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Stanc:latd N. Y B.T .U. Form 8002 - Bargain and Sale Deed, with Covenant against Granlor'_ Acts - Uniform Acknowledgment
Fonn 3290
CONSULT YOUR LAWYER BEFORE.fRNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED,BY LAWYERS ONLY
THIS INDENTURE. made theJ roay ~. 2003
::::TUne...
BETWEEN
POLIVIOS POLl as surviving Joint tenant of CLEANTHY POLl, who died a resident of Suffolk
County on 2/16/01, residing at ~Inlet View East. Matt~uck, NY 11952
~g~
party of the first part, and
MARY HARDERS, residing at 428 Puritan Drive. Shirley. NY 11967.
party of the second part,
WITNESSETH, that the party of the first part, in consideration of Ten and 00/100------------____
-----------------------------------($10.00)-------------------------- dollars.
and other good and 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, situate, lying and being at Mattituck, in the Town of Southold,
County of SUffolk, State of New York, shown and designated as Lot #7 on a certain map entitled "Map of Inlet
East Estates., filed In the Suffolk County aerk's Office on May 1, 1975 under file # 6249.
RESERVING to the party of the first part a life estate in the premises.
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 01 April, 1975 with correction deed recorded in Liber 7833 et page 148, which said deed
was recorded in the Suffolk County Clerk's Office on the 1" day of May, 1975.
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 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 the party of the first part covanants 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 01 paying the cost of the improvement and will apply the same
first 10 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" 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 frrst above
written.
IN I'RESI!NCE OF,
~~-
Poli\'ios Poli
""')
fd.r
TO BE USED Q.tI.b:!. WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YOR~T.!;
State .of New York. County of Suffolk as:
. On th'/~y of~n the year 2003.
before me, the undersigned. personally appeared
POLIVIOS POLl
personally known to me or proved to me on the basis of
uUsfactory evidence to be the indivJdual(a) whose name(aJ la
(are) subscribed to the within instrument and acknowledged to
me that helahelthey executed the same In hlslherlthelr
capaclty(les). and that by hlllherltheir slgnature(s) on the
Instrument. the Indtvldual(.), or the person upon behalf of which
the Individual ed. executed the i me t.
.
State of New VOrk, County of
On the day of In the year
before me. the undersigned. peraonlluy appeared
personally known to me or proved to me on the b_ls of
satisfactory evidence to be the individual(e) wholl8 neme(.) Ia
(are) subscribad to the within Instrument and acknowledged to
me that heJahelthey executed the same In hisJherltheir
capacily(les), end thet by hlllharllhelr slgnalura(s) on tha
instnnnenl. the IndividuaICs). or the person upon behalf of which
the individual(s) acted. executed the Instrument.
sa:
(signa ce 0 I Ivldual taking acknowledgment) (signature and office of Individual taking acknowledgment)
NollIfY Publ _GAIL A. WlCICIIAII
-." -. __of _V....
No. 112.4842871 . lluffDIk~--
Commiulon Expi.... Mttreh 30. .::>
~.....
'=.7:.,-.C:rO'BE.jjS:elt2NtY'WHE1ii'tifE-ACKNOW~~DGMENT IS MADE OUTSIDE NEW YORK l!TATE
State (or Distrid of Cofumbla. Territory. or Foreign Country) of
as;
On the
day of
in the year
before me. the undersigned. P8t1lonally appeared
personaUy known to me or proved to me on the basis of satisfactory evidence to be the Indlvldual(s) whose name(a) ia (are)
sub8Cribad to the within Instrument and acknowledged to me that ha/she/lhay exacuted the same In hlslherltheir capaclty(les), and
thet by hlalherllheir algnaturecs) on the Instrument, the individuaICs). or the person upon behalf of which the IndividualCs) aded.
executecl the instrument. and that such individual made such appearance before the undet8igned in the
In
(and Insert the Stale or Country or other place the .cknowtedgrlleld waa leken)
(insert the City or other political aubc:Uviaion)
(signature and office or individual taking acknowledgment)
BARGAIN AND SALE DEED
WITH COVENANT AGAINST GRANTOP:'S ACTS
Title No.
POLIVIOS POLl as surviving joint
tenant of CLEANTHY POll, who died a resident
of Suffolk County on 2/16/01
TO
MARY HARDERS
STANDARD FORM OF NEW YORK BOARD OF TITLE UNDeRWIUTERS
_ DIs_ by
o CommOn~~!~_...v
COMwo";WHA!.ntl."hU 'rm.l~ INSURANClt Cl'l!>otPA,,"Y
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Number of PllIes
TORRENS
3
RECO.DEU
2003 Jun 16 12:43:27 PN
Ed~ard P.Ro~~i~
CL:;RK OF
. SUFFOLK COUNTY
L C'00012256
P 2e7
on 02-~3306
Serial #
Certificate /I
Prior Clf. /I
, Doed J Mor1&Age IDstnlmont
Deed J Mottgqe Tax Slamp
FEES
Recording J Filing Stamps
4
Page I Filing Fee
-
Handling
TP-SI4
5-
6-==-
Mottl"3e AmI.
1. Basic Tax
2. Additional Tax
Notation
Comm. of Ed.
Affidavil
5-
~
s~
Sub Tolal
EA.SZ 17 (County)
EA-SZI7 (S....)
RP.T.S.A.
Sub To"l
'Qc..(-
Other
I t?-=-----. Sub Total
GRAND TOTAL
SpecJAlsit.
Or
Spec. J Add.
TOT. MTG. TAX
Dual Town Dual County_
Held for Apportionment _
Transf.. Tax _ lJ-
ManslOll Tax
The property covered by this mortgage is or
will be improved by a one or two family
dwelling only.
YES or NO
[fNO. see appropriate tax clause on page /I
- of Ibis instrumeDL 'I -0 ~
6: Communi Preservation Fund
Consideration Amount S ~ 0
Cettified Copy
Reg. Copy
s
Real Property Tax Service Agency VerifiClllion
Dill. _ _ ~~i~. __ _ Block. - -, -- ..
- . 1000 10000 0300 010007
cpp Tax Due
$
Slamp
Dale
Improved
lnitials
Vacant Land
7
t .______
SatisfactionSlulscnargoSl.K.Dleases List Yroporty owners Mailing Addre
.' RECORD II< RETURN TO:
WI Q.ILh:un. ~(es~Lcu- ~(jYddh broJ
~ 0 ~ ~ I c.t;;)'-/,"
fY\cvU-t +ve k JJV{ /1-1'52..
TO
TO
TO
9
Suffolk Coun
B Title Company Information
Co. Nam.e
Title #
& Endorsement Pa e
lbis page forms part of tile attached
made by:
~I \ V, oS '"::pC \",
(SPECIFY TYPE OF INSTR.UMENI')
The premises herein is situated in
SUFFOLK COUNTY, NEW YORK.
In the Township of .s fi"u4Rl'\ Ic!.
In the VILLAGE ..
or HAMLET of -(V) a..:lh +0 c. /J......
BOXES 5 TIlRU 9 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
TO
(Y)(MVj 4(J rriu {j
111111111111 11111111111111111111 11111 111111111111111111
1111111111111111111111111
SOFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEEDS/DDD
Number of Pages: 3
TRANSFER TAX NUMBER: 02-43306
Recorded:
At:
LIBER:
PAGE:
06/16/2003
12:43127 PM
D00012256
287
District:
1000
Section: Block:
100.00 03.00
EXAMINED AND CHARGED AS FOLLOWS
$0.00
Lot:
010.007
Deed Amount:
Received the Following Pees
Page/Filing
COE
BA-CTY
TP-584
RPT
Transfer tax
$9.00
$5.00
$5.00
$5.00
$30.00
$0.00
Por Above Instrument
Exempt
NO Handling
NO NYS SORCHG
NO !!:A-STATE
NO Cert.Copies
NO SCTH
NO Comm.Pres
Fees Paid
$5.00
$15.00
$50.00
$0.00
$0.00
$0.00
$124.00
Bxempt
NO
NO
NO
NO
NO
NO
TRANSFER TAX NUMBER: 02-43306
THIS PAGE IS A PART OF THE INSTRUMENT
Edward P.Romaine
County Clerk, Suffolk County
.
FOR COUNlY USE ONLY
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http:// www.orps.state.ny.us or PHONE (5181 473.7222
REAL PROPERTY TRANSFER REPORT
C1. SWIS Code
17"'7, -<;, I? ;?,'(' I
hi /h'
Month Dav
C2. Date need Recorded
*
C' 11 . .
Year JI
,;),8,71 \;' '":!!>''' ..!
C3. Book 1/ .;z ,.;2., ,~&; I C4. Page 1
PROPERTY INFORMATION
1. Property I
Location
?Rl)
STREET NUMBER
...I..n..le.:t-_1Tiew... ~~"'...
STAEETNAME
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP.S2I7 R~v JI'YI
Southold
CITV 011 TOWN
Mattituck
VILLAGE-----
111952
llPeODE
2. Buyer
Name
Harders
MXKX~ Mary
OIR$TNAME
LASTN.>.MF.'COMP/l,W
LAST N....ME I COMPA\Y
FIRS-NAME
FmSTNAMF.:
3. Tax Indicate where fUlure Tax Bills are to be sent
Billing if other then buyer address (at bonom of lor-)
Addr...
IASTNAME.'CDMI'AN'-
STREET NUMBER ANO-sfflEET NAME
CITY OA TOWN
liP CODE
4. Indicate the number of AS58ssrnent
Roll parcels tranAerred on the deed
1 I # of Par~als OR D Part of 11 Parcel
5. Deed
Property
Size
1 X L____u_.j OR I.
OEPTCI
ACREll
. 9 7 1
FAQNTFEn
6. Seller
Name
Poli
LASTNAME./CQMPANV
Pol ivioK
f1R~. '.'AME
lASTNAMt!CQMPANY
_._FiP;si-,,";i~-
7, Check the box below which most accurately describlls the use of the property at the time of sale'
A~oneFamilYRCsidt'ntial
B 20r3FamilyResidential
C ResidentialVacar,t land
o Non-Residential Vacant Land
E~ Agti~ultu'i11
F Commercial
G Apartment
H Entertainment i Amusement
'~commun.t\'.serVice
J Indust<a:
K PlJblic$"rVlce
L Fo'es!
SALE INFORMATION
SrATi:
(Onlv if Part of a Parcell Check as they apply;
4A. Planning Board with $;.Ibdivision Autho'ity Exists D
48. Subdivision Approval was Required for Transfer D
4C. Parcel Approved for Subdivision with Map Provided D
Check the boxes below as they apply;
8, Ownership Type ;s Condominium
9, New Construction on Vacant lar:d
10A. Property Located within an Agricuitural District
108 Buyer received a d:sclosure notice i~dicating
that the property is in an Agricultural District
o
o
o
o
11. Sale Contract Date
~L---,
~("Ih Day Year
1~, Check one or more of these conditions as applicable to transfer.
12, Date of Sale I Transfer
rc
10'3 .J
Year
^
B
C
D
"
F
G
H
r
I
/1
Morillo
Do,
, 01. 0 ,.!L."
, , .
IFuil Sail) Pr;ce is the tolal amOL.nt paid for the prcperty including personal property.
This payment may be in the form of casll, other property ur gooes, 0" the assumption of
mortgag9s or other obligations.) Pleasa round to the ncarest whOle dollar amount.
13, Full Sale Price
14, Indicate the value of personal
property included in the sale
,0 0 I
, , .
ASSESSMENT INFORMAT!ON - Data should reflect the iatest Final Assessment Roll and Tax Bill
16. V~r o~ A$sess~cnt Roll from In1 n? I 17 Tota! ASS8$sed Value lot 01/ parcels in transfer) I
which mformatlon taken .
18, Property Class
2
19. School District Name I Matti tuck-Cutcho9..ll:~
1
q-LJ
20, Tax Map Idontifierlsl ( Rolltdentifierls) (If more than four, attach sheet with additional identifier(s))
1000-100-3-10.7
I.
. -----.J
Sale 8etv/een Relatives or Former Relatives
Sale Between Related Companios or Partners in Business
One of t"le Buyers is aiso a Seller
Buyer or Seller is Government AgUflCy or lending Institution
Deed T\'pe not Warrenty or Bllrgain and Sale (Specify Below)
Sill," ot l'ract:onal or less tllan Fee Interest lSpec;fy Below)
$igniIiCi.lnt Change in Property Between Tnxable Stat...s and Sale Dates
Sale of Business is Included in Sale Price
t>/ Other Unusual Factors Affecting Saie Price !Specify Below)
No", 1#'
Ka.~I.J . IMf.:h....-
7
7 0 01
I CERTIFICATION
I c:ertify that all uf the Items of informatiun entered on this funn are true and correct (to the bE"it of my knowledl!:e and helif"l) und I undcnitand that the making
uf any willful false statement of material fact he",in will subject ilK.' to the pnwisions of th(. ~Ilal law r('larh'e to the making Ilnd filing of faLw in.~tnJmenlt;.
1',
__---1 \\,~
~~:
__J.
Ullil63
'I'lickhurn
lASTNAMF
BUYliR$IGNATURE
DATE
0( <JS' I ~'h Id 1iL~ /1muV
STAEe-c NUM\lER STflHT NAME (liFTER SAU;l
631
BUYER'S ATTORNEY
Abiqai1
fiRST ~AME
298-8353
TULPHONENUM!*.R
AREA CODE
'177,dUJc _
c:TY OR TOWN
.vy
STATF
,,(L7S:L
~
-/P~-4-C^
SHlERSIGNATuAE
Ivc J., J
DATE
NEW YORK STATE I
COpy
J