HomeMy WebLinkAboutTR-6734AJames F. King, President ~apf SOUTy~
Jill M. Doherty, Vice-President ~~ l~ ~
Peggy A. Dickerson
Dave Bergen d+ C
Bob Ghosio, Jr. ~~ ~ ~O
l~C~un11+~
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631)765-6641
CERTIFICATE OF COMPLIANCE
# 0356C Date August 22, 2008
THIS CERTIFIES that the addition to the existing deck, new front stoop and 24" canopy over
the front stoop.
At 600 Grove Rd., Southold
Suffolk County Tax Map #51-6-25
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 9/21/07 pursuant to which Trustees Wetland Permit #6734A Dated 10/3/07 was
issued, and conforms to all of the requirements and conditions of the applicable
provisions of law. The project for which this certificate is being issued
is for the addition to the existing deck, new front stoop and 24" canopy over the front stoop.
The certificate is issued to AMELIA MANCINI owner of the
aforesaid property.
f4 - aCj
Authorized Signature
.
.
James F. King, President
Jill M. Doherty. Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 6734A
Date of Receipt of Application: September 21,2007
Applicant: Amelia Mancini
SCTM#: 51-6-25
Project Location: 600 Grove Rd., Southold
Date of Resolution/Issuance: October 3, 2007
Date of Expiration: October 3, 2009
Reviewed by: Board of Trustees
Project Description: To construct an addition to the existing deck, replace the
existing front stoop, and add a 24" canopy over the front stoop.
Findings: The project meets all the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code. The
issuance of an Administrative Permit allows for the operations as indicated on the
survey received on September 21,2007.
Conditions: The installation of a drywell with the capacity to contain the roof run-
off from a 2"tainfall.
If the proposed activities do not meet the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code, a
Wetland Permit will be required.
This is not a determination from any other agency.
Jame~, ::6-
Board of Trustees
.
.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Southold Town Board of Trustees
Field Inspection/Worksession Report
Date/Time:
IO-~-07
Name of Applicant: Al<'e11t1 (Y\ u. 'lc:"i
Name of Agent:
Property Location: SCTM# & Street
(;0 0 Grwc. ~ ~ I -, - 2..S
\. A-JJ.,;~'t'O eN-t>h')olcct
<SVV-- ~"'H-<ror
Brief Description of proposed action:
'2.. P-C.pl"''' ~t- ~
3 rJ.,g 2'1" ~"r~
Type of area to be impacted: ~
_Saltwater Wetland ~eshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above:
Part of Town Code proposed work falls under:
_Chapt.97 _Chapt. 37 _other
Type of Application: _ Wetland _Coastal Erosion _Amendment _Administrative
_Emergency
Info needed:
6~.
Dry ~~
Modifications:
Conditions:
Present Were: J.King ~herty P.Dickerson D. Bergen
- - - -
Other:
Bob Ghosio, Jr.
Mailed/Faxed to:
Date:
Comments ofEnvirornnental Technician: B<2-'t-l,df'L '"
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(\0 rn~vJ b...~
aOARD OF T~TEES
~~
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It.fCommW
J9/17:2007 B8:49
"15<,1
.Jamel;'l F. King, Pr~jd~J"lt
.Ji11 M. DohertYl Vicp.-Preside:nt
Peggy A. Dic:.:;:ersoll
Dave Bl2rg(,m
Bob '.....nwsdo, ';1';.
PAGE 01
Town Hall
53095 Roll,te 25
P.O. Box 1179
So'Uthold, New York. 119'11..0959
Telepho". (S31) 76.5-1892
Fu (631) 765.6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
_'~o.stal Erosion Pemit Appl1cAticn
__ Wct1i!1.l1d Per:mt ..Application ............Admir.istrath.e Permit
_AmcndrrttntTra19f,J.:.;ten:",!Qll
~eoeive:1 Application:.,.. :JIll
~ece1Ved Fee:s..:J:2_4l-+f-1-rn
._.~leted ApplicatlOn_I.LSl:'!l.:::J
__.Incomp1cte__.____.~__.__
._SEQRA Classi'ication:
T.,,,e I_.-;yPc 1I_l"nh'ltcd_
Coordination'(dat~ sent)
~-=l \VRP Consincncy As~;;Smc:n'tF;r:n_"___._.,.,.__
CAe Refena: Sent:
-/r)atc oftnspeonon /0 f~J]L
_Receip' of CAe Repotl:_~_
__Lead Agency De:ennlll3.tlcm:__
Technical Review:
-:::f'\'bHc Heattng l'leld:-irJfl1/lJJ
__ResolutiQu: _.~~._.,.
Namc of Applicant AM... L .~ P MARc.f ^' ;
Add(e8s__(p.QO_~~,.I Rd .c....\lJ-UJ__N~ 1('1' L
______ ~PhoneNumber:('51 If 31 B. ~lp~e,
Suffolk Coun.ty Tax :'vial' Number: 1000. __.---'ls.L~.:__~~5'
Propert:vLo<:;atbn:up4 PoI-e ~5. WQ..}j StJ<. c;rW~
"
?;~") ~ .<;l')Ji-~ or ^lOR~ R~ {CO()l)bt._~~
(provide ULCO Pole #. distance to cross strec's. and location)
Ortie. Us. Only
AGENT:
(If applicable)
s-o..i'1~
Adcress:
~"1 ~
fD) IE rc; IE ~ ~1 lE I~~
ru~~~1 ~007 ID
Southold Town
Board of Trustees
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a7>? Ltv--\~~
K ti~
uJa~ II~
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Phone: 51(_ 3/R. g.,38
!j'3l1 ;-'/ 2007
08:49
7555541
. Board
BOARD OF TRUSTEES
of Trustees APPlio~on
PAGE ,j2
GENERAL DATA
Land Area (in square feel):~I, "/ .,-0
,\rCH Zoning:
R<jO
P-evious lIse of property:
CN~ ~"\ I I"
,
j)w{.,~____
intended use of property:
Covenan:s and ReSlIictiolls:__Ycs _~_No
If "Yes", please provide copy
Prior permits/approvals for site improvements:
Agency /,...-T
'"Bel. e.t. S'ou!:b.J::L 10 w n \-A(S,lu.5
Date /)
~u~ ~<f. 200S I-'O'tmll;& I., \ 11
_._------------~ -----,~--_._-------
___ No prior permits/approvals for sitei:nprovem""ts,
Has any pel1uit'approval "yer been revoked or suspended by a govemmentaJ agcncy?
~No_ Yes
]fyes, proyide cxplanation:________
ProJect Description (use attachments .fnecessary):
Md,+..o~_ ~,~~d~c.k: ..~m\~ \i1S"!..('-\..
~o..c.~ 41l5J.t~ ..fro".\- s-l-oOf>(~~~::L""'\",,"S1S<\5')
Add .:z4 '~ ~~ o'(e.-r ~~~~h.~~,-_____
J9/17 '2801'
08:4':1
'b5SE,41
.
Board of
30ARD OF TRUSTEES
Trustees APPli~ion
PAGE
I);
WETLANDfTRUSl'EE LANDS APPLICATION DATA
Purpose of the proposed operations:
Area ofwetlallds on lot;
o
o
square feet
Percent coverage of lot:
~/O
Cla.sest ctistmcc bli.lWee~earest exisling structltre and upland
:dge ohvetlands: A feet
'" ... -
Cl"sest distance betw~'~arCSI propo,cd SlrJcture nnci upland
~dgf: oiwetlancls:_ __ _,,_.__feet
000' the project ;l1"o)ve excavation vi tilling:
x ~o______ Yes
If yes. how much rmterial will be excavatcd?___cubic yards
How much matel;al wiU be fillcd",,___
cubic yards
Depth ofwhiell malctcal will be remo'.'ed or deposhcd:_.___ feet
Proposed slope throughout th; a~ea ,"f operations:
;.,[anner in which material will be removed or depos;red:__
.---.-.-----.-----.
Stateme,lt ofthc effect, if any. on the wetl~nds and tidal waters ofthe town that may r,sull bv
;'eason ofsudi propoicd operations (\ISC attaC1JJnellts ifapprop,jate):' . ,. ._'., ....<..
.__NOl-/of'
-
'-I
.
.
617.20
Appendix C
Slate environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
,PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
'4-1&-4 C9/95)-Text 12
I PROJECT 1.0. NUMBER
SEaR
,. ~LICANT /SPONSOR . I 2. PROJ~ NAME
""~l.,,:, P MAN.c.J ^J i ~ 0 0 (~OJ" fZcl
3. PROJECT LOCATION: \0'\ SUr~c.>l K
Munlclpolny s~A"u Counly
4. PRECISE LOCAnON (St,"1 address and rad Interaectlona. prominent landmarks. etc., or provide map) ~
,~OO ~ro"-(.. t'oo.ol / \Nt.\. -\.s~ol~ 53.:>. S SotiJ-h. () P- I\.lcliL- ~
( O:Jr)(\J,.y 'ReA U:t./e)
5. IS PROPOSED ACTlON;
oNow o Ellpan.lon ~ loIodlflcatlonlollOro.1on
6. [)ESCRIBE PROJECT BRJEFLV: ~ k .....kl 4 9&....Q.+.
4dd,~o", --10 4\~-M~ ~C-\::.. 0 O''f'&>......crt~'"'' '1 Ie .
A.a. ._.. -+ ~lA.c~ ./VF./3\-,"-j -Co",-\- s40oflC.So..'V\~ d\"",\~-0
,4cJcI oN It ~<1>'1 0 'Ie.-.- ---{:;oY\ -\- s-k,~
7. AMOUNT OF LAND AFfECTED:
Initially ""'" unl_''''' .....
8. WILL PROPOSED ACTION COMPLV WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRlCTIOIlS'l
1i!l'Vos oNO If No._....fly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
'SAesldtlfttlal o Indu,triaI o CommercIal o Agrtcunura o I'aIO/FotaaIIOpn ,poco oOtIlor
ctlb<<
10. DOES ACTtON INVOLVE A PERMIT APPROVAL., OR FUNDING, NON OR ULTlMATELV FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL.
ST~R LOCALl'I
os DNa II yes, 11'\ agancy(s) and pormIu.,.,..~....
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLV VAUD PEIlMIT OR APPROVAL?
oVos fiaNa II yes, 1Ia1 agancy ....... and porml\lallpla'ral
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAI'PA\lVAL REQUIRE MODIFICATION?
oVos oNO
I CERTlPV THAT THE INFORMATION PROVIDED ABOVE " TRUE TO THE lEST Of MV I\NOWLEDQE
Appllcanl/a__ name: :of Dalr.
Slgna.u.
If the .ctlon Is In the Coastal Area. and you are a atat. agency, complet. the
Coaatal Auesamant Fonn b.fore proc:aadlng with thla .....am.nt
OVER
~
.
.
PART II-ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR. PART 617.4? II yes. coordinate U'le review process ant:: u.se T!'Ie FULL cAF
:.Yes ,..,
No
_. WILi.. ACT\ON RECEIVE COORDINATED REVIEW AS PAOVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.6? It Nc. a neg8hve ':eclaraIIO~
may be suOerseded by another involveC agency.
Ye. rtNO
e COULD ACTION RESULT IN ANY ADveRSE EFFECTS ASSOCIATED WITH THE FOLLOWING; jA.....""er! may 08 handwnUen, il1egiole\
e, EXlstine air Quality. slJrface or groundwaler Quality or Quantity, noise levelS. existing Iralfic patterns, solid waste t]rOO1JC~lon Of disposal
Dotenllal tor erO$lon, drainage Of !lOading I)fOblems? ExPlain onefly:
-
C2. Aesthetic. agtlCulturaL archaeological. /''lISloric, or other natural or cultural resources: or community Of naighbOrhooa characler,? EXPlain briefly:
CJ. Vegetahon or launa. jish. sneHfish Of wildlife species. signiticant !\aDila's. or threatened or endangered $Dltcies? Exgiain brrefty~
C4. A community', exiSl.ng plans or goals .. officially adopted. or a change in use or intensity of 1.1$. of land or otner natural resources? Explain Drielly.
C5. Growth. suDsequent development, 01 related activities likely to be induced by Ihe proposed action? Explain briefly.
C6. Long term, short term. cumuialive, Of otner eUects not identified in Cl.C5? Explain brM!f1y.
C7_ Olher impacts {including cnanOes in use of either quantity or type of energyl? Explain briefly.
O. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABUSHMENT OF A CEA?
DYes DNo
E. IS THERE, OR IS THERE LIKELV TO eE. CONTROVERSV RELATED TO POTENTiAl ADVERSE ENVIRONMENTAL IMPACTS?
Dv.s DNO It Yea, explain briefly
PART III-DETERMINATION OF SIGNIFICANCE (To be completBd by Agency)
rNSTRUCnON$: For each advtlnse effeet IClentlfied ebOVe, determine whether It la substentlel, lero', important or otherwise significant.
Each eltect should be ..sessed in connec1lon with Its (e) setting (i.e. urban or rurel); (b) probability of occurring; (cl duretion; (d)
irreversibility; (e) geographic scope; and (1) magnitude. If necessary. add attachments or reference supporting materia's. Ensure tnat
explanations contain sufliclent detell to Show thet all relevant adY8fS8 Impacts heve been identllled anc:l adequately addreSsed. If-
question D 01 Part II we. checked yes, the determination and significance must ...Iuate the polentlal.lmpact of the proposed ectian
on the environmental characteristics of the CEA. .
o
o
Check this box if you have identified one or more potentially large or significant Bdverse irrr~ilcts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a posltl~ declaration. '
Check this box if you have determinBd, based on the Information and analySiS above and any supporting
documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts
AND provide on allachments as necessary, the reasons supporting this aetermination:
Namlt oi lead ^.encv
Print or Type rum\! 01 A,noomibl" Othc::t'I' in lead "seney
Title of RtiPO'U.~ OthUf
Slln.1UTe- of Respon"ble Q'heer In Lpd Apncy
.
~..natuft!! 01 Preparer (It diltetent uom teJpon~t>>e oihcerl
Dalt
2
09/17.'2087 e8:~9
7555541
.
BOARD OF TRUSTEES
.
Board of Trustees Application
PAGE 0,
County of ~ug'el~ (\) t\.'Sscu....
State of New York
0.~e.\<>- V. ~Q<:'\C\,^'..~ BEIN"ODULY SWOR..l\;
DEPOSES Ai'lD AFFIRMS THAT HEiSHE IS THE APPLICANT FOR THE ABOVE
DESCRillED PER\fIT(S) A.."lD THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND TfLo\ T ALL WORK
WH.-L.I3E DOl';ti r-l THEMA!'<NER SET FORTH IN THIS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGr:.EES TO HOLD THE TO\\'N OF SOFIHOLD AND THE TOWN TRUSTEES
T-IARM],ESS AND FREE FROM. ANY .o\""D ALL DAMAGES Ai'ID CLArrv.lS ARISING
IJN"DER OR BY VIRTUE OF SAID PERMIT(S). IF GRANTED. .TN C01\.f.PLETlNG THIS
."PI'LICATJON, I HEREBY AUTHORIZE THE TRL'SThES, THEIR AGENT(S) OR
REPR,ESBNTATIVES(S), TO ENTER ON1"O 1vfY PROPERTY TO INSPECT THE
PREMISES 1'< CO:\TJUNCTTON WITH REVI.EW OF THIS APPLICATION.
A-~Ct': ? ~_ .. :.u'
..-~ Sjgnlir~
SWORN TO BEFORE \1E THIS \~~_._DAY OF~~ ,ZOp'!
-~_o- \J _
'<Otarv Public ~ 0-
. ummAK ~"
liIalIrY Public State of New'tblt<
No.4e10941
Qualified in NnMU County
is8lon Elcplres ,\ - ';) - 0'\
Comm. .___.u...u____....___...._
Q9/17/2007 08:49
7541
BOARD OF T~EES
PAGE 08
APPLlCANT/AGENTIREPRESENT A TlVE
TRANSACTIONAL DISCLOSURE F'ORl\I
The 'Towh M~i"t\lIhold'~ Code of Ethics I)rnhibit~ conflict,; of interest on the part pDq)Yt1: r..fficers ~..!IlW()"ccs, The DllIno~ 'U
lhil form i~ 10 nmv;cJe !.nfQ.{mation wh~~an alert the town of Dossiblc conf'lict~ !~f'bI:en!:Sl atld tHow it to t1lk~ wh~t~er f1clbh i!
!1':-~~rv t() avoid same. ...
YOl!R NAMR: ..t!J. 4.N <:"'1 "t ~ A M ~ L. :"-
(Lsst nlllme, first n~. l1I.iddlo initial, I,.It1Jcs~ yol.! 3ft appJyina in 'dIe name of
90~one else or other entity. such fl.1lj a company. If so, indicate the other
person's (If company's name.)
~IAME OF APPLICATION: iCh,ck.1I that apply.)
Tax gfie\'al1C~
Varhm.:e
Change c. i Zone
Appro\-al ()f "llll'
Exc:mptiof1 [tom plat or official mnp
Other
(Jf .'Other" Mtlle the activity.) _ ,__.
Building
Tru,tee
Coastal E.rosion
Moori ng
Plandng
Do YOtl pcrscmlly (Ot' thro!Jg:h YOlir C'omp.m)'. s~<H.I~':, sjhlit'lt~, pattflt, or c!lild) have:l; relationship with ar.)' offic.er or cmplc,yec
')fjhc: Towr\ OfSOL.,tl~\>",j? "Rcl\ltiomhip" includes by blood, ro~rriJgc, f'r bus'incs.'i inte(.:~ "Bll,;.in{,,~5 intci:.:o;f' mC~JJJ~ a b,I:.,inc5...<o;,
luc1udirlg a p:utm.:nhip, in wh1.:h the town officer (Iorcmpl<'t),cc:: hn.' !owen il pO-I'tia! owncrsh:p1.)((o}f cmploymcnl by) a. ':.OI'lX)tlltion
in whior;h 111<:: ~(lWtl officer cr employ.:c owns more thflr. 5% ofth:: shJIC's.
YES
~o
-K__
If )"0\1 I1n,wcred "YES~, ~Qmpictc- tl1c l;tnlnncl;: Ml.his brill and d~tc illld $iJ.n WhCf;:: :ndicll'ed.
~i\me of per .son emrioytd by the Town ofSoul"(I1iJ _/. .
r'!!IO or po:::itioll of that penc'" __._~____.____
Dcs;cribc the relallOn;i1ip bel.\Ve~n you!self(thc appl:c\t:ltlflg.;nVfcprC5entlllive) and the t()Wfl otllcr:f r)r t:::n:'h~:rfC. i::,thl: che;:k
(he .appropriate line ;..'j through D) and/or describe in the space prQv:dcd.
The lowr, (\fliG~r or employee or his or h!:;r spouse, ~iblit\g, ral'cnl, or c.hild is (<:h<:c.k all thai ~pply.';
__._ A) lM owner of ~rE:ater than 5% Jfthc Sh~trc:$ of the cOT'J'O,atc stock ofthc applicant
(when '!t.e a.pplicant is. a cOrpOratittn):
___9) Iht' legal or beoftici:t1 own~r (of {try inlere!ll. in a (l()f1-(;,)rpor:1lc entity (whcn the
applicant is nor 1lI;l(lrpclraljoT1);
_~C) an officer. director. J;'lntlr\et, or et1l1,lo)'ce oflhc applicant; or
_D) thf' actLlalllpplic~llt.
DESCRIPTION or RELA T10NSHiP
SUhllj:te~ _daYOf~290,J
S'gnrJur . ~ lP. ~_
PrinlNnmo .t~ P. f.{.....;._~
Form TS I
I [E [; lE ~ W [Ei l,rN: U'
'III NORTH ROAD (COUNTY ROAD 48)
JUL L u 2005 b
Southold Town '"
Board of Trust s IN
'"
57'56'OO"E \ \ "'.
N 100.00'
CONe
MON
:z: Ul
0J \ \ 0J
N
"l ............ c:i
0 -----.. \ ""
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0 0
q \ ITi
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20.4' \
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"- \ -j ASPHAL T DRIVE
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'0 (3) '" V1 '"
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0 \ Z STOOP W/iV\IUNGS
Z ()
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0 N u
~ %
0
~ <J1 \ wOOD STEPS u
0 20.4'
\ W/RAll 36.3'
'---. \0 WOOD DECK
W!RAlUNG
)p ~ 'Jd/T N
~L \6 '" rN? -----.. <J1
PIPE \:; <;c~\ '-- --- 0
'-; ""
0' PIPE
/ S 57'56'OO"W 100.00' '--
/
N/F WELLS
SURVEY OF
DESCRIBED PROPERTY
ARSHAMOMAQUE,
SUFFOLK
SITUATE
TOWN OF SOUTHOLD
COUNTY, N,Y,
NOTE ELEVATIONS SHOWN HEREON
ARE IN 1929 NGVD.
SURVEYED FOR: AMELIA P. MANCINI
ANN MARIE VER PAULT
CUARANT[ES INOIc,t., lED HeRE: ON SHALL RUN
QNL Y TO mE: PERSON FOR WHOM THE: SUR~Y
IS PREPARED, AND ON HIS BEHALF TO THE
TinE COMPANY, GOvtRNMENTAL AGENCY,
LENDING fNsnrvnON, IF L1STm HEREON, AND
TO THE ASSIGNEES OF THE LENDING INsnrunoN.
GUARAN7[ES ARE NOT TRANSFERABLE TO
ADOlnONAL INSTITUnONS OR SUBSEQUENT OK'NERS.
SURVEYED: 7 OCTOBER 2004
SCALE 1 "= 20'
AREA = 11,250 S,F.
OR
0258 ACRES
UNAUTHORIZED AL TERA TtON OR AOOlnON TO THIS
SURVEY IS A II10LA nON OF SEcnON 7209 OF
THE NEW YORK STA rE [OUCA nON LA w.
fBJ~UDHi~
lfl) SEP 2 1 2007 Jl
SURVEYED BY
STANLEY J, ISAKSEN, JR.
P.O. BOX 294
NEW SUFiFOLK. NY 11956
631-73 1-5835
COPIES OF TH/S SURVEY MAP NOT BEARING
THE LAND SURV[YORS EMBOSSED SEAL SHALL
NO T BE CONS/OERm TO BE A VALID mUE
COpy
TM# 1000-051-06-025
SOlJthold Town
Board of Trustees
-j
Cii
GJ
:::0
o
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fT1
:::0
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GUARANTEED TO:
AMELiA p, MANCINI
ANN MARIE VER PAULT