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SUFFOLK COUNTY CLERIC
RECORDS orrICB
RECORDING PAGB
Type of Instrument. DBEDS/ODD
NUmber of Pages: 3
Receipt Number : 04-0032273
TRANS PER TAX NUMBER: 03-34920
Recorded:
At:
03/23/2004
11.19.43 AM
LIBIR:
PAGB:
D00012308
870
JOHN A RBVBN'1'LOW
JOHN 'A RBVBN'1'LOW
District:
1000 .
Section: Block:
103.00 07.00
BXAKINBD ABD C1l'UGBD AS l'OLLOWS
$0.00
Lot:
007.000
Deed Amount:
Received the Following Fees
Page/Filing
COB
EA- C'l'Y
TP-584
RPT
Transfer tax
$9.00
$5.00
$5.00
$5.00
$30.00
$0.00
For Above Instrument
Bxempt
NO
NO
NO
NO
NO
NO
Handling
NYS SRCHG
IA-STATB
Cert.Copies
SCTK
COIDIIl.Pres
Fees Paid
$5.00
$15.00
$50.00
$0.00
$0.00
$0.00
$124.00
g....""'lpt
NO
NO
HO
NO
NO
NO
TRANSFER TAX HUMBBR: 03-34920
THIS PAGB IS A PART OF THE INSTRTJJIEN'1'
THIS IS NOT A BILL
Bdward P.Romaine
County Clerk, Suffolk County
~2
3
Numller or pages
-.,3"
RECORDED
2004 Plar 23 11,19.43 All
E~rd P.Roeain.
CL.ERI( OF
SUFFOLK COlltlTV
L 000012308
P 810
[oJII 03-34920
TORRENS
sma.,
Cenificate 1#
Prior etf. 1#
Deed / Monpae Instrument
Deed / ManJl8llC 1'1. Slimp
FEES
RccanJing / t'ilina Slamps
4
PogC/ Filina Fee
MonPllC Ami.
J Iond.ina
TP-584
I. Basic 1&x
2. Additionll Tax
NOlation
Sub Tolll
EA-52 17 {Counly)
EA-5217 (SlaIc)
RP.l:S.A.
Sub Total
Certmod Copy
Reg. Copy
Other
SubTotal
SpecJAlsil.
O.
Spcc./Add.
TOT. MTG. TAX
Dual Town Dual Coun'y_
Hold ror Arportionment
Transrer Tax ~
Mansion Tax
'Ibe property covered by this lIlort_c is ur
will be Improved by I one or Iwo ran,ily
_lllng on'y.
vr,s or NO
IrNO. see opproprille II. c~ poge 1#
- or Ibis instrument. 3- \ 1-<5L\
6 Communit Preservation Fund
Consld..ratlon Amount S 0
~o
Comm. or E'd.
AITKlavil
5 <1U-'
ORAND TOTAL
,
Ral''roperty Tax Service Agency Verification
,Dill, Section B lock ....
:- 04012338 1000 10300 0700 007000
( pT S
RCFEA
~~,
CPF Tax Due
s 0
Stomp
DIIe
Improved ][
1
SatilfsctionslDischlUlleslReleases Lilt Property Owners Msiling Add
RECORD" RETURN TO:
V acan I I...and
Initials
.J_ O'IIAIILOII. BllQUDlB
:no IL"n....... AVIlIIUB
POIlT ~ STATIOX. II'l' 11776
TO
TD
TO
9
B Title Company Information
Co. Name AIISOLUTIl ABSTIlACl'. DIe.
Thl..N
Suffolk Count Recordin & Endorsement Pa e
'Ibis page fOl1llS part of the attached
Daed
CSPUC1FY1"YJ>U OF INSlRUMENT)
made by:
.f0llll A. lUSy....J:LOII
"The premises herein is situated in
SUFFOlK COUNIY, NEW YORK.
TO In the Township of
.JOBII A. ....__...ow . BRDI RIw_x..ow. b:f.e rife In the VILLAGE
or HAMLET of
ScNt:bold
Cut:choRue
BOXES S 1liRU 9 MUST DE 'IYPE!) OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR fiLING,
(OVER)
.
t-'Lt::A~t: I yt"'t: UK t-'Ht:::;::>> t-IHIVIL Y WHI::.N WHIliNG UN t-UHM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
FOR COUNTY USE ONLY
Cl. SWIS Code
1,7'>?, ") ,~,c;r I
REAL PROPERTY TRANSFER REPORT
."J'.
'. II
'- ' .~
kP..:Hn R~v JI'T1
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
C2. Date Dead Recorded I 0"::; / ~ SO / 0 Y 1
Month OilY Year
C3. Book 1/ ,.) ~ j, [!?, q CO. Page I , ?j, -7,
PROPERTY INFORMATION
RP - 5217
.01
1, Property I
Location
1000
Sffi~E"l\IlJMBfR
Stillwater Avenue
STREET NAME
Southo1d
Cutc~e
John A.
FIRST NAME
ZIP COO~
11935
CITY OR TOWN
VILLAGE
2. BUy!}r
Name
Revent:low
lAST NAM~ I COMPANY
Reventlow
Erin
l.AST NAME f COMPANY
FIRST NAME
3. Tax Indicate where future Tax Bills are to be sant
Billing jf other than buyer &ddress (Ott bottom of form)
Address
lAST NAME f COMrANY
FIRST NAME
smEET NUMBER ANOSTllf.ET NAME
CITY OR TOWN
STATE
,ZIPCQOE
4. Indicate the number of Ass8$$ment
Roll parcels transferred on the deed
L 'ofPareels
o
o
o
o Parto1aParcel
(Only If Part of a Pal'C&ll Check as tney apply:
4A. Planning Board with Subdivision Authority Exis~
4B. Subdivision Approval was Required for Transfer
4C. Psrcel Approved for Subdivision with Map Provided
OR
6. Deed I X [
Property
Size FAONTFEET
6. Seller R"'vf'lnt"lnw
Name LAST NAM~ i COMPANY
lOR I
1. 3
31
'ACRes
"""
John A.
fIRST NAME
LAST NAME I COMPANY
FIRSTNAMf.
7. Check the box below which moat accurately d..cribe. the use of the property at the time of sale:
Cneck the boxes below.. they apply:
8. Ownership Type is CondominIum
9. New Conatruction on Vocant land
lOA. Property located within <Ill Agricultural District
lOB. Bu~r received 1'1 di$<:losuro notice indicating
that the property is in an Agricultural Disuict
o
o
o
o
A~ One Fnmily Rosldential
B 2 or 3 Family Residenti..1
C ResldentfaJ Vacllnt Land
o Non-Residential Vacant Land
E~Agrlcultufal
F Commercial
G Apartmenl
H Entertainment I Amusement
l~communityservice
J Industrial
K Public Service
L Forelt
SALE INFORMATION
15. Check one or more of tl18H oondkions as .applicable to transfer;
/ N/A /
Moo. D., y~,
.5 / II / ell
Monlh 0., Year
Sale BetWeen Relatives or Former Relatives
Sale Between RelilItad Companies or Partners in Busine88
One of the Buyers is also II Seller
Buyer or Seller is Government Agency or Lending Institution
Dead TY)JQ not Warranty or Bargain and Sale (Speclfy Below)
Sale of Fractional or Less tllan Fee Intorast {Specify Below}
Significant Change in Property Between Taxable Status and Sale Dates
Sale 01 Business is Included in Sale Prico
Other Unusual Factors Affecling Sale Price lSPfilcify Below)
None
11. Sale Contra<< Date
A
B
C
D
lJ
F
G
H
I
J
12. Date of Sale I Transfer
"~
, , .
(FuJI Sillle Price is the total amount paid for the property including personal property.
This payment may be in the form of cash, other property or goods, or the assumption of
mortgages or other obligations.) Please rOIJnd to the fIt)~ole dollar amount
14. Indicate the value .of per$Onal I . ,~ " 0 , 0 I
property included In the sale, , .
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill
13. Full Sale Pric.,
, II
III
16. Year 01 Assessment Roll from
wl1ich infOrTnStion taken
2,100/6,000
, , ,
17. Total Assessed Villus lot all parcels in transferll
~-;
18. Property Class
12
1 0 I-U 19. School Oistriqt Name I
Hattf.tuck
20. Tax Map ldentifier(sj I ROllldenti'ier(s) IIf mOrt! than four, attllCh sheet with addltiollalldlilntifier[sll
(o~ Sect. 103; B1k. 7; Lot 7
CERTIFICATION
nil of th~ item... of infonnation c-nt~n..d till thL.. form arc- Inlc imd correct (to ttw b~'S1 of my kn(lwlL'dKe and beJief) und I understand that lIw makin/ol
f I. e sWlclIlcnl (If lie. l"act ~rein will sunjfd me 10 the nnlViMOTL'i of the Dellal 11m relalin' 10 the mllkin~ Imd nUn!! 01' ffllo;c IU!l1rumenL'!i.
BUYER'S ATTORNEY
otBan1on
LAST NAME
Janet:
FIRr;TNAM~
1000
STRHTNUMSFI!
Stillwater Avenue
smEU NAME CAneR SALEI
631
AIlEACOIX
928-8000
HLEPliO'lE'lUMElEIl
Cut:chosme
C'TY OR TOWN
NY
STJ\U
11935
;tIPCOCE
NEW YORK S1AfE
COpy
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