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S18nd11rd N. Y .B. T.U. FQfm 8002 -. B81'Q181n end Sa. Deed, with eovenlnt -sllinat GrinlOr'. Acts - Unlfonn Acknowtedgment
Fonn 3290
CONSULT YOUR LAWVER BEFORE. SIGNING nus INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
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THIS INDENTURE, made the :l'/day of March, 2004
BETWEEN
MICHAEL KALOSKI, residing at Route 2, 1930 Alvah's Lane, Cutchogue, New York, as to a ninety-
fove (95%) percent undivided interest, and LORRAINE I. SIMON, residing at 27 Stacey Lane,
Madison, Connecticut, 06443, as to a five (5%) percent undivided interest, as tenants in common,
party of the first part, and
HOWARD SIMON AND LORRAINE I. SIMON, as tenanls by the entirety, residing al 27 Stacey
Lane, Madison, Connecticut, 06443, 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, with the buildings and improvements thereon erected. s~uate,
lying and being 81 Culchogue, in the Town of Southold. County of Suffolk and State of New York, bounded and
described as follows:
BEGINNING at a point on the eastarly side of Alvah's Lane at the southwesterly comer of land now or formerly
of Rainhardt and the northwesterly corner of land of Michael Kaloskl; running thence along said land now or
fonnerty of Reinhardt. the following two courses and distances; (1) North 48 degrees 54 minutes 30 seconds
East, 407.28 feel; thence (2) South 49 degrees 04 minulea 29 seconds East. 706.98 feet to land now or
formerly of Batuello; thence along said land, South 47 degrees 25 minutas 20 seconds East, 136.26 feet to
land now or formerly of Kerrigan; thence along said land, South 42 degnses 51 minutes 20 seconds Wast.
429.52 feet to the eastarty line of Alvah's Lane: thence along said line, North 47 degrees 08 minutes 40
seconds West, 256.00 feet to other land of Michael Kaloski and Irene Kaloski; thence atong said land, the
fol1owing three COUr1les and distances (1) North 42 degrees 51 minutes 20 seconds East, 150.00 feet; thence
(2) North 47 degrees 08 minutes 40 seconds West, 150.00 feel: thence (3) South 42 degrees 51 minutes 20
seconds West, 150.00 feet to the easterty line of Alvah's Lane; thence along said line, North 47 degrees 08
minutes 40 seconds West, 479.78 feet to the point or place of BEGINNING.
BEING AND INTENDED TO BE the same premises conveyed to the party of the fir1lt part by deed dated June
5,2003, recorded June 5, 2003 in Liber 12254 page 894.
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 thareof; 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 granl8d unto the party of the second part, the heir1l or successors and assigns of tha party of
\ha second part forever.
AN 0 the party of the first part covenants thai the party of the first part has not done or sulfered anything
whereby the said premises have been encumbered in any way whal8ver, except as aforesaid.
AND the party of the first part, in compliance with Section 13 of \he 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 of paying the cost of the improvement and will apply the same
first to 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 tha first part has duly executed this deed the day and year fir1lt abova
written.
IN PRESENCE OF;
_.~'fn~~ /{~4IZ-IvI
~ MiCha~1 KaI05ki~ .
;l..1,.., "--- - --..fl ~
Lormim, I, Simon -
11dCC'd"
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TO BE USE.D ONI. Y WHEN THE ACKNOWL.EDGMENT IS MADE IN NEW YORK STATE
Slele 01 New York. County af Suffolk sis:
On the &\ ~ dey af Merch. In the yew 2004
before me. the undersigned. persansUy _ered
MICHAH KALOSKI
personally kno"n to me or proved to me ,)0 the ba.",is of
!iuiistactory evidence tf"l be the individualCs) wh,,~ numt."Cs) is
(arc) lliubscribed to tht!' within in~trunlent and acknowledg~d 10
mc that he/shelltk.-y eX<<UlnI the same in hislhcr/lhcir
capaC'ityCics). and that by hislherltheir signatun.-(sJ on the
instrument. the individ~l(s). or the person upt.ln hd\alf or
which the i.,,'. 1.181(5) Bctt.: . ex utoo t co instrument.
Slete af New York. County af Sulfallc ..:
On the dsy af . In the yes<
before me, the undersigned, personellyeppeared
personaUy known to me or proved to me on the basis of
satisfactory evkl8nce to be the indiviclual(s) whose namecs) is
(are) subscribed to the within instrument and acknowledged to
me that he/sh81they executed the same In hialherltheir
capscityOes). and that by hllllharllheir sign8lurs(s) an tha
instrument, the indlvtdual(s), or the person upon behalf of which
the individual(s) acted, executed the instrument.
(.ignsturs end oIfIca af indlvldualteking 8du1awledgrnanl)
. AIIIOI\II 14.. waHAM l'
"~~~~~2t:r'4lllll !
c:.n::=~IIIL~ldJps' .
TO BE USED ON!.. Y WHEN THE ACKNOWLE~MENT IS MADE OUTSIDE NEW YORK STATE
Slela (ar District 01 Columbia, Ter~tary, ar Foreign Counlry) af CONNECTICUT ....:
On the 'z.7";'O'Idsy 01 March, in the yeer 2004. before me. the undersigned, persanslly eppeered
LORRAINE I. SIMON
persanelty known la me or proved ta me an lhe besis 01 salisfectary evldenca la be the indlviduel(s) whoae neme(s) 18 (ere)
subscribed to the within Instrument and acknowledged to me that heIsheIlhey executed the same in hislher/lheir cepecityCl8s). and
that by hilllher/lheir slgnsture(.) an the inSlrument. the individuel(s). ar the person upon behelf 01 which the Individual(.) aded,
executed . Btrument. and sud1 individual made such appearance before the undersigned in the
in
Cnn".rilr.:,d
(endln88~~::~~::~:~::~1l
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. A111C1A1L 14.. WICIOfAM .
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ee. . In.. &,IIrqS..... 30. _~.J.-
SECTION
BLOCK
LOT
COUNTY OR TOWN
STREET ADDRESS
BARGAIN AND SALE DEED
WITH COVENANT AGAINST GRANTOR'S ACTS
Title No.
MICHAEL KALOSKI AND LORRAINE I. SIMON
TO
HOWARD SIMON AND LORRAINE I. SIMON.
AS TENANTS BY THE ENTIRETY
Recorded at Request of
COMMONWEALTH LAND TITLE INSURANCE COMPANY
STANDARD FORM OF NEWYORK BOARD OF TlT1.E UNDERWRITERS
DisIrlbu""'1J)'
'0 Common~~~~t,~..,.^,..,..,.
Wickham, Bressler, Gordon & Geasa, P.C.
P.O. Box 1424
13015 Main Road
Mallituck. New York 11952
Cl"I"'IO:'\I"1~1.' IIIA~II TI n.t" 1:o.1\I,1C.':'IOI.'~ CQ\tPMrlY
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Number or pag...
TORRENS
~
RECORDEI>
2004 Jun 01 04:47:35 PM
Edward P.Romaine
. CLERK OF'
SUFFOLK. COUNTY
l 00001=2
P47S
OTt 03-45184
SeriaJlI
Certificate N
Prior Ctf. II
Deed I Monaaa. Instnunenl
Deed I Mona... Tax sWnp
PEES
Reconling I Filing S.....p.
4
Pag.' Filing Fee
Handling
'Il'-584
Mortgage AmI.
I. Buie Tex
Notatioo
2. Additional Tex
Sub Tolal
EA-52 17 (County)
EA-5217 (State)
_ Sub TolBI
Certified Copy
Rag. Copy
Other
Sub TolBI
SpccJAs.lt.
D.
Spec./Add.
TOT. MTG. TAX
Dual Town Dual County_
Held ror Apportionment
Tronsr... Tax 4
Man.lon Tex .
The property covered by thl. mortgage is or
will be Improved by a one or two rom lIy
dwelling only.
YES or NO
Ir NO, see approprillfe tax elou.. on page 1#
~ oflbia IDllnlmont.
R.P. T.S.A.
Comm. of Ed.
00--
5 lW.-
Affidavit
ORAND TOTAL
5
Real Property TaX Service Apu:y Vorificotion
D1st. Section B lock
- .. - --- - - .
~2~ 1000 10200 0400 006002
Lot
Communi Preservation Fund
Consideration Amount $
Stamp
CPF Tax Due
s
08t.
Improved '-
W~ckham, Bressler, Gordon & GeBsa. P.C.
P.O. Box 1424
Mattituck, New York 11952
~
Vacent Land
Initials
3 SatisfactionsIDischargealRDlcase. Liit P"riipeitY OWnen MBIliDg Addres
RECORD .. RETURN 'fO:
/ cJCTO
TO
TO
TO
9
Suffolk Coun
g Title Company Information
Co. Name
Title #I
Recordin & Erldorsenient Pa e
This page fonns part oftbe ........-bed
Bargain and Sale Deed with Covenant
mad. by:
MICHAEL KALDSKI AND LORRAINE I, SIMON
(SPECFYTYPE OF JNSTR.UMENI')
. The premises bacin is situated in
SUFFOLKCOUNIY, NEW YORK.
TO
HOWARD SIMON AND LORRAINE I:J;. SIMO,," ,
as cenants by the entirety
In the Township of
In the VILLAGE
or HAMLET of
Southold
Cutchogue
. BOXES 5 nnw 9 MUST BE TYPED OR PRINIED IN BLACK. INK. ONLY PRIOR TO RECORDING OR FILING.
1111111111111111111111111111111111111111111111111111111
1111111111111111111111111
SUP FOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGB
Type of Instrument: DBEDS/DDD
NUmber of Pages: 3
Receipt Number : 04-0062539
TRANSPER TAX NUMBBR: 03-45184
Recorded:
At:
06/01/2004
04:47:35 PM
LIBBR:
PAGB:
D00012322
478
District:
1000
Section: Block:
102.00 04.00
BXAMINBD AND CHARGBD AS POLLOWS
$0.00
Lot:
006.002
Deed Amount:
Received the Po11owing Pees Por Above Instrument
Exempt Bxempt
Page/Piling $9.00 NO Handling $5.00 NO
COE $5.00 NO NYS SRCHG $15.00 NO
EA.-CTY $5.00 NO EA.-STATE $50.00 NO
TP-584 $5.00 NO Cert.Copies $0.00 NO
RPT $30.00 NO SCTM $0.00 NO
Transfer tax $0.00 NO COIIIII\.Pres $0.00 NO
Pees Paid $124.00
TRANS PER TAX NUMBER: 03-45184
THIS PAGE IS A PART OP THE INSTRmmNT
THIS IS NOT A BILL
Bdward P.Romaine
County Clerk, Suffolk County
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (5181 473-7222
FOR COUNTY USE ONLY
C1 SWIS Cod. 7<,7, i', &",9,9'1
,
C2. Date Deed Recorded ~ /0/ / &7'1
Month Day Vea'
C3.Book I ~~,3, 2,~C4.P.g.1 ,~,?,g,
PROPERTY INFORMATION
,. Prop,.rtv I Alvah's Lane
LocatIon STREETNI)MBfR SlREETNAME
Southold
CITVORTOWN
2. Buver Simon
Name lAST NAMf I COMPANY
Simon
LAST NAME I COMPANY
3. Tax
Billing
Address
Indicate whereflJtureTax Bills are to basen!
Jf other lhan buyer address (el bottom oflorm/
w
-
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
llP.5217k",)197
Cutchofi!;ue
VilLAGE
11935
ZIPCOOE
Howard
FIRST NAME
Lorraine I.
FIRST NAME
LASTNAM"~i.i:OMPANY
FIRSTN/l,ME
STRE!;TNUM6ERANOSTREFTNAME
4. Indicate the number of Assessment
Roll parcels transferred on the deed
CIIY OR TOWN
STATE
2IPCOOE
I # of Parcels OR 0 Part of a Parcel
5.DHd
Property
Size
I X I
lOR I
FRONT FEET
DEPTH
6. Seller
Name
Kaloski
LAST NAME/COMPANY
Simon
LAST NAME/COMPANY
'ACRES
7 .8
{Only if Part of a Parcslj Check as they apply:
4A, Planning Board with Subdivision Authority Exists 0
<l8. Subdivision Apploval was Required for Transfer 0
4C. Parcel Approved for Subdivision with Map Provided 0
o I
Michael
FIRST NAME
Lorraine I.
FIRST i'IAM~
7. Check the box below which most accurately describes the use of the property at the time of sale:
Check the bOKes below as they apply:
8. Ownership Type is Condominium
9. New Construction on Vacant Land
lOA. Property located within an Agricultural District
lOB, Buyerrecaived a disclosura notice indicating
that the propel1y is in an Agricultural District
o
o
o
o
A~oneFamilYReSidential
B 20r3 Family Residenlial
C ReSidential Vacant Land
D Non-HliIsidential Vacant Land
E~Agricultural
F Commercial
G Apartment
H Entertainment I Amusement
l~conH.l1UnitYService
J Industrial
K PLlbllcService
L Forest
SALE INFORMATION
11. Sale Contract Date / /
Month Oay Year
12. Date of Sale 'Transfer
3 / &1L~
Mont~ Oay Yoor
13. Full Safe Price , , ~ 0 , 0 I
(Full Sale Price is the total amount paid for the property inclLldin gpersonalproperty.
This payment maybe in the form of cash, other property or goods. or theassLlmptionof
mortgages or other obligations,l Please round 10 Iht: nearest whole dollar amount.
15. Check one or more of these conditions as appli<:able to transfer.
Sale Between Relatives or f'ormer Relatives
Sale Between Related Companies or Partnel"5 in Business
One of the BLlyers is also a Seller
Buyer or Seiler is Government Agency or Lending InstitLllion
Deed Type not Warranty or Bargain and Sale (Specify Belowl
Sale of Fractional or Less than Fee Interest (Specify BeiOw)
Significant Change in Property Between Taxable Status and Sale Dates
Sale of Business is Included in Sale Price
B
C
D
E
F
G
H
I
J
Other Unusual Factors Affecting Sale Price (Specify Below)
None
14. Indicllltethe velue of personal I , '____J ,0 , 0)
property included In the safe , .
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill
16. Year of Assessment Roll from ~ 17. Total A$sesS41d Value (of aU parcels In transferl I
whiCh information taken
1 9 0 0 I
,
18. Prop&rtyClass
11 ,2 ,0 I-U 19. School Distric::tName I Mattituck-CutchoRue
1000-.102.00-04.00-006.002
20. Tax Map Identifier{s) , Rollldentjfierls) (If more than four, attach shelrl with additionalldentifier{s)l
.----.-J
I CERTIFICATION
I certify that all of the items of information entered on thi.~ ronn arc true and corrt'('t (10 the best of m)' knowll>dge and belief) and I under:stand that the making
of any willfuJ false statement of material fact herein nil! ~Ubjl'l.t me to the Dro\isiOIb of the oenallau ~[ati\'l.' to the making and liIing Qf false in.~tllJment.~.
BUYER
/ ./," ;;J ... ..'
f'i~*~~14'V',JJ-,~, '<'~7/tIf
Howa\"'lf-R S'l"mM'fi Lorraine I~ATESi on I
~I
I st,,\~ 0uv";
STRU,TNA ~ iAFTHlS/llEI
STR~~T I'/UM8ER
,
-1D 11 d UH9,,- ~
CITY OR TOWN
CT
f&Y'-iL
'~ '
STATE
SElLER
'1;7 L:?'--<'~d. If< ~
Sl:lLEM'k1i~l Kaloski
~,'
BUYER'S ATTORNEY
Wickham,
Abigail A.
H"T~"t.lf
,-"s~ ".....0
631
298-8353
..~E':' COD.
HlEPHONE ~iJM8~R
NEW YORK STATE
COpy
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