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CONI~"T YOUlt LAWYD .UO. SIGNING THIS 'NSTIIUMBI'I'_TIUS INIT....... SHQI&D .. US. n LAWY" ONLY.
THIS IJIIDunvRE, made tile 3rd
IIE'I'WI!EN
ANNA LYGNOS, as
736 Island Way.
clay of February
, in lhe )'ear 2003
surviving tenant by the entirety wlth.NICHOLAS LYGNOS,
H 1206, Clearwater Beach, FL 33767
party of the lint part, """
ARISTIDES SIDERIS, & KALIOPE SIDERIS, being married to eaeh other,
851 Bayway Blvd., Clearwater Beach, FL 33767
party of tile Ieamd put,
wrnIE5IE'nf. that tile party of the lint part, in COI1lIideration of Ten Dollar. and other valuable eonoiderat~
paid by tile party of the IeCOIId pan, does hereby g....t and reI....., unto the party of the seeond part, the heirs
or aucccuon and auigna of the party of tbe sec:ond part forever,
AU. that certain plot, pi_ or paruI of land, with the buildinp and improvements ~ ...-..I, oit_le,
lying """ being in the
SEE SCHEDULE A
TOGETHER with.1I right, title and interest, if any, of the pany of the fint part in and to any streets and
n.ads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances
and all the e.tate and rights of the party of the lir.t part in and to laid premise.; TO HAVE AND TO
HOLD the premises herein granted unto the pany of the second pirt, the bein or suc:ccuors and aui&na of
the pan,. of the second part. forever. _
(0. ...
AND the part). or the: first part covenants that the party .of tbe:first pan .... not done 01' suffered aoythine
whereby the said rremises ha,,'e1been encumbered in any. way whatc:\o'er, except as aforesaid. .
AND the party 0 the first part, in compliance'",~ith Section 13 or the Lien Law. covenants that the party 0'
the first part will receive the consideration for this conveyance and will hold the right to receive such ~aid-
ention as a trult fund to be applied first for the purpo.c of paying the cost of the imfrovement and will apply
the saine: first to the lllit.)"me:nt of the C05t of the improvement before usine any part 0 the total of the sazne for
any other purpose.. _
The \'\'\)rd '.pan)'" shall be construed as if it rcacl '.parties" whenevt'r the sense of this indenture so requires.
IJII WITNESS WIIEREOF, the party of tile lirst part bas duly executed "'i. deed tile clay and year firat """"'
written.
br P8ESENCB 07:
ANNA LV
by:
MICHA L YGNOS
Attorney-In-fact
.. .-.
SCHEDULE A
ALL thai c:ertain plot, piece or parcel ofland, situale, lying and being al Mattitw:k, Town of
Southold, County of Suffolk IalJd SIaIe of New York known and dtcigJowted as Lot No. lOon
-Map of Sunset KnoUs, M8ttituck, TOWI1 of Southokl, Suffolk County, New York-, and filed in
the.SuffoIk County. Clerk's Office on. January 5, 1968 as Map No..5023.said Iot.beiagmore
p8l1icularly bounded and described as fonows:
BEGINNING at a point on the southerly side ofSIaIIley.P.oad where the divisioa line betweea
LOIS 11 and ) 0 as shown on the above mentioned map inlersects same, said point of
beginDing also being distanl 755.00 feet westerly &om the westerly ead of au arc which arc
CODDeds the southerly side of Stanley Road and the westerly side ofLuthers Road;
RUNNING THENCE south 02 degrees 49 minutes 00 seconds west, 198.02 feet;
RUNNlNG THENCE north 88 degrees 47 minutes 00 seconds west, 130.29 feet;
RUNNING THENCE north 06 degrees 05 minutes 00 seconds east, .150.00 feet;
RUNNING THENCE northerly and easterly along the arc of a curve, bearing to the left, having a
radius of51.90 feet a Imgth of81.52 feet to the southerly side ofSlallley Road;
RUNNING THENCE along the southerly side of Stanley Road south 87 degrees 11 minutes 00
ser,ondseasl, 69.79 feet to.t1lepoint orplacc of BEGINNING.
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M 5 1 =--Sl.IIIDq.'I"lrrfOl.~rGcn~.J.II\MI'crdt AIIotncy: "
wilh.1ll'u...iroJ(alldnIq.CiOI..j.'''OI' 12 p1.I)'pc.ll~
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DURABLE GENERAL POWER OF ATTORNEY
, NEW YORK STATUTORY SHORT FORM
, ,
THE POWERS YOU GRANT BELOW CONTINUB TO BE EFFECTIVE
SHOUW YOU BECOME DIS,\BLED OR INCOMPETENT
Caution: This is an Important documenL It gives the person whom you designate (your "Agent")
broad powers to handle your properly during your lifetime, which may include powers to mortgage,'
sen, or otherwise dispose of any real or personal property without advance notice to you or app~val by
you. Tht'st: powers will continue to exist even aller you become di"iabled or IncompetenL These powers
arc explained more fully in New York General Obligations Law, Article S, nde IS, Sections 5-1502A
thmugh 5-1503, which expressly permit the use of any other or dilTerenl form of power of iltome)'.
, 1'his doCument dOl.'li notllUthOrize anyone to make medical or OthL'I' health Care decisions. You may
execute a health caJ"C proxy to do this.
If there is anything about this fonn that you do not understand, you should ask a lawyer to explain it
to~ . '-.c'
nus is intended to constitute a DURABLE GENERAL POWER OF ATIORNEY pursu:mt to Anicle 5.
TItle 15 of the New York General Obligations Law:' ,;: '.:' "
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ARISTIDES SIDERIS, RESIDING'AT~8Sl Bayway Blvd., Unit 80S,
Clearwater Beech, Florida 37767
. ..' ,.
:- (inseri ~;; nm,.).';'J uJd~ss) : do hereby appoint:.
MICHAEL W. LYGNOS, RESIDIN~ AT' 736,Ialand Way, Unit 1206
Clearwater, Florida 37767". '.:,:~,:
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.llf I persO'1 is.tf) bt appointeJ agell!', ins~r,t the nllllle IJ/rJ adJnss of .VOIU agtnr abol"e)
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(If Z or nwre persOllS are If) be uppoinred agentf by you insert /heir nwnes and addrtsses above)
my :1ltomey(s),in-fact TO ACf
(/f 1IWn: lhan mIL' agen! is desigllll,ed, CHOOSE ONE of the f{lllt,,,,ing 1\1'0 dwiw b,Y PIl/,ing your illilillls in ONE
oflhe blank spaces 10 lilt leftof:'our choke:) .
[ I Ea.:h agent m:lY SEPARATELY :lCI.
[ ] All agents must act TOGETHER.
(If nei,her blank space i.l,iniliuleJ. Ihe agenls lI'iII be required 'f) aCI TOGETHER)
IN MY NAME, PLACE AND STEAD in :lny way which I myself could do. if I were personally present.
with respect to, the following m:ltters as each of them is ddined in Title 15 of Article 5 of the New York
General Obligations I...:1w to the extent th:lt I am pennittcd by (;IW to act through an :lgcnt:
.'
. ". 5 ..... .... ",' ._',': ., . . "
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",:' . . " '(I>IRECTlONS: i~ilial in the hiank'space to the 'left 'oC your choice anyone or more or the rollowing
:',:' ," I..ttered subdivisions lIS to \I'hic:h you WANT "'give YOlir agl.'1lt authority. IC the blank'space to the left
'" "oC any particula,r,lettered subdivision is NOT initialed, SO AU~HORITY WILL BE GRAl\"ED Cor
, ' matters that are ,in"luded in that subdivision. Alternatively, the kiter corresponding to e"dch power }'ou
" " wi~h to grant ~ay' be written or typed on the blank line in subdivision "(Q)", and you may then put
. ' your initials in ~he blank ,space ,lo the left ~C subdivision "(Q)" in order to grant each of the powers
:' 50 indicated.) " , "
I{{;- " I, (~) real estate transactions;
[ ", J (~) ch:ill~1 and gOOds transactions;
[ . I '(C) bond. share and commodity
, : 1rd/1$ICtions;
,:'Jfil-.~'I (D) banking 'tr~sactions; ,
~[ , "J (E) business ~perating transactions;
/j I'IF) , ,
, ., msur;mce lrJnsac!lons;
~ J ,(G)'es~!e transact~~s;:
[ ], (H) claims and litigation;
[ J (I) personal rtl:llionships and aff~irs;.'
[ I (l) benefits from militill}"service;
, rt{2-.]: (K) ~onls, ~pons and statements;
, '[ , ~. ,] (9 'ri:tirc~lent benefitlr;ns3Crions;
, .
~r-'(M)making '~ifts to my spouse, chil~n
, and more remote descendants,
and parents, not to exceed in the
aggregate $10,000 10 each of su~h
, , , persons in any year;
, ~. (N) la.\ mailers; , '
[ ) (0) all ~the~ mallers
[ I (P) full and unqualified aUlhority to my
:Illl.lmey(s).in-fact to delegate any
or all of the foregoing powers to
any person or persons whom my
" altomey(sl-in-facl shall select:
~ (Ql ea~h of the above mailers idcntitied
, .' " by the fol,l~wing lencrs: ...!.!............. '
.....n...................................................
(Specia/ provisions and limilations ~y be included in lilt SlaR/tory short form durable pOlI'er of altorne.' only
", if they conform In tile reqlliremenrs of seerion 5-/501 of the Ne". York General Oblig/JIion,l Lall~)
';R~ll ~;tte~s per~a~n1~g to,'&al~ of 855 ~tan~ey Roa~, :Hatt1tUCk. New York.
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This Du~ble Power'of Anorncy shall not be affected by my subsequcnt disability or incompetcncc'. ,
. '. ,',.. '. . .
I f every agcnt named abovc is unable or unwilling to'servc. I appOint (inserllwme and addll!SJ of successor) ,
'.
:" . : to be my agent for all purposes hereunder.
1'0 induce any third party to act hl!reunder, I ht.'l'ehy ugree that ~ny third party receiving a duly e.uc:uted
" copy or facsimile of this im1rUment may ad hereunder, and that revOClltion or termination hereof shall
, be inl!ffcctive as to such third party unlcs.~ and until actual notice or kno,,'ll!dgl! of such revocation
or termination shaD have been n.'ceived hy 5IIch third party, and I for myself and for my heirs. executors,
legal rcprese'n~tives and assigns, hereby agrt.'C to indemnify and hold harmless any such third party
from and against any and all claims that may arise against ~'Uch third party by reason of such third party
having relied on the provisions of this instrument' '
"
This Durable Gcnerall'lIwcr of Attorney may he revoked by, me at any time.
, In Witness lJbU20(, I havc h~rcunto signed my na
January 2003
. ~': . ....... .", .
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.. " (YOU SIGN HERE:
..'....
(SignalUrt of Principal)
ARISTIDES SIDEns.
, '
," ' .. , : ACKNOWLEDGMENT IN NEW YORK STATE I'
STA're OF NEW YORK. COUNTY OF 7uffo{ k 55.:
On January .J 'I, 2003 !lefore me,lhe und.:rsill".'d, pcJ1lORully appcared
ARISTIDES SIDERIS " , '
personally known to me or proved III me on the b:1..is of satisfuclory cv!dern:e 10 be the individuul(s) whose nume(s) is (ure)
subscribed to the within instrument und acknowledgo:d 10 me thai helshe/they c~ecur.:d the same in hii"her/lheir eapacity(iesl. '
and that by hislher/their signalUn:(S) on th.e instrUment. the individuu!(s). or the pcJ1l n behalf of wh~e irnlividuul(sl
aclC\l,e~eculedtheinstrUment.' JAM' S ~2 ~ ,
E RIO..... II
pl.hl;,.. St.t,ofNew__ .
lSir..".... NO'J>III2RIllllQ8S8el ",lull ""tnowW"...,.,I
" , ~ed in Suffolk County .
, . " My CommilslOll Expires MItch 21, 20..2. (
ACKNOWLEDGMENT OUTSIDE NEW YORK STATE
STA're OF COUNTY OF sS.:
" ,
~forc me. the undersigDed. pcllOnally uppcared
, 'On
personully known !:D mc or prov~ 'to nle on the b....is of satisf~tory evidence III be the individual(s) whl",e narne(s) is (:l1'I:l
subso:ribcd 10 the within in.'llurnent und acknowlcdgo:d to me !hat hl:/sIIe1lhl:y execuu:d the sume in hislher/thcir capucity(ie.l.
and th:u by his/her/their signulun:(s) on the instrUinenl, the individual(sl, or the person upon behalf of which the irnlividuul(sl
lIClCd. e:\tl.'Ut.'t! die insllUmcnl, and !hat such indi,'idual m:lde such appearance before the undersill"o:d in
(illSerr cil~ or rOUliClll 'lfh~i,.;.iolf ami Slale or cDlmly or OIhe~ plare adno.../.dgmenll~n).
f.r;~'IQ',.,e and (lffi,;r u/ iJ!d"idwdl hWlIJ &b:oltl4o"ltrl,:'rw",;
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AFnDAVITTHAT I'OWER OF AITORNEV IS IN FliLLFORCE
, (Sigll htfor~ a fUltury pub(;.;)
STATE OF )JeqjYc,; f:. , . COUNTY-OF C;tf!hl k
'M/ej1Itf/1 IV'~ "LjJ'ntJ.~~ '.'
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~ing duly sworn, dcpos.:s and say,;:
"
l. TIk: Prindpal within did, in \\-TIling. appoinl me a.~ Ihc Principal's IlIIt: ami lawful ATIORI'l/EY(SHN-FACT in Ihc wilitin'
POWI:r of Allomey" ' ,
2. I have no aclWlllmowlL-dge or III:rual nUtk:c ofn.....ocation or temlinalion oflhc PowLTof AIllln1ey by ~ IlrOlhtrw~" '
Ilr knowkLIge of :my focrs indicating !he same, [ funher represenl [hat !he Principal i.~ alive. ha.~ not !e\'okl;d or repuolialdllite:
Power of Allomey and lite: Power of AIIOIlIl.'Y slill is in full force and e:ffect
3. I make Ihis ~ffidavil for Ihe purpose of inducing .I:i><~,
" ro ac;;epl dc:livCt)i of lite: fllllowing InslIUmc:nl(sl, as executed by ru... in my ClIpacily a.~ !he AITOR:'I:EYIS).IN-FACf, with
lull knowledge Ihatliti-l a1TIda\'il will be t\':licd upon in ;]l.'Cc:pting the eXecubon and delivery of the: [nslrunll:nl(s) ani(in paying'
gllOl! and valuable c~i~t:llion dlerefor. ..
',:,. .
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, SwOn) lAJ before ~ on "3....4 ~/t.4r '" r' ' , -u..(jJJJtjj::~"j~
,ti:frVJ.~1' ;.~." ._~
"'J/ ,~R~GEN'
(U, NOTARY9(JBLIC, St2.le 01 New York
, , ' LNo. 02HA4n7029 '
, " " Qualified in Sulloik County tJ6
' 'CammIs&ionExpIresMarc:h21.~_
Pub(islld s Ntlte: This rl<<lullelU is primed on jO%' am(1II ptJf'cr. Ulr/ike or.!i,",ry p/tlIt.",.O{1)' poper. Ihi:! stol'k l't!si.rts Rim'
ing brinle ond b('(lllll ...ilh age, InsiSI 011 gelluine Bllfmbergj,m,.. (II en,~lIl't! I/(e /oo!lCl'ity oflhi., illll'orl(lJ,t Jt"'~ulletlt, ,
, TIlt' pU/;OlisMr II/lUlltoins proPer,').' righls in the (UYUUI, graphi,' Je.'ign ond O'{1f.'''.vle of thi:! filnll lIS ...ell as in tlle t''''''Puny's
tradell/JJrked Iugo o,uJ "ame, KeproJa,'tinn of blollk copies "f Ihi, filnn ...itho," the {1llblish.'r's pem,is.,c", is prohil>itrcL Such'
u/IIJI,dlOriZt/( use nUlY ,'I)'lStilute a \'i,,(anIJlI oflulY or of f''''fessi(JI/Jl( clllit's nd.", Ho"'/!'..er. OIIc:C II fom, has bcenfilled in. p/kJIO'
c"Jpyin,~ is pe"',itted, ' , '
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:~~~~::~~'~.:.t:tt.~~~: :~I:;~' ~::[~~t~I:~,
. STATE OF NEW YORK I . STATE OF NEW YORK)
) a..: ) IL:
COUNTYOF~q~~ COUNTY OF I
On th.3~ay .fpt."'''''''!i. lhoy_~ofDl'O ....'h. ..,._.On 'ho_day.f in lh. year __._ bef.", me, .h.
unders1lned. penIOnally appeari:d N,,;'~ -~AJ.. ~#"'7 ~~ i' undersigned. personally appeared _
personally known to me or prowed to me on the basis or stKtory personally known 10 me or proved to me on the basis ofSDIisfadory
c\iclence 10 ~ the individual(s) whose name(S) is (are) IUbKribed 10 evidence to be the individWlI(s) whose namc(s) is (are) subscribed 10
the within insarument and acknowledged to me thM heIshcIrhcy .. ,'" "Ibe within instrumenllllld acknowledSed 10 me thu helshclthey
executed rile 5aInI: in hislhcrhheir apac:ity(ies). and lhHt by executed the same in hislhcr/their capacilyties). and that by
hislhCTllheir sianalurc(s) on .he inllrument. the individuaJ(l). or the hislhcrllheir sianature(s) on the insrrumc:nt, the mdividual(s). or the
peTSon upcm behalf of whim the individual(s) aded. executed the prrson upon bebalf of which me indivldual(s) IJCIcd. eAccurrd lhe
instnunmt. instrument.
7-
SIp81:are ..d 0fIJn. of
ladl\1dua. taklft.ac:kaowledKIIMtI.
f
ladlvldua. I.kla.ackaa IDleoJ_ -
KAREN J. HAGEN
NOTARY PUBLIC, Sla:. 01 New 'lbn.
.. ..or adcnowledClllftltllakC'a la New York Sc.te. NO. 02HA4927029
Co Ouali'ied i" Suffolk Cou:%O. )
RVnJl8Ion Expires March 21 Z>
. '-
.. SlalC'" DlstrlCI orColmmb... Territory. PoIsnsIo_. Or FordiD Couatry
I A.:
On the _ day 0' in the year ~ before me. the undersigned. personally appcan:d "
pcr&onIIlly known 10 me or proved 10 me on Ihe buill ofsatisfactory evidence: to be IlK:' individulIl(s) whose namels) IS (are) subscribed to the
within instrument and IlC'knowlcdgcd to me that helshelthcy executed the smne in hislherhhcir capacity(ies). lhat by hlslher/tht"ir sI8naturc(s)
on the instrumcnl. the individual(s). or the person upon behalfor",lIich the individualCs) DC'ted. executed the instrurnmt. and that such
individual made such 8ppeoanlnCC before the uncIersisned in the . (Insen the cilY or other political
subdivision and the Stale or eountry 01'" other place:' the acknowledgment was takm).
Slanatare aad 0fIlH of
Individual takln.. adUlowted&mnt
.. Forackn.wll'dcmeBu laken outside 0' New York State.
~iII anll ...Ie .nll
WIIH COVENANT ACAINST GRAN10l\'S AC15
TIT1.2 No.. RH80023546
LYGNOS
DistrictO'61880
SECnON 1 .
BLOCII; 08.00
LOT 012.000
COUNTY 011. TOWN
TO
SIDER IS
R:lcorded At RequeSlof
PInt Amerbn nile Inswance Coil1paii)' CJI New YOI'll:
..yuaN .Y MAIL TO:
ar...... PO_ Of NIW YOMt ICM.ID Of ft", UNDllWlma
D~IJ:r
First American Title Insurance Compang
of NtnIJ York
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l'Iumbc:r of pag..
TORRENS
Cenif'ICQle 1/
RECOI<f)EI>
2003 Feb 20 02.36.43 PM
Ed...rd P. ROlla ine
ClERK OF
SUFFOLK COUNT\'
L ??oo12236
P 298
1>11 02-27893
.. Serial"
". I!rior elf. N
Deed I Mongoae Inslrument
Deed / Mort&8lle TIX Stamp
FEES
Rec:onling/ Filing Stamps
4
Page I Filing Fee
Handling
TP-5114
a~
5
s
Mortgage AmI.
I. Busic T..'t
2. Additional Tax
Notatiol1
Sub Tolal
R.l'.T.8.A.
5 _ Sub Tutal
.;z<;'
30_
39
f"'-52 17 lCowlly)
EA-5217 IStale)
Olln:r
IS
Sub ToIo1
15.
SpecJAssiL
Or
Sp<..../Add.
TOT. MTG. TAX
Uual Town Dual County_
"cld fiJr Apponionnlclltrr-
Tnulsfer Tax ~
Mansion Tax _
The property C'overed by this mortgage is or
will be improved by a one or two family
dwelling only.
Vf,s or NO
If NO. .ec appropriate lax clause un poge II
_ oflhi.. instnllncnl.
Connn. of Ed.
5 Q2--
Affidavit
Certified Copy
Reg. Copy
GRANI) TOTAL
6 Cummunily Preservation Fund
COllsidcr'ation A_nount $ If:}
CPF Tax Due S .:>
l
Itcall'ropc:rty Tax Service ^lll"'''Y Verification
Dier ~p.ll':tlnn _ B lock Lot
1000 10600 0800 012000
Improved
0/"/
Stamp
Date
Initials
7 Satisfactions/Discharges/Releases List Properly Owne.. Mailing Addre
RECORD & RETURN TO:
tft;t-hdtL/ LYY'nps~ r; ~ .
/15 SoLl/-/"7- ~?oY-1- k,
-r~41 j;L .336~
Vacant Lend
TO
TO
TO
10
B Tille Company Informa~ion
Co. Name
Title 1/
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(
9
Suffolk Count Recordin & Endorsement Pa
1ms page fonns part of the attached /:)po d
(SrEaFY TYPE OF INSlRUMENT)
made by:
4nq..-.
f >':fh OS
,
.Ibe premises herein is situated in
SUFFOLK COUNIY, NEW YORK.
9oc.l-~.u-
.A1allrlu~k
111 the Townsbip of
TO
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1I0XES 5 'IHRU 9 MUST BE 1YPED OR PRlN"IlilllN llLACK INK ONLY "'{lOR TO RECORDING OR FILING.
(OVERI
In the VillAGE
or HAMLET of
1111111111111111111111111111111111111 11111 1111111111111
111111111111111111111 I11I
SUFPOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEEDS/DDD
Number of Pages: 8
TRANSFER TAX NUMBER: 02-27893
Recorded:
At:
LIBER:
PAGE:
02/20/2003
02:36:43 PM
D00012236
298
District:
1000
Section: Block:
106.00 08.00
EXAMINED AND CHARGED AS FOLLOWS
$0.00
Lot:
012 . 000
Deed Amount:
Received the Pollowing Pees
Page/Piling
COE
BA-Cfy
TP-584
RPT
Transfer tax
$24.00
$5.00
$5.00
$5.00
$30.00
$0.00
Por Above Instrument
Exempt
NO Handling
NO NYS SORCBG
NO BA-STATB
NO Cert.Copies
NO SCTM
NO Comm.Pres
Pees Paid
$5.00
$15.00
$25.00
$0.00
$0.00
$0.00
$114.00
b""'lpt
NO
NO
NO
NO
NO
NO
TRANSPER TAX NUMBER: 02-27893
THIS PAGE IS A PART 01' THE INSTRUMENT
Edward P.Romaine
County Clerk. Suffolk County
.
;
-----
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
FOR COUNTY USE ONLY
C1. SWIS Code
'I 7,_~,f?,q,c?,1
;;2..1
Month
REAL PROPERTY TRANSFER REPORT
..-
" ",.- .)
~. ~".,"
Rl'-.!i217Re.'3197
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
C2. Date Deed Recorded
';:?OIOYI
Day Yell'
, ;2, '1, >ill
I
Ca. Sook I /, ;;J...,;;l..~ '1,C;
RP - 5217
I C4. Page I
PROPERTY INFORMATION
~,. .,l
1. r:~::~ \
7F'1>$
STRE'f'TNUMElfOR
a~~-l"'\-
U'l~z.-I
~ KoJ)','"e--
~Q...
ST'REHNAMf4
(Y\,.,OI L.k-
VilLAGE
A-i~~~
flRl>TNAME
2. Buyer
Name
SA .
LASTi'4AMEI~:P~
3. Tax.
Silling
Address
lAST NAME/COMPANY
Indicate where future Tax Bills are to be sent
ifotherthanbllyeraddresslalbottomofforml
FIRST NAME
LAST NAME I COMPANY
fiRST NAME
STRJ;ET NUMB!R AND STREET NAME
CITY OR TOWN
STATE
ZIP CODE
4. Indicate the number of Assessment
Roll parcels tranllferred on the deed
I I # of Parcels OR D Part of a Parcel
(Only if Part of a Paroell Check as they apply:
o
o
o
4A. Planning Board with Subdivision Authority Exists
.48. Subdivision Approval was Required for Transfer
4C. Parcel Approved for Subdivision with Map Provided
5 Deed 1 X I
Property
Size FRONTFEH
.. Seller ~~~
Name LASTN I OMPANV
lOR I
ACRES'
.-s"'51
PEP'H
~~
FIRST NAME
LASTNAMEICOMI'ANV
FIRST NAME
7. Check the box below which most accurately describes the use of the property at the time of sale:
Check the boltes below as they iilPply:
8. Ownership Type is Condominium
9. New Construction on Vacant Land
o
o
o
o
A~ne Family Residential
B :I or 3 Family Residential
C esidential Vacant Land
D Non-Residential Vacant Land
I SALE INFORMATION I
11. Sale Contract Date
E~Agricultural
F Commercial
G Apartment
H Entertainment I Amusement
I ~ Community. Service
J Industrial
K Public Service
L Forest
10A.
'08.
Property Located within an AgricultUl1l1 District
Buyer received a disclosure notice indicating
that the property is in an Agricultural District
15. Check one or more of these conditions as applicable to transfer:
07. / :z.4-
Do,
1 <<>2...l
Year
A
B
C
D
E
F
G
H
[
J
Sale Between Relatives or Former Relatives
Sale Between Related Companies Or Partners in Business
One of the Buyers is also a Seller
Buyer or Seller is Govemment Agency or Lending Institution
Deed Type no;;ot Warranty or Bargain and Sale (Specify Below)
Sale of Fractional or Less than Fee Interest (Specify Below)
Significant Change in Property Between Tal<:able Status and Sale Dates
Sale of Business is Included in Sale Price
Other Unusual Factors Affecting Sale Price {Specify Below)
None
12. Oate of Sale I Transfer
02./07
16'3
Year
Month
Doy
13. Full Sale Price
, , - D-,- ,0, 0 I
, , .
(Full Sale Price is the total amount paid for tha property including personal property.
This payment may be il"' the form of cash. other property or goods, or the assumption of
mot1gages or other obligations.l Please round ro the nearest whole dollar amount.
14. Indicate the value of personal
property included in the sale
~, ,-;0-,001
, , .
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill
16. Year of Assessment Roll from I
which information token
I 17. Total A&$essed Value lof all parcels in transfer! I
<;;---001
,
18. Property Class
L~_.J~-LJ 19. School DIstrict Name I
(Y\i.J i ". \" ,\l..
20. Tax Map Identifierbll Rollldentifierlsl lIf more than four, attach sheet with additional identifier!sJ)
L I Doc> -lO?o" -6'3.0D-l>/'2..-=
I CERTIFICATION
I certifY that all of the items of infonnation entered on this fQl'TIl are true and COlT~t (to the best of my knowledge ami beljef) and I understand that the makin~
of any willful faL~ statement of material fact herein will subject me to the provisions of the penal law relativl;' to the making and flUng of false instruments.
BUYER'S ATTORNEY
(1w,~ S;~ ~~~~
b'J i'Vi'/:J8 " ., . .' (,7/J" . ' YGNi.;'i,lfl/,,,,,,,,-,^-(J,<f-
M'~IN,t.--Yu.m.A/tJ~;n_ ' IOZ(Os/o3
6UYE~ SIGNATu~f DATE ,
~.'\",,;;;p( I). 9*-8:2b
s E NAMEIAF FlSA .
..LJ.. .....-."'~ <3 - &.. FL.
CITYOFlTQWN
L YGNoS ,
~TNAME
!'vi i CH-AEL.
FrFlSTNAME
8bb
'ii'?(
STIlEETNUMSEIl
5'lf4 - q '-I <; 'f.
TElEPHONE NUMBEFI
AREACOOE
STATE
~(.7
ZIPCOOE
/
SELLER
~ A-#""1~/.-~J.
M"~~~~lgl~.~-Nf)~
NEW YORK STATE
COPY
02/05 /~3
OAT!!' .