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Standard N. V .B. T U. Fol'l11 8002 - Bargain Bnd Sale Deed, with Covenant against Granlor's Acts - Uniform Acknowiedgment
Form 3290
CONSULT YOUR LAWYER BEFORE~NING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
THIS INDENTURE. made the'Fllay of-M8yo, 2003
-;r.;1I'L.
BETWEEN
POLIVlOS POLl as surviving joint tenant of CLEANTHY POLl, who died a resident of Suffolk
County on 2116101, residing at 285 Inlet View East. Mattituck, NY 11952
party ofthe first part, and
POLIVIOS POLl, residing at 285 Inlet View East, Maltituck, NY 11952, and MARY HARDERS,
residi~g at 428 Puritan Driva, Shirley, NY 11967, as joint tenants with right of survivorship.
party of the second part,
WITNESSETH, that the party of the first part, in consideration of Ten and 00/100---
_________________________________($10.00)_____________------------ -<lollars.
and other good and valuable consideration paid by the party of tha 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, situate, lying and being at Matt/tuck, in the Town of Southokl,
County of Suffolk, State of New Yor1c, shown and designated as Lot #4 on a certain map entitled "Map of Inlet
East Estates", filed In the Suffolk County Clerk's Office on May I, 1975 under file # 6249.
SUBJECT to covenants and restrictions dated the 17'" day of September, 1974 and recorded in the Suffolk
County Clerk's OffICe in Liber 7833 at page 107.
BEING AND INTENDED TO BE a portion of the premises as conveyed to the party of the first part by Doris D.
Reeve on the 29" day of April, 1975 with correction deed recorded In Liber 7833 at page 146. which said deed
was recorded in the Suffolk County Clerk's Office on the 1~ day of May, 1975.
TOGETHER with all right. tl~e 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 centar 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 HAVE AND 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 tha 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 lfle 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 tha same
first to the payment of the cost of the improvement before using any part of the total of the sama for any other
purpose. The word .party" shall be construed as If it read 'parties' when ever 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:
. ~/.. '.fl ~~'.
Polivio5 Poli
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YORK STATE
State of N_ York, County 01 Suffolk ss:
", ';">J>-
On the day of ~ in the year 2003,
before me, the undersigned. personally appeared
POLlVlOS POLl
penronally known to me or proved to me on the basis of
aatlsfactory evidence to be the individual(s) whose name(s) is
(are) subscribed to the within Inatrument and ecknowledged to
me that helllhelthey executed the 1I8me in hlalherAheir
capaclty(lea), end thet by hlalherllhelr aignature(a) on the
Instrument. the individual(s), or the person upon behalf of which
the individ a) acted. Be d U\e: Instrument.
State of New York. County of
On the day of in the year
before me. the undersigned, personally appeared
personally known to me or proved to me on the bal.. of
satislactory evidence to be the Indlvldual(a) whose name(s) Is
(are) subscribed to the within Instrument and acknowledged to
me that helshelthey executed the same In hlalhernhelr
capaclty(les), and that by hlolharltnelr signature(s) on the
instrument. the indlvidual(s). or the person upon behllf of which
the individual(s) aded. executed the Instrument
as:
(algnBture and office of Individual taking ecknowtedgmenQ
ABIGAIL A. WICKHAM
lII_ry Public. __ of _Valle
No, IIz.4I42871 . Suffolk C_ty
Commls.lon Eopl...-'30. sa::
Sc.~-I- "2..OOS'"
'-'t"G-BE tJSED:EiNI='l-WHEN-THE,'~KNOWldiDGMENT IS MADE OUTSIDE NEW YORK STATE
State (01 Dis.rid of Columbia. Territory, Dr Foreign Country) of
8S:
On the
day of
in the year
before me, the undersigned. personalfy appeared
personally known to me or proved to me on the basis of satisfactory evidence to be the Individual(s) whose name(s) ia (are)
subscribed to the within instrument and acknowledged to me that helshelthey executed the ume in hialherlthelr C8p8City(i..), and
that by hlalherllhelt aign.lure(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument. and thai such Individual made such appearance before the under"gned in the
in
(and insert the State or Country Dr other place the acknowledgment was takenJ
(insert the City or other political subdivision)
(Signature and off'1CtI of individuall.ldng .ck~l_nt)
BARGAIN AND SALE DEeD
WITH COVENANT AGAINST GRANTOR'S ACTS
Title No,
POUVIOS POLl as surviving joint
tenant of CLEANTHY POLl, who died a residenl
of Suffolk County on 2/16/01
TO
POLlVIOS POLl and MARY HARDERS
STANDARD PORM 0.. NEWYORK BOARD OF 1T1'Le UNDI!R'r-~ITI!RS
Distributed by
o common~~,!!~o",...,
COMMONWEAL TlI L"..."o TITL!::: lr.;suRA....a COMPANY
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Number of pagel
TORRENS
s
RECORDED
2003 JL'n ~6 12:43,27 PM
Edward P.Roeaine
CLERK OF
, SUFFOL~ COUNTY
L 000012256
P 286
DTlI 02-43305
Serial ~
Certificate #
Prior Clf. ~
Deed I MaRple InstrulllCllt
Deed I Mortgage Tax StOmp
FilES
Recording I Filing Stamps
4
Page I Filing Fee
Handlinll
TP-584
t~
?--
?~
Mortgage Amt.
I. Basic Tax
2. Additional Tax
NotatioD
Comm. of Ild.
~--
00 -
~=
5~
Sub Total
~
Sub Tota.
1lA-52 17 (County)
IlA-52 1 7 (State)
R.P.T.S.A.
Certified Cop)'
Rei. Cop)'
SpeeJAs_iL
0.
Spec. I Add.
Other
.\ ~-==-- SubTotal
ORAND TOTAL
. J 0-6-
TOT. MTG. TAX
Dual Town Dual Count)'_
Held Cor Apponionment
Tranlfer Tax -0-
Mansion Tax . _
lbe property coyered by this monaaae is or
will be improved by lone or two ram iI)'
dwelling oDl)'.
VIlS orNO_
IfNO, lee appropriate tax clause on pago ~
_ofthilln_
-DJ
Affidavh
l
Real Property Tax Service Agency Verification
01_1. Section B locIc
Lot
6 Conununi Preservation Fund
Consideration Amount S n.-
Initials
r
I
I
1000 10000 0300 010004
CPF Tax Due
$
Stamp
Date
Improvod
aClnt Land
7
Satisfactioi._ -......._a-&_I......~......in r IVIJ'iOII.Y vWUC:&:' lYlal1UIK J'\.adrcs
.' RECORD & RETURN TO:
l01~th(lm ~es~~:- G(jY~ q.~J~
q, () <:6 t)K l1/-::J 1"';
(Yl ehLA ~e,~
TO
TO
TO
8
Title Company Information
9
Suffolk Count
Co. Name
Title#.
e
This page fOtTIlS part of the 81tIIcbcd
'\Jot; 'lIDS f:>o I;
made by:
(SPEaFYTYPE OF INSTRUMENI')
The premises herein i. situated in
SUFFOLK COUNIY. NEW YORK.
TO In the Township of SV1J Lit I] leY
r:t> c> II 1/ I O~ ~ -r,- In the Vll.lAOE 11
fYlo[11 J-lQ ~rI~~ , or HMfLJITOf--fY] (1''itJ -hie L
BOXES 5lHRU 9 MUST BE TYPED OR PRINIED IN BLACK INK ONLY PRIOR TO RECORDING OR flUNG.
1111111111111111111111111111111111111111111111111111111
111111111111111111111 I11I
SOFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEEDS/DDD
Number of Pages: 3
TRANSFER TAX NUMBER: 02-43305
Recorded:
At:
LIBER:
PAGE:
06/16/2003
12:43:27 PM
D00012256
286
District:
1000
Section: Block:
100.00 03.00
EXAMINED AND CHARGED AS FOLLOWS
$0.00
Lot:
010.004
Deed Amount:
Received the Following Fees
Page/Filing
COE
EA-CTY
TP-584
RPT
Transfer tax
$9.00
$5.00
$5.00
$5.00
$30.00
$0.00
For Above Instrument
Exempt
NO Handling
NO NYS SURCHG
NO EA-STATE
NO Cert.Copies
NO SCTH
NO Comm.Pres
Fees Paid
$5.00
$15.00
$50.0!)
$0.00
$0.00
$0.00
$124.00
Exempt
NO
NO
NO
NO
NO
NO
TRANSFER TAX NUMBER: 02-43305
THIS PAGE IS A PART 01' THE INSTRUMENT
Edward P.Romaine
County Clerk, Suffolk County
.
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518i 473-7222
REAL PROPERTY TRANSFER REPORT
FOR COUNTY USE ONLY
C3. Book I
ICf?3,f?,~fl
b//t'i
Mor,lh Dav
,(d,,;J.,S,~ I C.. Page I
C1. SWIS Code
C2. Date Deed Recorded
c:'? I
-m;,
,d, Ji,{:
PROPERTY INFORMATION
1. r;::i: I
1835
STR~ET IIIUMBER
Rppvp. ROni'l
STREET NAME
2. Buyer
Name
""oylilt\llYX o9"tRo1a
Poli
LAST~AMEiCOMPMY
I Harders
lAST NAME I COMI'A'IY
3. Tax Indicate where future Tax Bills are ,0 be sent
Billing if other than buyer address (at bottom of form)
AddrllS5
I
~ST""'I/E,COMP"'~Y
STREETl'<UMBER AND STREET NAME"
."
. ",
, - j'
, -II
." ..CJ
. 4'",,",~ .
l~.iLt1.....].
Polivios
'IRSTN"'ME
Mary
HRS1NAME
4. Indicate tile number of Assessment
Roll parcels transfened on the deed
1 J # of Parcels OR 0 Part of a Pucel
OTYORTOWl'<
5. Deed
Property
Si~e
! OR L----
I xl
DEPTH
FIiONTFen
6. Seller
Name
Poli
LAST NAM~, COMPANY'-
LAST NAM~/COMP"'NY
. 9 2
hCR(S
7, Check the box below which most accurately describes the use 01 the property at the time of sale
A~oneFamilYReSidential
B 2 or 3 Family Residentiai
C Resid&ntial Vacant land
D Non-Residentiai Vacant land
E~A9'i,""","' T~
F Corn:~1ercia. J
G Apartment K
H Entertainment,' Af"usement L
SALE INFORMATION
11. Sale Contract Date
/
Manit" 0., Yea,
f..e II /0'7, 1
M~n:h go, Year
12. Date of Sa Ie I Transfer
13. Full Sale Price , ~Q__~
, , .
(Full Sale Price is the total amountpllid for the oroperty includill\) pe,sonalpraperly.
This payment may be in the form of cash, other property or goods, or the assumption of
mortgages or other obligations.) Please round to the Marestwnole o'olliirarllount
Comrruni:yService
Indu~lriill
Public Service
Forest
Polivios
HHSTNAMF
HHS'''AMf
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
IU".S~17 Rov3lcn
111952
2'1' too.
,
---"
FIRSTNAM.
---L..
STATf'
21f'COOE
A
R
C
D
E
F
G
H
I
J
(Only if Part of a Parcell Check liS they apply:
4A. Planning Board with Subd'visio~ Authority Ex:sts 0
4B. Subdivision Approval was Required for Transfer 0
4C. Parcel Approved for Subdivision wim Map Provided 0
_ ...J
Check the boxes belOW as they apply:
8. Ownership Type is Condominium
9. New Construction on Vacant land
10A. Property Locatedwithi"1 an Agricultural District
lOB. I3l.lyer received a disclosme notice indicating
:h",..lhe property is in an Agricultural District
o
o
o
o
15. Check one or more of these conditions IS appliceble to transfer'
Sale Between Relatives or Formar Relatives
Sale Between Related COrT'panies or Partners in Business
One of the Buyers is also 11 Sellar
Buyer or Selle! is Government Agency or Lending Institution
Deed Type not Warranty or Bargain and Sale (Specify Belowl
Sale of Fractional or less than Fee Interest (Specify Belowl
Significant Change in Prooerty Between Taxable Status and Sale Dates
Sale 01 B.Jsiness is Included in Sale Price
Other Unusual Factors Atlecting Sale Price ISpecify Below)
None
14. Indicate the value of personal I 0 OJ
property included in the sale, , .
ASSESSMENT INFORMATION. Data should reflect the I<lrost Final Assessment Roll and Tax Bill
16. Vear of Auessment Roll from
whichinlormatiantaken
ilL02.J
17. Total Assessed Value (af all parcels in transfer) I
1
;
4 OX 0
I 3 1,1 I..U 19. Schaol District Name I Mattituck-Cutchogue
18 Property Class
1000-100-3-10.4
20. Tax Map Jdentifierlsll Rallldentifierh.1 (II more than four, attach sheet with additional identlfier\s!!
L
----.J
I CERTIFICATION
J certify that all of the it"lllS of infonnaLion entel"ffl (In this form are tru.. and correct (to the bt-st of n.)' knu"1edge and belieO and J understand that the making
of allY willful false statement of material fact herein will subject me w the tlnlvisioflS of the m.....1 law relative to the making and tiling of false instruments.
BUYER
0) '.' ( v.L..
OA'E
I',
[fA 'eZ
I f1 ,',' :.. ~\ "
~ f ( IL' L.Cv..,
ST~~ET NAME 14nF~ SA.l.l;j
rllrli/ttl ~JQ...ll
CI OR TOWN
1'-1'1
ST41f
It'! 5;.:;1
LIP co~t
SELLER
-'.d:: 4_; ....,fi:--t.'
SELLEflS1GNA.TURE I
, ..<1:
I Lelli I () .J
~"
Wickham
I...~t '~AME
631
AREA COD~
BUYER'S ATTORNEY
i Abiqai 1
fIHS,N4Mf
298-8353
nL(PHONENUM"E~
r:w YOR~ ST.A~ ]
l COpy