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PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
I~STRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
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FOR J)QeNfy USE CflIL Y
Cl. SWIS Code
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REAL PROPERTY TRANSFER REPORT
C2. Date. Deed"Recorded
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C3.Book I /1;11/'1 )
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Month
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Day
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STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
Year
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RP - 5217
RP-5217 Rev.lf97
1. Property I
Location
PROPERTY INFORMATION
20C I \;\J i \'se
I STREET NAME
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2. Buyer
Name
LAST NA E I COMPANY
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LAST NAME I OMPANY
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^,I.RSTNAME
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3. Tax Indicate where future Tax Bills are to be sent
Billing if other than buyer aCldress (at bottom of form)
Address
LAST NAME I COMPANY
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FIRST NAME
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STREET NUMBER AND STRE~T NAME
4. Indicate the number of Assessment
Roll parcels transferred on the deed
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CITY OR ToWN
ST~TE ZIP CODE
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ACRES
(Only if Part of a Parcell Check as they apply:
4A. Planning Board with Subdivision Authority Exists D
4B. Subdivision Approval was Required for Transfer D
4C. Parcel Approved for Subdivision with Map Provided D
# of Parcels OR D Part of ~ Parcel
5. Deed
Property
Size
6. Seller
Name
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LAST NAME I COMPANY
FIRST NAME
~one Family Residential
B 2 or 3 Family Residential
C Residential Vacant Land
o Non-Residential Vacant land
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Agricultural
Commercial
Apartment
Entertainment / Amusement
I ~ Community Service
J Industrial
K Public Service
L Forest
Check the boxes below as they apply:
8. Ownership Type is Condominium
9. New Construction on Vacant Land
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7. Check the box below which most accurately describes the use of the property at the time of sale:
10A. Property Located within an Agricultural District
10B. Buyer received a disclosure notice indicating
that the property is in an Agricultural District
SALE INFORMATION
Month
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13. Full Sale Price , ,)-, J. 0 I 0 I
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(Full Sale 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 round to the nearest whole d ar amount.
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15. Check one or more of these conditions as applicable to transfer:
Sale Between Relatives or Former Relatives
Sale Between Related Companies or Partners in Business
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One'ofthe Buyers is also,a Seller'
~uyer or Seller is Gove'rnment Agency or Lending Institution
Deed Type not Warranty or'Bargain and Sale (Specify Below)
Sale of Fractional or less than Fee Interest (Specify Below)
Significant Change in Property Between Taxable Status and Sale Dates
Sale of Business is Included in Sale Price
Other Unusual Factors Affecting Sale Price (Specify Below)
None
11. Sale Contract Date
12. Date of Sale I Transfer
,Year
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Month: ,
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14. Indicate the value of personal
property included in the sale, , .
I ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Still I-
16. Year of Assessment Roll from I~ {)I . ! / /)3 - --(3
h. h' f t' t k -- 17. Total Assessed Value (of all parcels In transfer) ,'" . ,
WlClnormalonaen , ,
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18. Property Class
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20. Tax Map Identifier(s) I Roll Identifier(sl lIf more than four, attach sheet with additional identifierlsll
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tCEATiFlCAtlON
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I certify that allot the items of infonnation entered on this fonn are true and correct (to the best of my knowledge and belief) and I understand that the making
of ~ny willful false_ statem"?lt o~ material fact herein will subject me to the provisions of the nenallaw relative to the making and tiling of false instruments.
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BUYER'S ATTORNEY
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DATE
LAST NAME
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UYER SIGNA URE
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STREET NUMBER
STREET NAME {AFTER SALEI
AREA CODE
TELEPHONE NUMBER
CITY OR TOWN
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STAT~
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ZIPCOOE
SELLER
CITYffOWN ASSESSOR
COPY
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SELLER SIGNATURE
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