signed on the day and year first above written. MICHAEL INNAMORATO ~ILLIAN DIAZ TOWN OF SOUTHOLD SCOTT A. RUSSELL, SUPERVISOR State of New York ) ss: County of Suffolk ) On this~O day of/~/~', 2008, before, the undersigned, personally appeared Michael Innamofato and Lillian Diaz, personally known to me or proved to me on the basis of satisfactory evidence to the be 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, exe~~ Notary Public pATFIICIA C. MOORE NotaW publiC, State of New Ik counW ' No. 4861 ~misSion E~res June 18, ~ State of New York ) SS: County of Suffolk ) On this ? day of ~.~7-. ,2001], before, the undersigned, personally appeared SCOTT A. RUSSELL, personally known to me or proved to me on the basis of satisfactory evidence to the be 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. Notary Public u . LINDA J COOPER NOTARY PUBLIC, State of New York NO. 01C04822563, Suffolk Coun.t~( Term Expires December 31, 20 /~ TP-584'(3/07) New York State Depertment of Taxation and Finance Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax Recording ofhce time stamp See Form TP-584-1, Instructions for Form TP-584, before completing7 this form, Please print or type. Schedule A -- Information relating to conveyance Grantor/Transferor [] Individual [] Corporation [] Partnership [] Estate/Trust [] Other INNAMORATO, MICHAEL & DIAZ, LILLIAN Mailing address 2145 OAKLAWN AVE Social security number City State ZIP code Federal employer ident, number SOUTHOLD NY 11971 Grantee/Transferee Name (if ~hdividual, last, hrst, middle initial) Social security number [] Individual TOWN OF SOUTHOLD [] Corporation Mailing address Social security number [] Partnership PO BOX 1179 [] Estate/Trust City State ZIP code Federal employer ident, number [] Other SOUTHOLD NY 11971 i ~-- ZOO (" ? -.~ ? Location and description of property conveyed Tax map designation Address City/village Town County Section Block Lot 2145 OAKLAWN AVE SOUTHOLD SOUTHOLD SUFFOLK 70 3 22,3 Type of property conveyed (check apphcable box) 1 [] One- to three4amily house 5 [] Commercial/Industrial 2 [] Residential cooperative 6 [] Apartment building 3 [] Residential condominium 7 [] Office building 4 [] Vacant land 8 [] Other Date of conveyance Percentage of real property conveyed which is residential real property % Condition of conveyance (check all that apply) a. [] Conveyance of fee interest b. [] Acquisition of a controlling interest (state percentage acquired .%) c. [] Transfer of a controlling interest (state percentage transferred %) d. [] Conveyance to cooperative housing corporation e. [] Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest (attach Form TP-584,1, Schedule E) f. [] Conveyance which consists of a mere change of identify 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 584 1, Schedule G) h. [] Conveyance of cooperative apartment(s) i. [] Syndication j. [] Conveyance of air rights or development rights k. [] Contract assignment L [] Option assignment or surrender m. [] Leasehold assignment or surrender n.[] Leasehold grant o. [] Conveyance of an easement p. [] Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part III) q, [] Conveyance of property partly within and partly outside the state n [] Other (describe) EASEMENT For recording officer's use Date received Amount received Schedule B., Part 1 $ Schedule B., Part Il $ · Page 2 of 4 TP-584 (3/07) Schedule B -- Real estate transfer tax return (Tax Law, Article 31) Part ! - Computation of tax due I Enter amount of consideration for the conveyance (if you are cia~ming a total exemphon from tax, check the exemption claimed box, enter consideration and proceed to Part III) .............................. [] Exemption claimed 2 ~ntinuing~iendeducti~n(seeinstructi~nsffpr~pertyistakensubjectt~m~rtgage~rlien) ......................................... 3 Taxableconsideration(subtractline2fromlinel) ................................................................................................... 4 Tax: $2 for each $500, or fractional par thereof, of cons deration on line 3 ......................................................... 5 Amount of cr.edit claimed (see instructions and a tach Form TP-584,1, Schedule G) .................................................... 6 Total tax due (subtract line 5 from line 4) ................................................................................................................ 000 000 000 000 000 000 000 Part [! - Computation of additional tax due on the conveyance of residential real property for $1 million or more I Enter amount of consideration for conveyance (from Part 1, line 1) ........................................................................ I 1. I 2 Taxab~ec~nsiderati~n(mu~tip~y~ine1bythepercentage~fthepremiseswh~chisre$identia~rea~pr~perty~assh~wninSchedu~eA)~.~ 2.I 3 Total additional transfer tax due* (mu #ply ne 2 by % (or)) 000 O0 Part I]I - Explanation of exemption claimed on 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 NewYork, 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 b. Conveyance is to secure a debt or other obligation ............................................................................................................................ b [] c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................... c [] d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realtyas bona fide gifts ....................................................................................................................................................................... d [] e. Conveyance is given in connection with a tax sale ............................................................................................................................. e [] 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 dwellings0 Attach Form TP-584.1, Schedule F .................................................................... f g. Conveyance consists of deed of partition ........................................................................................................................................... g h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................. h 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 ................................................. 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 the grantor's personal residence and consists of a one-, two-, or three-family house, an individual residential 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 apartment ....................................................................................................................................... k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401 (e) (attach documents supporting such claim) ........................................................................................................................................................................... k Other(attach explanation) ..................................................................................................................................................................... I *Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in NewYork City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Schedule C -- Credit Line Mortgage Certificate (Tax Law, Article 11) Page 3 of 4 TP-584 (3/07) Complete the following only if the interest being transferred is a fee simple interest. I (we) certify that: (check the appropriate box) 1. [] The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. [] 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: [] 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 before the transfer. [] 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 obligors or ¢3) to a person or entity where 50% or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). [] The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. [] The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and 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. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. [] Other (attach detailed explanation). The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: [] A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. [] 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 a,s soon as it is available. The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by 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 or, if the recording is to take place in New York City, make check payable to the NYC Department of Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, including any return, certification, schedule, or attachment, is to the best of his/her knowledge, true and complete, and authorize the person(s~ submitting such form on their behalf to receive a copy for purposes c~ rec~'ding ~ deed or other instrument effecting the conveyanc~e..~__/~'..../co C,~.../L~.~ ~ -- Grantor ~i~nature ~ ~ ~ O ~ -- ' ~ ~ . --.~ ¢-~ ~ ~ Grantor signature Title Grantee signature Title Reminder: Did you complete all of th~red information in Schedules A, B, and C? Are you required to complete Schedule D? If you checked e, ~ or g in Schedule A, did you complete Form TP-584.1 ? Have you attached your check(s) made payable to the coun~ clerk where recording will take place or, if the recording is in New York City, to the NYC Department of Finance? If no recording is required, send your check(s), made payable to lhe Department of Taxation and Finance, directly to the NYS Tax Department, RE~ Return Processing, PO Box 5045, Albany NY 12205-5045. ' I~age 4 of 4 TP-584 (3/07) Schedule D - Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit Is being transferred by an individual or estate or trust. Part 1 - New York State residents If you are a New York State resident transferor(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferors/sellers of the real property or cooperative unit is a resident of New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferors/sellers. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) as signed below was a resident of New York State, and therefore is r~ot required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of this unit. MICHAEL INNAMORATO LtLLIAN DIAZ Note: A resident of NewYork State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed. Part ti - Nonresidents of New York State If you are a nonresident of NewYork State listed as a transferodseller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but are not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferor(s)/seller(s), that transferor(s)/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space provided, if more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonresident transferors/se~lers. If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated personalincome tax, on page 1 of Form TP-584-L Exemption for nonresident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) (grantor) of this real property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: ~]The real property or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from to (see instructions). Date Date [] The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. [] The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signature Print full name Date Signature Print full name Date Sig~ature Print full name Date Signature Print full name Date Peconic Bay Region Community Preservation Fund Please print or type. Schedule A Information Grantor [] Individual [] Corporation [] Partnership [] Other Grantee [] Individual [] Corporation [] Partnership [] Other Relatin$ to Conveyance Name (individnal; last, first, middle initial) INNAMORATO~ MICHAEL & DIAZ, LILLIAN Mailing address 2145 OAKLAWN AVE City State ZIP code SOUTItOLD NY 11971 Name (individual; last. first, middle initial) TOWN OF SOUTHOLD Mailing address PO BOX 1179 City State ZIP code SOUTHOLD NY 11971 Location and description of property conveyed Social Security Number Social Security Number Federal employer idenl, number Social Secu]ity Numier Social Secuity Numier Federal employer idenl, number Ill &oo Tax map designation Address Village Town Dist Section Block Lot 1000 70 3 22.3 H45 OAKLAWN AVENUE SOUTllOLD SOUTItOLD Type of property conveyed (check applicohle box) Date of conveyance Dual Towns: [] Improved j j j [] Vacant land Condition of conveyance (check all that apply) a. Conveyance of t~e interest b. - Acquisitionofacontrollingintercst(state percentage acquired %) c. - Transfer of a controlling interest (state percentage transferred %} d. - Conveyance to cooperative housing corporation e. - Conveyance pursuant to or in lieu of foreclosure or enforcement of seculity interest f. - Conveyance which consists of a mere change of identity or form of ownership or organization g. Conveyance f~r which credit (or lax previously paid will be claimed h. - Conveyance ol cooperative apartntent(s) i. - Syndication j. - Conveyance of air rights or development rights k. - Contract assignment I. - Option assignment or surrender tn. - Leasehold assignment or surrender n, - Leasehold grant o. - Conveyance of an easement p. - Conveyance for which exemption is claimed (complete Schedule B. Part II) q. ~ Conveyanceofpropertypartlywithinand partly without the state n - Other (describe) Schedule B - Community Preservation Fund Part I - Computation of Tax Due 1. Enter amount of consideration for the conveyance (from linc I TP584 Schedule B) ................................. 2. Allowance (see below) ......................................................................................................... 3. Taxable consideration (sub/ract line 2 from linc 1) ........................................................................ 4. 2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK 5. Property not subject to CPF Tax (See Schedule C) ........................................................................ 1 0)1 2 0)( 3 0)( 4 0)( For recording officer's use Transaction number Allowance: East Hampton Shelter Island Southampton $250,000.00 Improved $250,000.00 Improved $250,000.00 Imprttved $100,000,00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) Riverhead $150,000.00 Itnproved $ 75,000.00 Vacant Land (Unitnproved) Southold $150,000,00 Improved $ 75,000,00 Vacant Land (Unimproved) Schedule C - (continued) Part II - Explanation of Exemption Claimed in Part 1, 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) ............................................................................................................ b. Conveyance is to secure a debt or other obligation ............................................................................................. [] c. Conveyance is without additional consideration to confirm, correck modify or supplement a prior conveyance ..................... [] d. Conveyance of real property is without considemtion and not in connection with a sale, including conveyances conveying realty as bona fide gifts .............................................................................................................................. [] e. Conveyance is given in connection with a tax sale ............................................................................................. [] Conveyance is 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 rea] property comprising the cooperative dwelling or dwellings.) ............................................................................................................... g. Conveyance consists of deed of partition ......................................................................................................... [] h. Conveyance is given pursuant to the federal bankruptcy act .................................................................................... [] 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 .......................................... [] j. Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) (j) or (k) of Article 31-D of the Tax Law. (See required Town approval, below) ............................................................................................................... [] k, Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, enviromnental, or historic preservation purposes ................................................. [] I. Other list explanations in space below (Grandfather/Contract) ................................................................................. [] m. The conveyance is approved for an exemption from the Community Preservation Transfer Tax. under Section 1449-ee of Article 31-D of the Tax law. (See j in Schedule C) Tuwn Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing to file a return or to pay any tax within thc time required shall be subject to a penalty of 10% of the amount of tax duc plus an interest penalty of 2% of such amount of each month of delay or fraction thereof after the expiration of the first month after such return was required to be filed or thc tax became duc. However, the interest penalty shall not exceed 25% in the aggregate. Interest Daily compounded interest will be charged on the amount of the tax due not paid within the time required. Signature (both the grantor(s) and grantee(s) must sign). The that return, undersigned certify the above including ...~.__oc.O t,L ~1~,. <_~.` ~ .~/.x:~~ ~'~ '.'~ of his/her / ~~ple~ ~ any certification, schedule~r attachment, is to~ best { . Grante~ ~ / ~ ~ ~ , MARTIN D. FINNEGAN TOWN ATTORNEY martin.finnegan@town.southold.ny.us JENNIFER ANDALORO ASSISTANT TOWN ATTORNEY jennifer, andaloro@town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hulse@town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hall Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD AugHst 4, 2009 RECEIVED VIA FACSIMILE and FIRST CLASS MAIL Patricia C. Moore, Esq. 51020 Main Road Southold, NY 11971 AUG 5 2009 Southold Town Clerk RE: Deer Run/Road and Drainage Dedication Dear Ms. Moore: Pursuant to Kieran Comoran's letter to you dated February 5, 2009, as well as telephone conversations with Betsy in your office over the past few months, please be advised that we are still awaiting receipt of the recorded Declaration pertaining to the center island, an additional copy of which is enclosed, in connection with the referenced matter. Please note that we were contacted by Joseph Small, a resident on Deer Run, yesterday afternoon inquiring about the status of the referenced dedication. This dedication has not been concluded and will not be concluded until we are in receipt of the recorded Declaration regarding the center island. If you have any questions regarding this matter, please do not hesitate to call me. JA/Ik ~iA~sfstant ~Tow~ Enclosure / cc: Ms. Elizabeth Neville, Town Clerk (w/encl.) Mr. Peter Harris, Superintendent of Highways (w/o encl.) Mr. Jamie Richter, Engineering Inspector (w/o encl.) DECLARATION This Declaration ("Declaration") is made this day of building Partners, LLC, hereafter referred to as "Decloxant" ,2005, by Freeform WHEREAS, the Declarant is the owner in fee simple of real property situate in the Town of Soutbold, county of Suffolk. State of New York, known and designated on the Suffolk County Tax Map as District 1000, Section 75, Block 2, Lot 2 and WHEREAS, Declarant has acquired the rights to build a certain subdivison of real property consisting of tlve (5) lots, as shown on the Subdivision map of , annexed h~mto and made a pa~ hereof as Exhibit "A" and WHEREAS, Declarant desirss to provide for maintenance and management of tho certain culdusac "island consisting of a certain design as Annexed hereto and made a part hereof as Exhibit "A"; NOW, THEREFORE, for the pmposes of carrying out the intentions above expressed and in consideration of the foregoing recitals, the Declarant hereby covenants and agrees that all of the said Lots shall hereafter be subject to the covemmts and restrictions as herein cited. All the provisions of this Declaration shall operate aa covenants running with the land and shall be binding upon all purchasers and holders of the Lots, their heirs, succas~ors and assigns, to wit: A. ISLAND DESIGN AND CONSTRUCTION The subdivision mad culdusac shall contain a certain Island consisting of decoralive vegetation and design as set forth in Exhibit "B' and to be located a ~bown on the subdivision map and shall be of a kind and nature consistent with that approved by he municipality having said jurisdiction to approve same all to be consU'ucted in accordance with Town of Southold specifications. Title to the culdusac land, vegetation and design shall be dedicated to the Town of Southold subject to this declaration which shall be a covenant and restriction running with the land of each and every of the Five homes constructed under the approvals given by the Town, and shall be equally divided amongst each and every one of thc homeowners of said Five homes contained in this subdivision subject to this Declaration. MAINTENANCE AND MANAGEMENT OF ROAD 1. The owners of each of the subdivision lots hereby covenant and agree that they shall manage, administer, maintain and operate the Islkand contained in the said culdesac area in accordance with the provisions of this Declaration. The homeowners hereby agree to provide year~round management of the culdusac island in accordance with normal, customary and responsible management practices, which practices include but are not limited to: The routine maintenance of thc vegetation, plantings, decorative structures, and all other items placed within the boundaries of said Island structure, including but not limited to, litter collection, pruning, replacement of deceased, dangerous or defective plantings or vegetation, and repair of the surface and or structures contained thereon and therein, including that of any electric or water supply as the case may be, and to generally and as necessm~j keep the Island in presentable appropriate order as defined by the Town of Sothold and or other Municipality having jurisdiction. The use and or retention of agents, subcontractors or employees deemed by Freeform Building Partners, LLC or its successors or assigns to be reasonably necessary to carry out the responsibilities under this Declaration. MANAGEMENT COSTS 1. Freeform Building partners, LLC, in its sole discretion, shall: Prepare a budget and apportion to thc Lot Owners an equal share of the costs of managing the Island contained in thc culdusac (hereinafter referred to as "Maintenance Costs") including, but not limited to, the costs of administration, if any, taxes if any, insurance, maintenance and repair. In the event that unforeseen extraordinary expenses arise and sufficient funds are not available thc homeowners may recommend and require a special assessment to each of the homeowners which must be approved by a simple majority of ail Lot Owners so assessed. Subsequent to approval thereof the homeowners shall be obligated to promptly pay the amount of the Special Assessment to repair, replace and or maintain said culdusac Island, PERMITTED AND PROHIBITED USES 1. Declarant hereby declares that the Island Culdusac shall be not be used by the Owners, their guests and invitees other than as a decorative parcel whci shal be maintained by thc homecwners at all times, subject to the following restrictions: When installing, maintaining, or otherwise servicing utility and service lines, Lot Owners shall have their respective agents, employees, contractors, and subcontractors, and other representatives (1) use reasonable care not to damage the vegetation, plantings and or other smictures contained therenn or therein.; (ii) minimize the disturbance of shrubbery or other vegetation within the boundaries of the Island within the culdnsac; and (iii) upon completion of any repair or maintenance, restore the Island substantially to the same condition as it existed at the time of commencement of the work, bo The Island within the Culdusac shall not be used for the dumping or abandoning of any solid waste or debris on or along its boundaries. No construction or installation or substantial alteration of any sa'uctures of any kind, permanent or otherwise, or the vegetation thereon (including, hut not limited to, fences), may be made without prior written consent of the Town of Southold. No construction or installation of any structures and/or landscaping which serve to impede sight lines along, entering upon, or exiting from the culdusac may be made. No alteration or modification of the Island, once constructed, will be permitted without prior written consent of the Town of Southold Planning Board, the Buildings Department or any other municipality having jurisdiction there over, TERMS OF PAYMENT All Maintenance Costs, Reserve Fund fees, and Special assessments as detailed above shall be billed to the lot Owners in their preportionate share and shall be requh, ed to be paid within thirty (30) days after the date of thc bill submitted for same. The Lot Owners shall comply with the terms of this declaration. In the event that any Lot Owner fails to comply with thc terms set forth herein within thirty (30) days al~er notice of violation is given, the Town of Southold, or any other municipality having jurisdiction shall have thc right and POWer to enforce by any proceeding at law or in equity, ail the terms of this Declaration. MISCELLANEOUS 1. Freeform Building Partners, LLC its successors and assigns hereby mal~e a continuing offer of dedication of the Island within the culdusac to the Town of Southold which the Town may formally accept in the event one or more of the following events occurs: a. The conditions for acceptance of the offer of dedication of the road set forth in the Resolution of Conditional Final Approval for the subdivision adopted by the Town of Southold Planning Board on That the Island within the Culdusac is in a state of disrepair and remains in that state for a period of 120 days after receipt of written notice from the Town of Southold, That these covenants and restrictions contained herein shall be construed to be in addition to and not in derogation or limitation upon any local, state or federal laws, ordinances, regulations or provisions in effect at the time of execution of this agreement, or at the time such laws, ordinances, regulations and/or provisions may hereafter be revised, amended or promulgated. If any section, subsection, paragraph, clause, phrase, or provision of these covenants and restrictions shall, by a court of competent jurisdiction, be adjudged illegal, unlawful, invalid or held to be unconstitutional the same shall not affect the validity of these covenants as a whole, or any other pa~l or provision hereof other than the part so adjudged to be illegal, unlawful, invalid, or unconstitutional. The within declaration is made subject to the provisions of ali laws required by law or by their provisions to be incorporated herein, and they arc deemed to be incorporated herein and made a part hereof as though fully set forth. The within declaraf~un shall run with the land and shall be binding upon the Declarant, his heirs, successors and assigns, and upon all persons or entities claiming under them, and may not be annulled, waived, changed, modified, terminated, revoked, or amendixi by subsequent owners of the premises unless and until approved by a majority plus one vote of the Planning Board of the Town of Southold or its successors, following a public hearing. If Freeform Building Partners, LLC or its successors or assigns fails to meet its obligations with regards to the terms of this Island and Maintenance Agreement, the Declaration may be enforced by thc Town of Southold against Freeform Building Partners LLC, its successors, assigns, or the individual lot owners. All notices required under this Declaration shall be mailed to the Lot Owners' addresses rather than to thc propcrty addresses unless other arrangements have been made by thc Lot Owner. Notice shall bc deemed effective when mailed. In the event that the Declarant is no longer in title to any portion of the subdivision, then, in that event, notice shall be given to thc then owners of the lands making up the ~ubdivision by nmiling said notice to their addresses shovra on thc current Town tax rolls. IN WITNESS WHEREOF, the Declarant has executed this Easement and Declaration the day and year first above written. Declarant: FREEFORM BUILDING PARTNERS, LLC: STATE OF NEW YORK) ) SS:. COUNTY OF ) On the day of In thc year 2005 before me, the undersigned, a Notary Public in and for said state, personally appeared , 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 executed the same in his capacity and that by his si~,turc on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed thc instrument. NOTARY PUBLIC RESOLUTION 2009-937 ADOPTED DOC ID: 5453 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2009-937 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON DECEMBER 1, 2009: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute the Declaration of Covenants and Restriction~ (oertainine to the Center Island) and all other necessary documents to effectuate same between Zoumas Contracting Corp. and the Town of Southold in connection with the road dedication for the ZOumas at Deer Run subdivision, subject to the approval of the Town Attorney. Elizabeth A. Neville Southoid Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Albert Krupski Jr., Councilman SECONDER: Vincent Orlando, Councilman AYES: Ruland, Orlando, Krupski Jr., Wickham, Evans, Russell -MARTIN D. FINNEGAN TOWN ATTORNEY martin.finnegan@town.southold.ny.us JENNIFER ANDALORO ASSISTANT TOWN ATTORNEY jennifer.andaloro@town.southold.ny.us LORI M. HULSE ASSISTANT TOWN ATTORNEY lori.hulse@town.southold.ny.us SCOTT A. RUSSELL Supervisor Town Hsll Annex, 54375 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 OFFICE OF THE TOWN ATTORNEY TOWN OF SOUTHOLD To: From: Date: Subject: MEMORANDUM Ms. Sandi Berliner Lynne Krauza Secretary to the Town Attorney December 4, 2009 Zoumas at Deer Run/Road Dedication Declaration of Covenants & Restrictions Please be advised that Jen has reviewed and approved the attached documents in connection with the referenced matter. A copy of the resolution authorizing Scott to sign these documents is also attached. In this regard, kindly have Scott sign all documents where indicated, using black ink, and return all to me for processing. Thank you for your attention. If you have any questions, please do not hesitate to call me. Ilk Enclosures ~ cc: Ms. Elizabeth A. Neville, Town Clerk (w/encls.) P-584 (3/07) New York State Department ct Taxation and Finance Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal IncomeTax Recording office time stamp See Form TP-584-1, Instructions for Form TP-584, before completin~l this form. Please print or type. Schedule A -- Information relating to conveyance Grantor/Transferor [] Individual [] Corporation [] Partnership [] Estate/Trust [] Other Name (if individual; last. first, middle initial) Social security number FREEFORM BUILDING PARTNERS, LLC Mailing address 142 Mineola Ave., City State ZIP code Roslyn Heights NY 11577 Grantee/Transferee Name (d individuah last, first, middle initial) [] Individual TOWN OF SOUTHOLD [] Corporation Mailing address [] Partnership PO BOX 1179 [] Estate/Trust City State ZIP code [] Other SOUTHOLD NY 11971 Social sccudty number Social security number Federal employer ident, number Location and description of property conveyed Tax map designation Address City/village Town County Section I Block Lot Deer Run Southold Southold Suffolk 79 4 17.19 & 17.20 Type of property conveyed (check applicable box) I [] One- to three-family house 5 [] Commercial/Industrial 2 [] Residential cooperative 6 [] Apartment building 3 [] Residential condominium 7 [] Office building 4 [] Vacant land 8 [] Other Date of conveyance Percentage of real property I [ conveyed which is residential real property .% month day year (see instructions) Condition of conveyance (check all that apply) a. [] Conveyance of fee interest b. [] Acquisition of a controilincj interest (state percentage acquired. %) C. [] Transfer of a controlling interest (state percentage transferred %) d. [] Conveyance to cooperative housing corporation e. r-I Conveyance pursuant to or in lieu of foreclosure or enfamement of security interest (attach Form TP-584.1, Schedule E) f. [] Conveyance which consists of a mere change of identify 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-584.1, Schedule G) h. [] ~ of cooperative apartment(s) i. [] Syndication j. [] Conveyance of air rights or development rights k. [] Contract assignment Date received Schedule B., Part I $ Schedule B., Part I1 $ I. [] Option assignment or surrender m. [] Leasehold assignment or surrender n.[] Leasehold grant o. [] Conveyance of an easement p. [-I Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part//I) q. D Conveyance of property partly within and partly outside the state r. [] Other (describe) Page 2 of 4 TP-584 (3/07) Schedule B -- Real estate transfer tax return (Tax Law, Article 31 ) Part ! - Computation of tax due I Enteram~unt~fc~nsiderati~nf~rthec~nveyance(ify~uarec~aimingat~ta~exempti~nfr~mtax~checkthe exemption claimed box, enter consideration and proceed to Part I11) .............................. [] Exemption claimed I 1. I 2 Continuing ~ien deduction (see instructions if property is taken subject to mortgage or lien) ......................................... 2. 3 Taxable consideration (subtract line 2 from line 1) ................................................................................................... 3. 4 Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ......................................................... I 4. I 5 Amount of credit claimed (see instructions and attach Form TP-584.1, Schedule G) ................................................... I 5. I 6 Total tax due* (subtract line 5 from line 4) ................................................................................................................ I 6. I 0.00 0.00 0.00 0.00 0.00 0.00 0 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 (from Part [, line 1) ........................................................................ 1. 2 Taxabiec~nsiderati~n(mu~tip~y~ine1bythepercentage~fthepremiseswhichisresidentia~rea~pr~pert~assh~wninschedu~eA)`~I 2.[ 3 Total add't'onal transfer tax due* (multiply line 2 by 1% (.01)) .................................................................................. I 3. I 0 0 Part III - Explanation of exemption claimed on 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 b. Conveyance is to secure a debt or other obligation ............................................................................................................................ b c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................... c d. Conveyance of real properly is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts ....................................................................................................................................................................... d 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.) Attach Form TP-584.1, Schedule F .................................................................... f g. Conveyance consists of deed of partition ........................................................................................................................................... g h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................. h 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 pumhase real property, without the use or occupancy of such property ................................................. j. Conveyance of an option or contract to pumhase 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 the grantor's personal residence and consists of a one~. two-, or three-family house, an individual residential 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 apartment ....................................................................................................................................... k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401(e) (attach documents supporting such claim) ........................................................................................................................................................................... k L Other (attach explanation) ..................................................................................................................................................................... I *Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in New York City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department. RETT Return Processing. PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (3/07) Schedule C -- Credit Line Mortgage Certificate (Tax Law, Article 11) Complete the following only if the interest being transferred Is a fee simple Interest. I (we) certify that: (check the appropriate box) 1. [] The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. [] The real property being sold or transferred is subject to an outstanding credit tine mortgage. However, an exemption from the tax is claimed for the following reason: [] 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 before the transfer. [] The transfer of real property is (A) to a person or persons related by blood, marriage or adoption to the origina~ obligor or to one or more of the original obligors or (B) to a person or entity where 50% or mom of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). [] The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court, [] The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and 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. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. [] Other (attach detailed explanation). 3. [] The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: [] A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. [] 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. 4. [] The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by 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 or, if the recording is to take place in New York City, make check payable to the NYC Department of Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, including any return, certification, schedule, or attachment, is to the best of his/her knowledge, true and complete, and authorize the person(s) submitting such form on their behalf to receive a copy for. p_.~poses of recording the deJ~or other instrument affecting the conveyance. ,~_.~a~t_ureJ ~,~"~ ~ T/~J ' Grantee signature Tit~e Grantor signature Title G[antee signature Title Reminder: Did you complete all of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you checked e, f, or g in Schedule A, did you complete Form TP-584.17 Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department of Finance? If no recording is required, send your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 4 of 4 TP-584 (3/07) Schedule D - Certification of exemption from the payment of estimated pemonal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit is being transferred by an individual or estate or trust. Part ! - New York State residents If you am a New York State resident transferor(s)/sel~er(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferers/sellers of the real property or cooperative unit is a resident of New York State, each resident transferer/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident trensferem/sellers. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s} as signed below was a resident of New York ~.ate, and therefore is not required to pay tax under Tax Law, section 663(a) upon the sale or tra~ ~perty ( ,~ative unit. estimated personal income si~~ Print fu~l name Da~/ KEVIN MILLER Signature/'~ ~ ~. Printfullname Date Signature Print tull name Date Signature P~nt lull name Date Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed. Part [! - Nonresidents of New York State If you are a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but are not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferer(s)/seller(s), that transferor(s)/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663, Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonresident transferors/sellers, If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated personal income tax, on page 1 of Form TP-584-[. Exemption for nonresident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) (grantor) of this real property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: [] The real property or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121 ) from Date tO- Date (see instructions). [] The transferer/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. [] The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signs{ute Print fult name Date Signature Print lull name Date Signature Print tull name Date Signature Print tull name Date TP-584 (3/07) Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal IncomeTax Recording office time stamp See Form TP-584-1, Instructions for Form TP-584, before completing this form. Please print or type. Schedule A -- Information relating to conveyance Grantor/Transferer Name (if individual;lest, first, middle initial) Social security number [] Individual J & MJ SMALL REVOCABLE TRUST [] Corporation Mailing address Social security number [] Partnership 165 DEER RUN [] Estate/Trust City State ZIP code Federal employer ident, number [] Other SOUTHOLD NY 11971 Grantee/Transferee Name (if individuah last, first, middle initial) Social security number [] Individual TOWN OF SOUTHOLD [] Corporation Mailing address Social security number [] Partnership PO BOX 1179 [] Estate/Trust City State ZIP code Federal employer ident, number [] Other SOUTHOLD NY 11971 Location and description of property conveyed Tax map designation Address City/village Town County Section Block Lot Deer Run Southold Southold Suffolk 79 4 17,,1,I Type of property conveyed (check applicable box) I [] One- to three-family house 5 [] Commercial/Industrial Date of conveyance Percentage of real property 2 [] Residential cooperative 6 [] Apartment building r conveyed which is residential 3 [] Residential condominium 7 [] Office building L J real property. % 4 [] Vacant land 8 [] Other mor~h day year (see instructions) Condition of conveyance (check all that apply) a. [] Conveyance of fee interest b. [] Acquisition o~ a controlling interest (state percentage acquired %) c, i--I Transfer of a controlling interest (state pementage transferred d, [] Conveyance to cooperative housing corporation e. [] Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest (attach Form TP-584.1, Schedule E) For recording officer's use f. [] Conveyance which consists of a mere change of identify 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-584.1, Schedule G) h, [] Conveyance of cooperatiw apa~ment(s) i. [] Syndication j. [] Conveyance of air rights or development rights k. [] Contract assignment Amount received Date received Schedule B., Part I $ Schedu e B., Part It $ I, r-'l option assignment or surrender m, [] Leasehold assignment or surrender n. [] Leasehold grant o, [] Conveyance of an easement p. [] Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part///) q. D Conveyance of property partly within and partly outside the state r. [] Other (describe) Transaction number Page 2 of 4 TP-584 (3/07) Schedule B -- Real estate transfer tax return (Tax Law, Article 31) Part ! - Computation of tax due I Enter amount of consideration for the conveyance (#you are claiming a total exemption from tax, check the I I exemption claimed box, enter consideration and proceed to Part II/) .............................. [] Exemption claimed'1 1. I' 32 Continuing lien deduction (see instructions if property is taken subject to mortgage or lien) ......................................... 2. Taxable consideration (subtract line 2 from line I) ................................................................................................... I 3. Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ......................................................... I 4. I 4 5 Amountofcreditclaimed(seeinstructionsandat~achFormTP-584. l, ScheduleG) ................................................... I 5'1 6 Total tax due* (subtract li~e 5 from line 4) ................................................................................................................ I 6. I 0.00 0.00 0.00 0.00 0.00 0.00 Part II - Computation of additional tax due on the conveyance of residential real property for $1 million or mom I Enter amount of consideration for conveyance (from Part ], line 1) ........................................................................ 1. 2 Taxable consideration (multiply line 1 by the percentage of the promises which is residential real properS, as shown in Schedule A) ... I 2. I 3 Total addmt~onal transfer tax due* (muliply li~e 2 by 1% (.01)) .................................................................................. I 3. I Part Il! - Explanation of exemption claimed on Part [, line 1 (check any boxes thatapply) 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 pureuant to agreement or compact with another state or Canada) .............................................................................................................................................. a b. Conveyance is to secure a debt or other obligation ............................................................................................................................ b c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................... c d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts ....................................................................................................................................................................... d f. Conveyance is a mere change of identity or form of ownership or organization where them 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,) Attach Form TP-584.1, Schedule F .................................................................... f g. Conveyance consists of deed of partition ........................................................................................................................................... g h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................. h 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 pumhase real property, without the use or occupancy of such property ................................................. j. Conveyance of an option or contract to purchase real properly 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 the grantor's personal residence and consists of a one-, two-, or three-family house, an individual residential 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 apartment ....................................................................................................................................... k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401 (e) (attach documents supporting such claim) ........................................................................................................................................................................... k L Other (attach explanation) ..................................................................................................................................................................... I *Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in New York City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (3/07) Schedule C -- Credit Line Mortgage Certificate (Tax Law, Article 11) Complete the following only If the Interest being transferred Is a fee simple interest. I (we) certify that: (check the appropriate box) 1. [] The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. [] 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: [] 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 before the transfer. [] 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 obligors or (B) to a person or entity where 50% or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor), [] The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. [] The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and 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. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances, See TSB-M-96(6)-R for more information regarding these aggregation requirements. [] Other (attach detailed explanation). The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: [] A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. [] 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. The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by 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 or, if the recording is to take place in New York Ci~ make check payable to the NYC Department of Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, including any return, certification, schedule, or attachment, is to the best of his/her knowledge, true and complete, and authorize the person(s) submitting such form on their behalf to receive a coDv for purposes of recording the deed or other instrument affecting the conveyance. ~ r into~'s~gnature ' Title Grantee signature Title '~,~i_~,( .~_~ra~.~i~r'e ~ Title G,antee signature Title Reminder: Did you complete all of the required information in Schedules A, B, and C? Ara you required to complete Schedule D? If you checked e, f, or g in Schedule A, did you complete Form TP-584.17 Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department of Finance? If no recording is required, send your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. · Page 4 of 4 TP-584 (3/07) Schedule D - Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple Interest or a cooperative unit is being transferred by an individual or estate or trust. Part ! - New York State residents If you are a New York State resident transferer(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferers/sellem of the real property or cooperative unit is a resident el New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferors/sellem. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) as signed below was a resident of New York State, and therefore is not required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of tt y or cooperative unit. Signature ~~ Print full name Date MARY JANE SMALL Signature Print full name Date Signature Print full name Date Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed. Part II - Nonresidents of New York State If you are a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584} but are not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferor(s)/seller(s), that transferor(s)/seller(s) is not required to pay estimated pemonal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space previded. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonresident transferors/sellers. if none of these exemption statements apply, you must complete Form IT-2663, Nonresident Rea/Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated persona/income tax, on page 1 of Form TP-584-[. Exemption for nonresident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferer(s)/seller(s) (grantor) of this real property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: [] The real property or cooperative unit being sold or transferred qualifies in total as the trensferer's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from Date to Date (see instructions). ~--~ The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. [] The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York. the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signature Print full name Date Signature Print full name Dale Signature Print full name Date Signature Print full name Date TP-584 (3/07) Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax Recording office time stamp See Form TP-584-/, Instructions for Form TP-584, before completing this form. Please print or type, Schedule A -- Information relating to conveyance Grantor/Transferer Name (if individual; last, first, middle initial) Social security number [] Individual ZOUMAS CONTRACTING CORP. [] Corporation Mailing address Social security number PO BOX 361 [] Partnership [] Estate/Trust City State ZIP code •Other WADING RIVER NY 11792 /I- Grantee/Transferee Name (if individual:last, first, middle initial) Social security number [] Individual TOVVN OF SOUTHOLD [] Corporation Mailing address Social security number [] Partnership PO BOX 1179 [] Estate/Trust City State ZIP code Federal employer ident, number [] Other SOUTHOLD NY 11971 Location and description of property conveyed Tax map designation Address City/village Town County Section Block Lot Deer Run Southold Southold Suffolk 79 4 17.18 Type of properly conveyed (check applicable box) I [] One- to three-family house 5 [] Commercial/Industrial 2 [] Residential cooperative 6 [] Apartment building 3 [] Residential condominium 7 [] Office building 4 [] Vacant land 8 [] Other Date of conveyance Percentage of real property I I conveyed which is residential real property. % month day year (see instructions) Condition of conveyance (check all that apply) a. [] Conveyance of fee interest b. [] Acquisition of a controlling interest (state pementage acquired_ %) c. [] Transfer of a controlling interest (state percentage transferred _%) d. [] Conveyance to cooperative housing corporation e. [] Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest (attach Form TP-584.1. Schedule E) f.• g.[] h.[] For recording officer's use Amount received Schedule B., Part [ $ Schedule B., Part I1 $ Conveyance which consists of a mere change of identify or form of ownership or organization (attach Form TP-584.1, Schedule F) Conveyance for which credit for tax previously paid will be claimed (attach Form TP-584.1, Schedule G) Conveyance of cooperative apartment(s) Syndication Conveyance of air rights or development rights Contract assignment Date received I. [] Option assignment or surrender m. [] Leasehold assignment or surrender n.[] Leasehold grant o. [] Conveyance of an easement p. [] Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part II1) q. [] Conveyance of property partly within and partly outside the state r. [] Other (describe) · Page 2 of 4 TP-584 (3/07) Schedule B -- Real estate transfer tax return (Tax Law, Article 31) Part ! - Computation of tax due I Enter amount of consideration for the conveyance (if you are claiming a total exemption from tax, check the exemption claimed box, enter consideration and proceed to Part Iff) ..............................[] Exemption claimed 2 Continuing lien deduction (see instructions if property is taken subject to mortgage or lien) ......................................... 34 Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ......................................................... 14.1 Taxable consideration (subtract line 2 from line 1) ................................................................................................... 3. 5 Amount of credit claimed (see instructions and attach Form TP-584,1, Schedule G) ................................................... 5. 6 Total tax due* (subtract line 5 from line 4) ...... 6 0.00 0.00 0.00 0.00 0.00 0.00 0 Part ]! - Computation of additional tax due on the conveyance of residential real proper~y for $1 million or more 1 Enter amount of consideration for conveyance (from Part [, line 1) ........................................................................ I 1. ] 2 Taxab~ec~nsiderati~n(mu~tip~yline1bythepercentage~fthepremiseswhichisresidenlia~reaIpr~perty~assh~wninSchedu~eA)~ 2.I 3 Total additional transfer tax due* (multiply line 2 by I% (.01)) .................................................................................. 3. 0 0 Part H! - Explanation of exemption claimed on Part ], line 1 (chock 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 b. Conveyance is to secure a debt or other obligation ............................................................................................................................ b c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................... c d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts .............................................................................................................................................................. ; ........ d e. Conveyance is given in connection with a tax sale ............................................................................................................................. e 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.) Attach Form TP-584.1, Schedule F .................................................................... f g, Conveyance consists of deed of partition ........................................................................................................................................... g h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................. h 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 pumhase real proper~y, without the use or occupancy of such property ................................................. 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 the grantor's personal residence and consists of a one-, two-, or three-family house, an individual residential condominium unit, or the sale of stock in a cooperative housing corporation in connection with the grant or transfer of a propdetapJ leasehold covering an individual residential cooperative apartment ....................................................................................................................................... k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401 (e) (attach documents supporting such claim) ........................................................................................................................................................................... k I. Other (attach explanation) ..................................................................................................................................................................... I *Please make check(s) payable to the county clerk where the recording is to take place. ]f the recording is to take place in New York City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (3/07) Schedule C ~ Credit Line Mortgage Certificate (Tax Law, Article 11 ) Complete the following only if the interest being transferred is a fee simple interest. I (we) certify that: (check the appropriate box) 1. [] The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. [] The mai 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: [] The transfer of real property is a transfer of a fee simple interest to a person or pemons who held a foe simple interest in the real property (whether as a joint tenant, a tenant in common or otherwise) immediately before the transfer. [] The transfer of real property is (A) to a pemon or persons related by blood, marriage or adoption to the odginal obligor or to one or more of the original obligors or (B) to a person or entity where 50% or mom of the beneficial interest in such real property after the transfer is held by the tmnsforor or such related pemon or persons (as in the case of a transfor to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). [] The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. [] The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and 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, Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or mom as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for mom information regarding these aggregation requirements. [] Other (attach detailed explanation). The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: [] A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed, [] 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. The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by 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 or, if the recording is to take place in New York City, make check payable to the NYC Department of Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, including any return, certification, schedule, or attachment, is tq the best of his/her knowledge, true and complete, and authorize the person(s) submitting such form on their behalf to receive a copy for purpl~se~of recording the deed or other instrument effecting the conveyance. Gm,or sigma ~ Title Grantee signature e Reminder: Did you complete all of the required information in Schedules A,B, and C? Are you required to complete Schedule D? If you checked e, f, or g in Schedule A, did you complete Form TP-584.17 Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department of Finance? If no recording is required, send your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. · Page 4 of 4 TP-584 (3/07) Schedule D - Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit is being transferred by an individual or estate or trust. Part ! - New York State residents If you ara a New York State rasident transferor(s)/seiler(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. I1 one or more transferors/sellers of the real property or cooperative unit is a resident of New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all rasident transferars/sellem. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the raal property or cooperative unit, the transferor(s)/seller(s) as signed below was a resident of New State, and therefore is not mquirad to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of this ~ ,al/~)roperty or cooperative unit. Signature ~ x, ~ NICK ZOUMAS Signature "- Print tull name Date Signature Print tull name Date Signature Print full name Date Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed. Part II - Nonresidents of New York State If you ara a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but are not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferor(s)/seller(s), that transferor(s)/seller(s) is not raquired to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonresident transferors/sellers. If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated personal income tax, on page 1 of Form TP-584-[. Exemption for nonresident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the raal property or cooperative unit, the transferor(s)/seller(s) (grantor) of this raal property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: [] The real property or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from Date to Date (see instructions). [] The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. [] The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signature Print full name Date Signature Print tull name Date Signature Print full name Date Signature Print full name Date TP-584 (3/07) New York State Department of Taxation and Finance Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax Recording office time stamp See Form TP-584.1, Instructions for Form TP-584, before completing this form. Please print or type. Schedule A -- Information relating to conveyance Grantor/Transferor [] Individual [] Corporation [] Partnership [] Estate/Trust [] Other Name (if individual; last, first, middle initial) BUTKOVICH, RONALD J. & MARGARET Mailing address PO BOX 571 City State ZIP code SOUTHOLD NY 11971 Social security number Social se,cu~.rlt~ number Federal empl~er ident, number Grantee/Transferee Name (if individuah last, first, middle initial) Social security number [] individual TOVVN OF SOUTHOLD [] Corporation Mailing address Sccial security number [] Partnership PO BOX 1179 [] Estate/Trust City State ZIP code Federal employer ident, number [] Other SOUTHOLD NY 11971 11-6001939 Location and description of property conveyed Tax map designation Address City/village Town County Section Block Lot Deer Run Southold Southold Suffolk 79 4 17.22 Type of property conveyed (check applicable box) I [] One- to three-family house 5 [] Commercial/Industrial 2 [] Residential cooperative 6 [] Apartment building 3 [] Residential condominium 7 [] Office building 4 [] Vacant land 8 [] Other Date of conveyance Percentage of real property I I conveyed which is residential rea~ property .% month day year (see instructions) Condition of conveyance (check all that apply) a. [-I Conveyance of fee interest b. [] Acquisition o~ a cont~ling interest (state percentage acquired. %) c. [] Transfer of a controlling interest (state percentage transferred %) d. r-I conveyance to cooperative housing corporation e. 1'3 Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest (attach Form TP-584.1, Schedule E) For recording officeKs use Amount received f. [] Conveyance which consists of a mere change of identify 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-584.1, Schedule G) h. [] Conveyance of cooperative apartment(s) i. [] Syndication j. [] Conveyance of air rights or development rights k. [] Contract assignment Schedule B., Part [ $ Date received Schedule B., Part [1 $ I. [] Option assignment or surrender m. [] Leasehold assignment or surrender n. [] Leasehold grant o. [] Conveyance of an easement p. [] Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part 1ll) q, [] Conveyance of property partly within and partly outside the state r. [] Other (describe) Transaction number · Page 2 of 4 TP-584 (3/07) Schedule B -- Real estate transfer tax return (Tax Law, Article 31) Part ! - Computation of tax due I Enter amount of consideration for the conveyance (if you are claiming a total exemption from tax, check exemption claimed box, enter considemtion and proceed to Part lll) .............................. [] Exemption clalreed 2 Continuing lien deduction (see instruclions lf property is taken subject to mortgage or lien) ......................................... 3 Taxable consideration (subtract line 2 from line 1) ................................................................................................... 4 Tax: $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 Tota tax due* (subtract line 5 from line 4) ................................................................................................................ 0.00 0.00 0.00 0.00 0.00 0.00 Part [I - Computation of additional tax due on the conveyance of residential real property for $1 million or more 1 Enter amount of consideration for conveyance (from Part I, line I) ........................................................................ 1. 2 Taxab~ec~nsiderati~n(rnuliip~y~ine1bythepercentage~fthepremiseswhichisresidentia~realpr~per~assh~wninSchedu~eA)~ 2.I 3 Total additional transfer tax due* (mullip/y line 2 by I% (.01)) .................................................................................. 3. 0 0 0 Part Ill - Explanation of exemption claimed on 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 b. Conveyance is to secure a debt or other obligation ............................................................................................................................ b c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................... c [] [] [] d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts ....................................................................................................................................................................... d e. Conveyance is given in connection with a tax sale ............................................................................................................................. e 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.) Attach Form TP-584,1, Schedule F .................................................................... f g. Conveyance consists of deed of partition ........................................................................................................................................... g h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................. h 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 ................................................. 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 the grantors personal residence and consists of a one-, two-, or three-family house, an individual residential condominium unit, or the sale of stock in a cooperative housing corporation in conneclion with the grant or transfer of a proprietary leasehold covering an individual residential cooperative apartment ....................................................................................................................................... k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401 (e) (attach d~cuments supporting such claim) ........................................................................................................................................................................... k I. Other (attach explanation) ..................................................................................................................................................................... I *Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in New York City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (3/07) Schedule C -- Credit Line Mortgage Certificate (Tax Law, Article 11) Complete the following only if the interest being transferred is a fee simple interest. I (we) certify that: (check the appropriate box) 1. [] The reel property being sold or transferred is not subject to an outstanding credit line mortgage. 2. [] 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: [] The transfer of real property is a transfer of a fee simple interest to a person or pemons who held a fee simple interest in the real property (whether as a joint tenant, a tenant in common or otherwise) immediately before the transfer. [] 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 obligors or (B) to a person or entity where 50% or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). [] The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. [] The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and 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. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. [] Other (attach detailed explanation). 3. [] The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: [] A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. [] 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. 4. [] The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by 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 or, if the recording is to take place in New York Ci~ make check payable to the NYC Department of Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, including any return, certification, schedule, or attachment, is to tJ~,~best of his/her knowledge, true and complete, and authorize the person(s) submitting such form on their behalf to receive a copy for purpo~es~ reco~ing the deed or other instrument affecting the conveyance. /.//1/J tb/~l~"~ Title . Grantee ' nature Title Reminder: Did you complete all of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you checked e, f, or g in Schedule A, did you complete Form TP-584.17 Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department of Finance? If no recording is required, send your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. · Page 4 of 4 TP-584 (3/07) Schedule D - Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit Is being transferred by an individual or estate or trust. Part ! - New York State residents If you am a New York State resident transfemr(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferors/sellers of the real property or cooperative unit is a resident of New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferors/sellers. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real pmperfy or cooperative unit, the transferor(s)/seller(s) ss signed below was a resident of N~ ~ork State, and therefore is not required to pay estimated personal income tax under Tax Law, section 663(a} upon the sale or transfer of t~s ~ ~ cooperative unit. ' .... Sigllature Pdnt lull name Date ?~ ~ RONALD J. BUTKOVICH ~ . Print full name eate f/~ ~//~ MARGARET BUTKOVlCH ~i~ture ~ ' -- Print fu~l name Data Signa[ure Print full name Date Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed. Part !! - Nonresidents of New York State If you are a nonresident of New York State listed as a transferor/seller in Schedule a of Form TP-584 (or an attachment to Form TP-584) but am not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferor(s)/seller(s), that transferer(s)/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions betow must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonresident transferors/sellers. If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For moro information, see Payment of estimated personal income tax, on page 1 of Form TP-584-[. Exemption for nonresident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) (grantor) of this real property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the fo,owing exemptions: [] The real property or cooperalive unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from Date to Date (see instructions). [~The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. [] The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signature Print full name Date Signature Pri*~t full name Date Signature Print lull name Date Signature Print fu, name Date Peconic Bay Region Community Preservation Fund Proceeds of this transfer tax are disbursed to the Townships in which the transaction takes place for its acquisition of land, development rights, and other interests in property for conservation purposes. Townships: East Hampton 03 Riverhead 06 Shelter Island 07 Southampton 09 Southold 10 Please print or type, Schedule A Information Relating to Conveyance Grantor Name (individual; last, first, middle initial) ZOUMAS CONTRACTING CORP. [] Individual Mailing address ~ Corporation PO BOX 361 [] Partnership City State [] Other WADING RIVER NY Name (individual; last, first, middle initial) TOWN OF SOUTHOLD Mailing address PO BOX 1179 C~UTHOLD State NY [] individual [] Corporation [] Partnership [] Other ZIP code l 1792 ZIP code 11971 Social Security Number Social Security Number number /< , Number Social Security Number I I Federal employer idenl, number Location and description of property conveyed Tax map designation Address Village Town Dist Section Block Lot 1000 79 4 17.23 DEER RUN SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box) Date of conveyance [] Improved [] Vacant land ] I Dual Towns: Condition of conveyance (check all that apply) a. - Conveyance of fee interest b. - Acquisition of a controlling interest (state percentage acquired %) c. - Transfer of a controlling interest (state percentage transferred %) d. - Conveyance to cooperative housing corporation e, - Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest f. - Conveyance which consists of a mere change of identity or form of ownership or organization g. - Conveyance for which credit (or tax previously paid will be claimed h. - Cpnveyance of cooperative apartment(s) i. - ~ynolcauon ). - Conveyance of air rights or development rights k, - Contract assignment I. -Option assignment or surrender m. - Leasehold assignment or surrender n. - Leasehold grant o. - Conveyance of an easement p. - Conveyance for which exemption is claimed (complete Schedule B. Part ti) q. - Conveyance of property partly within and partly without the state r. - Other (describe) Schedule B - Community Preservation Fund Part I - Computation of Tax Due 1. Enter amount of consideration for the conveyance (from line 1 TP584 Schedule B) 2. Allowance (see below) 3. Taxable consideration (subtract line 2 from line 1 ) 4.2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK 5. Property not subject to CPF Tax (See Schedule C) For recording officer's use Amount received Datereceived Allowance: East Hampton Shelter Island Southampton Riverhead Southold 5250,000.00 Improved $250,000.00 Improved $250,000.00 Improved 5150,000.00 Improved 5150,000.00 Improved $1OO,000.00 Vacant Land (Unimproved) 5100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) 5 75,000.00 Vacant Land (Unimproved) 5 7S,O00.O0 Vacant Land (Unimproved) Schedule C (continued) Part II - 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 state or Canada) [] b. Conveyance is to secure a debt or other obligation [] c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance [] d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts [] e. Conveyance is given in connection with a tax sale [] f. Conveyance is 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.) [] g. Conveyance consists of deed of partition [] h. Conveyance is given pursuant to the federal bankruptcy act [] 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 [] j. Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) (j) or (k) of Article 31-D of the Tax Law. (See required Town approval, below) [] k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, environmental, or historic preservation purposes. [] I. Other list explanations in space below (Grandfather/Contract) [] m. Conveyance of real property as a primary residence where the grantee is a first-time homebuyer (attached approved application) [] n. Conveyance of real property to a tax exempt, not-for-profit corporation for the purpose of providing affordable housing. [] o. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 3 I-D of the Tax law. (See j in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing to file a return or to pay any tax within the time required shall be subject to a penalty of 10% of the amount of tax due plus an interest penalty of 2% of such amount of each month of delay or frection thereof after the expiration of the first month after such return was required to be filed or the tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Interest Daily compounded interest will be charged on the amount of the tax due not paid within the time required. Signature (both the grantor(s) and grantee(s) must sign). The undersigned certify that the above return, including any certification, schedule or attachment, is to the best of his/her Peconic Bay Region Community Preservation Fund Proceeds of this transfer tax are disbursed to the Townships in which the transaction takes place for its acquisition of land, development rights, and other interests in property for conservation purposes. Townships: East Hampton 03 Riverhead 06 Shelter Island 07 Southampton 09 Southold 10 Please print or type. Schedule A Information Relating to Conveyance Grantor Name (individual; last, first, middle initial) BUTKOVICH, RONALD J & MARGARET ~ Individual Mailing address [] Corporation PO BOX 571 [] Partnership City State [] Other SOUTHOLD NY Grantee Name (individual; last, first, middle Initial) [] Individual TOWN OF SOUTHOLD [] Corporation Mailing address PO BOX l 179 [] Partnership State [] Other ~UTHOLD ZIP code 11971 ZIP code 11971 Social Security Number $odal Security Number Federa employer idenl, number Social Securl~ Numbei Social Security Number I Federal employer idenL number \\ I (0 lq3c Location and description of property conveyed Tax map designation Address Village Town Dist Section Block Lot I000 79 4 17.22 DEER RUN SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box) Date of conveyance [] Improved [] Vacant land I I I Dual Towns: Condition of conveyance (check all that apply) a. - Conveyance of fee interest b. - Acquisition of a controlling interest (state percentage acquired %) c. - Transfer of a controlling interest (state percentage transferred %) d. - Conveyance to cooperative housing corporation e. - Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest f. - Conveyance which consists of a mere change of identity or form of ownership or organization g. - Conveyance for which credit (or tax previously paid will be claimed h. - Cpnveyance of cooperative apartment(s) i. J. - Conveyance of air rights or development rights k. - Contract assignment I. - Option assignment or surrender m. - Leasehold assignment or surrender n. - Leasehold grant o. - Conveyance of an easement p. - Conveyance for which exemption is claimed (complete Schedule B. Part II} q. - Conveyance of property partly within and partly without the state r, - Other (describe) Schedule B - Community Preservation Fund Part 1 - Computation of Tax Due 1. Enter amount of consideration for the conveyance (from line 1 TP584 Schedule B) 2. Allowance (see below) 3. Taxable consideration (subtract line 2 from line 1) 4.2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK 5. Property not subject to CPF Tax (See Schedule C) I % 2 (~ For recording officer's use Amount received Daterecelved Transaction number Allowance: East Hampton Shelter Island Southampton 5250,000.00 Improved $250,000.00 Improved 5250,000.00 Improved $100,000.00 Vacant Land (Unimproved) $I00,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) Riverhead Sl 50,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) Southold $150,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) Schedule C (continued) Part H - 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 state or Canada) [] b. Conveyance is to secure a debt or other obligation [] c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance [] d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts [] e. Conveyance is given in connection with a tax sale [] f. Conveyance is mere change of identity or form of ownership or organization where there is no change in beneficial ownership. fi.his exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) [] g. Conveyance consists of deed of partition [] h. Conveyance is given pursuant to the federal bankruptcy act [] 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 [] j. Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) (j) or (k) of Article 31-D of the Tax Law. (See required Town approval, below) [] k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, environmental, or historic preservation purposes. [] I. Other list explanations in space below (Grandfather/Contract) [] m. Conveyance of real property as a primary residence where the grantee is a first-time homebuyer (attached approved application) [] n. Conveyance of real property to a tax exempt, not-for-profit corporation for the purpose of providing affordable housing. [] o. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 31-D of the Tax law. [See j in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing to file a return or to pay any tax within the time required shall be subject to a penalty of 10% of the amount of tax due plus an interest penalty of 2% of such amount of each month of delay or fraction thereof after the expiration of the first month after such return was required to be filed or the tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Interest Daily compounded interest will be charged on the amount of the tax due not paid within the time required. Signature The knov (both the grantor(s) and grantee(s) must sign). ~lned certify that the above return, including any certification, schedule or attachment, is to the best of his/her ~ t~V t c ~Grantor Grantee Peconic Bay Region Community Preservation Fund Proceeds of this transfer tax are disbursed to the Townships in which the transaction takes place for its acquisition of land, development rights, and other interests in property for conservation purposes. Townships: East Hampton 03 Riverhead 06 Shelter Island 07 Southampton 09 Southold 10 Please print or type. Schedule A Information Relating to Conveyance Grantor Name (individual; last, first, middle initiall J & MJ SMALL REVOCABLE TRUST [] Individual Mailing address ~] Corporation 165 DEER RUN [] Partnership [] Other CS,OUTHOLDItv State Grantee Name (individual; last, first, middle initial) [] Individual TOWN OF SOUTHOLD [] Corporation Mailing address PO BOX 1179 [] Partnership Cidtv State [] Other SOUTHOLD NY ZiP code 11971 ZIP code 11971 Social Security Number Social Security Number Federal employer Idenl. number Social Security Number Social Security Number I I Federal employer idenL number Location and description of property conveyed Tax map designation Address Village Town Dist Section Block Lot 1000 79 4 17.21 DEER RUN SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box} Date of conveyance [] improved I-1 Vacant land I I I I Dual Towns: Condition of conveyance (check all that apply) a. - Conveyance of fee Interest b. - Acquisition of a controlling interest (state percentage acquired %) c. - Transfer of a controlling interest (state percentage transferred %} d. - Conveyance to cooperative housing corporation e. - Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest f. - Conveyance which consists of a mere change of identity or form of ownership or organization g. - Conveyance for which credit (or tax previously paid will be claimed h. - Conveyance of cooperative apartment(s) i. 1. - Conveyance of air fights or development rights k. - Contract assignment I. -Option assignment or surrender m. - Leasehold assignment or surrender n. - Leasehold grant o. ~ Conveyance of an easement p. - Conveyance for which exemption is claimed (complete Schedule B. Part II) q. - Conveyance of property partly within and partly without the state r. - Other (describe) Schedule 8 - Community Preservation Fund Part I - Computation of Tax Due 1. Enter amount of consideration for the conveyance (from line I TP584 Schedule B) 2. Allowance (see below) 3. Taxable consideration (subtract line 2 from line 1) 4.2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK 5. Property not subject to CPF Tax (See Schedule C) For recording officer's use Amount received Date received Allowance: East Hampton Shelter Island Southampton $250,000.00 Improved $250,000.00 Improved $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) Riverhead $150,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) Southold $150,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) Schedule C (continued) Part H - 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 state or Canada) [] b. Conveyance is to secure a debt or other obligation [] c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance [] d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts [] e. Conveyance is given in connection with a tax sale [] f. Conveyance is 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.) [] g. Conveyance consists of deed of partition [] h. Conveyance is given pursuant to the federal bankruptcy act [] 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 [] j. Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) (j) or (k) of Article 31-D of the Tax Law. (See required Town approval, below) [] k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, environmental, or historic preservation purposes. [] I. Other list explanations in space below (Grandfather/Contract) [] m. Conveyance of real property as a primary residence where the grantee is a first~time homebuyer (attached approved application) [] n. Conveyance of real property to a tax exempt, not-for-profit corporation for the purpose of providing affordable housing. [] o. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 31-D of the Tax law. (Seej in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing to file a return or to pay any tax within the time required shall be subject to a penalty of 10% of the amount of tax due plus an interest penalty of 2% of such amount of each month of delay or fraction thereof after the expiration of the first month after such return was required to be filed or the tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Interest Daily compounded Interest will be charged on the amount of the tax due not paid within the time required. ,~leOg~,~true and complete. ,-~(.~ ,~V~ ' ~rantor Signature (both the grantor(s) and grantee(s) must sign). The undersigned certify that the above return, including any certification, schedule or attachment, is to the best of his/her Peconic Bay Region Community Preservation Fund Proceeds of this transfer tax are disbursed to the Townships in which the transaction takes place for its acquisition of land, development rights, and other interests in property for conservation purposes. Townships: East Hampton 03 Riverhead 06 Shelter Island 07 Southampton 09 Southold 10 Please print or type. ZIP code 11577 Schedule A Information Relating to Conveyance Grantor Name (individual; last, first, middle initial) FREEFORM BUILDING PARTNERS LLC [] Individual ~] Corporation Mailing address 142 M1NEOLA AVE. [] Partnership City State [] Other ROSLYN HEIGHtl~ NY Grantee Name (Individual; last, first, middle initial) TOWN OF SOUTHOLD [] Individual [] Corporation Mailing address PO BOX 1179 [] Partnership City UTHOLDS0 State ZIP code [] Other NY 11971 Location and description of property conveyed Social Security Number I Social Security Number Social Security Number I Federal employer idenL number Tax map designation Address Village Town Dist Section Block Lot 1000 79 4 17.19 DEER RUN SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box) Date of conveyance Dual Towns: [] Improved Condition of conveyance (check all that apply} a. - Conveyance of fee interest b. - Acquisition of a controlling interest {state percentage acquired %) c. - Transfer of a controlling interest (state percentage transferred . %] d. - Conveyance to cooperative housing corporation e. - Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest f. - Conveyance which consists of a mere change of identity or form of ownership or organization g. - Conveyance for which credit (or tax previously paid will be claimed h. - Conveyance of cooperative apartment(s) i. J. - Conveyance of air rights or development rights k. - Contract assignment I. -Option assignment or surrender m. - Leasehold assignment or surrender n. - Leasehold grant o. - Conveyance of an easement p. - Conveyance for which exemption is claimed (complete Schedule B. Part II) q. - Conveyance of property partly within and partly without the state r. - Other (d~scribe) Schedule B - Community Preservation Fund Part I - Computation of Tax Due I. Enter amount of consideration for the conveyance (from line 1 TP584 Schedule B) 2, Allowance (see below) 3. Taxable consideration (subtract line 2 from line 1) 4, 2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK 5. Property not subject to CPF Tax (See Schedule C) 1 2 3 4 Date received Transaction number Allowance: East Hampton Shelter Island Southampton Riverhead Southold $250,000.00 Improved $250~000.00 Improved 5250,000.00 Improved $150,000.00 Improved $150,000.00 Improved $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) $ 75,000.00 Vacant Land (Unimproved) $ 75,000.00 Vacant Land (Unimproved) Schedule C (continued) Part H - 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 state or Canada) [] b. Conveyance is to secure a debt or other obligation [] c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance [] d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts [] e. Conveyance is given in connection with a tax sale [] f. Conveyance [s mere change of identity or form of ownership or organization where there [s 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.) [] g. Conveyance consists of deed of partition [] h. Conveyance is given pursuant to the federal bankruptcy act [] 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 [] ). Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) 0) or (k) of Article 31-D of the Tax Law. (See required Town approval, below) [] k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, environmental, or historic preservation purposes. [] I. Other list explanations in space below (Grandfather/Contract) [] m. Conveyance of real property as a primary residence where the grantee is a first-time homebuyer (attached approved application) [] n. Conveyance of real property to a tax exempt, not-for-profit corporation for the purpose of providing affordable housing. [] o. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 31-D of the Tax law. (See j in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing to file a return or to pay any tax within the time required shall be subject to a penalty of 10% of the amount of tax due plus an interest penalty of 2% of such amount of each month of delay or fraction thereof after the expiration of the first month after such return was required to be filed or the tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Interest Daily compounded interest will be charged on the amount of the tax due not paid within the time required. Signature (both the grantor(s) and grantee(s) must sign). The undersigned certify that the above return, including any certification, schedule or attachment, is to the best of his/her k~o~wledg~tru~and ~c o m~"t~.