HomeMy WebLinkAboutL 12268 P 923
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jCONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
Standard N.V.B.T.U. Form 8004 - Quitclaim Deed - Untform Ac*nowIldgment ,slngte sheet}
FOIm 2216-
THIS INDENTURE. made thedl ~day Df August, 2003
BETWEEN
MARY L. BERGEN, residing at 3655 Wickham Avenue, Mattituck, New York 11952
party of the first part, and
CLARENCE T. BERGEN, residing at 3655 Wickham Avenue, Maltituck, New York 11952,
WITNESSETH, that the party Df the first pari. in consideratlDn Df ten dDllars and Dther valuable conslderatiDn paid
by the party Df the second part, does hereby remise. re_ and quitclaim unto the party of the second pari. the
heirs or succesSDrs end assigns of the party of the second part forever, her life estate In,
AU tf1at certain plot, piece or parcel of land, situate, lying and being at MattJtuck, In the Town of Southold, County
Df Suffolk, Slate of New York, known and desc1bed more particularly as follows:
BEGINNING at a point on the northerly side of Wickham Avenue at tihe southeast corner of the premises
herein described, adjoining land of Vastola on tihe east; running thence along the northerly line of
Wickham Avenue South 310 05' 40" West 75 feet to land of Boeckmann; running thence along said land
North 530 37' 50" West 269.40 feet, more or less, to tihe high water line of Long Creek; running thence in
a generelly northeast direction along said high water line of Long Creek 75 feat, more or less, to land of
Vastola; running tihence along said land South 530 37' 50" East a distance of 269.40 feet, more or less,
to the point or place of BEGINNING.
BEING AND INTENDED TO BE the same premises as conveyed in deed dated February 25. 1984 and recorded in
the Suffolk CDunty Clerk's Office on May 10, 1999 in liber 11961 Page 407.
THIS DEED i. intended to release the life estate of the party of the first partin the premises.
Tha fee title is owned by Rosemary V. Youslk and Sharon Ann Yousik. subject to the life es_ of Clarence T.
Bergen.
TOGETHER with all right, title and inlerest, if any, Df the party of the first partin and to any streets and roads
abutting the above descrlbed premises tD the ",!nler 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 premlsss herein
granted unto the party of the second part, the heirs or successors and assigns of the party of the second part
fDrever. .
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 hDId the righttD receive such consideration as a trust
fund to be applied first fDr the purpose of paying the cost of the improvement and will apply the same firsllD the
payment Df the cost of the improvement before using any part of the total Df the same for any other purpose. The
word "party" shall be construed as if it read "parties" whenever the sense of this indenture so requires.
IN WITNESS WHEREOF, the party of the first part has duly executed this deed the dey and year first above
written.
IN PRESENCE OF:
:~if~
Ma . Be
f/rJeedqt4
.
Slale of New York. County 01 Sutlolk
so:
Stele of New York. County of
On the day of in the year
before me, the undersigned. perwonally appeared
pellOnally known to me or proved to me on lhe "'sls of
OBlisl8c\ory avidence to be the individual(s) _ name{s) is
(are) oubocribed to lhe wllhin instrument &nd acknowledged to
me Ihlll helahellhey _eel \he oame in hillherllheir
cepec:ily(ieo). and thaI by hillherltheir oIgnature(s) on \he
inoIrument, tha individual{s), or tha peroon upon behell of which
Ihalndividual(s) acted, executed IhalnlllrUment.
ss:
On \he z.., dey of Augusl. in \he yaar 2003
Mary L. Bargan
peroonelly known to me or proved 10 me on \he besla of
S8l1sfactory evidenoa \0 be \he individual(s) who.. name(s) is
(a",) oubllCl1bed to lhe wUhln Inslrument and aclcnowledged \0
me Ihlll helahellhoy executed \he aame in hlslherltheir
capaci\y{Iea), and thaI by hlalherltheir oIgnature(s) on lhe
instrument. \he uaI(s), or tha peroon upon behell of which
tha individual d. a Iha Inatrumanl.
I!,
Natery Public
....
ce of indO . nt)
NalMY PUBLIC. STATE OF NEW VORK (signature and office of individual laking -"owIedgmenl)
NO. 01 MCeO'5IOI oJ.. V . ^ ,,(!I1_ ILU
aW.F1ED1NSUFfQU(COUNTV .". ,..errl ~. H ULNfI I
MY OllIIUSSION EXPIRES 07-31.20..0.:.
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE
S181a Cor Di8lriCl of Columbia. Tarrltory. or Foreign Country) of
so:
On the
doy of
In tha yaer
belo", me, the undersigned, peroonallyappeared
personally known to me Dr proved 10 me on the be.is of aatiafactory evidence to be the individual(s) whose name(a) Is (are)
subacrlbed \0 \he within instrument and acknowledged \0 me thIIl helshellhey executed \he eame in h1a/herlthelr capacltyOas). and
thai by hi_lIhail signalure(s) on the instrument. tha individual(s). or tha peroon upon bahall of which \he Individual(s) acted,
executed the Insbument. and that such lndIvidual made such appearance before the unc:leralgned in the
In
(Inllert the City or other poIltICIlI aubcUvlalon)
(and insert the State or Country or other p'" the acknowlRgrnenl WI. tIlken)
(signelure and omce of indlvidU8llBking 8denowledgment)
Mary L. Bergen
TO
Clarence T. Bergen
SECTION
BLOCK
LOT
COUNTY OR TOWN
STREet ADDRESS
QUITCLAIM DEED
Title No.
Recorded at Request of
COMMONWEALTH LAND T1T1.E INSURANCE COMPANY
CO\L,""",,'EALnt LAtl:P 1l1'1.E ''''"Sl;JtN;(."I:: (;UMPAlIIY
8TANDARD FORM OF NEW YORK BOARD OF nn.e UNDERWnnEM
Dia_ by
o CO"!,~~~~!~!th
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1111111111111111111111111
SUFPOLK COUNTY CLBRK
RECORDS OPPICB
RECORDING PAGE
Type of Instrument: DBEDS/DDD
Number of Pages: 3
TRANSFBR TAX NUMBER: 03-03561
LIBBR:
PAGE:
08/27/2003
10:00152 AM
D00012268
923
Recorded I
At:
District:
1000
Section: B10ckl
107.00 09.00
EXAMINED AND CHARGED AS FOLLOWS
$0.00
LotI
008.000
Deed AmoWlt:
Received the Following Fees For Above Instrument
Bxempt
NO HlIDd1ing
NO NYS SORCHG
NO lA-STATE
NO Cert.Copies
NO SCTM
NO Camm.Pres
Fees Paid
$9.00
$5.00
$5.00
$5.00
$30.00
$0.00
$5.00
$15.00
$50.00
$0.00
$0.00
$0.00
$124.00
Exempt
NO
NO
NO
NO
NO
NO
Page/Filing
COE
!A-CTY
TP-584
RPT
TrllDsfer tax
TRANSFER TAX HUMBER: 03-03561
THIS PAGE IS A PART 01' THE INSTRUMBHT
Bdward P.Romaine
COWlty Clerk, Suffolk COWlty
l
Number of P....
TORRENS
5
F'..ECOR!'ED
2003 Hug 27 IQ'OO'~2 q~
E~rd ~.R~Malne
CLERJ( or
SUF"QLK COIr.-Il'i
L 000012..."68
P 923
DT' 03-D3S61
Sorlll/l
Certificate /I
Prior CtC. II
. Deed I Monpao Illl1rUl1\OlIt
Dood I Mortpao Tax slimp
FEES
RocordInI' FIlIn& Slim...
4
Pilei Filing Fee
Handlin&
TP-S84
Monllllo Amt.
I. Bale Tax
2. Addldonal TlIX
NOhldon
Sub TOIaI
S~
SpeeJAssIt.
Or
Spec. IAdd.
TOT. M:l'G. TAX
Dual Town Dual Coo
Held Cor Appc>ttionment
1'nnIferTax
EA-S2 17 (Coumy)
EA.S217 (Stale)
R.P.T.5.A.
Comm. of Ed.
_ Sub TolII
~)-
Affidavit
Certified Copy
Rea- Copy
Other
by this monpae is or
ed by a one or two Com lIy
Sub ToIaI
GRAND TOTAL
I RcaI Property TlIx Service Agency Verificadon
Dist. Sedloa .8 loc:Ic
Smrn' 03033119 1000 10700 OgOO 008000
Dale.
-
Lot
"Communi Preservation und
Conaldo~atlon Amount S ..r;::::r-
CPF Tak Due S
,
Improved
Icant Load
IOO~
. . .~.
Wickham. Bressler. Gordon & Gessa.
13015 Ma~n Road, P.O. Box 1424
Macclcuek. New York 11952
P.C.
I <-
.~
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,
9
Suffolk Coun
8 Tide Company Information
Co. Nlme
Title"
Recordin & Endorsement Pa e
1bis page forms part of the ....rNow!
Bargain and Sales need
mlde by'
(SPEaFY TI'PEOF INSTR.UMENf)
Mary L. Bergen
TO
The premises haein is situaled in
SlJf1'OLK COUNIY, NEW YORK.
s;~l!\~J
In the ToVlllShip of
In the VILLAGE
or HAMLET of
Clarence T. Bergen
!Iattituek
BOXES S n1RU 9 MUST BE lYPFD OR PRINIED IN BLACK INK mIL YPRlOR TO RECORDING OR FIlJNG.
FOR COUNTY USE ONLY
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
14,1 ,:S,1),~91
C2. Date Deed Recorded I g / 2..., / cB I
~Ih Dlly Year
C3. Book J ,22.,( ~ , 0 ICe. Pa..
PROPERTY INFORMATION
C1. SWlS Code
1. Proparty I
Location
3655
STFlmNI)MBE~
WICKHAM AVENUE
STFl~ET AAM~
SOUTHOLD
CITY Ofl TOWN
2.. Buyer
Name
BERGEN
LAST NAME! COMPANY
*
MATTITHCK
VILLAGE
CLARENCE T.
FI~ST NAME
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP_S21"1lb!y)ll17
I 11952
ZIP CODE
LAST_ME/COMPANY
3. Tax Indicate where future Tax Bills are to be sent
Billing if other than buyer address (at bottom of form)
Address
FIRST NAME
LASTIU.ME/CQMP/Io.NY
ST~1E
ZlPCOOE
STREHNUMIlERANOSTflEETNAME
4. Indicate ~he number of Assessment
Roll par<<'ls transflllTed on the deed
1 I 4# of Parcels OR D Part of a Parcel
CllYOR TQWN
5. Deed
Property
Size
1 X I
lOR I
",m
FRONTR;:ET
BERGEN
6. Seller
Name
LAST NAME I COMPANY
LAST NAME/COMPANY
ACRES
.5
o
MARY L.
FIRST NAME
7. Cheek the box below which most a<:c::urately describes the use of the property at the time of sale:
FIRST NAME
A~ Ooe Family Residential
B 2 or 3 Family Residential
C Residential Vacant land
D No....Residential Vacant land
I SALE INFORMATION I
11. &lIe Contr8ct Date
E~Ag,;,"I,"", I~
F Commercial J
G Apartment K
H Entertainment I Amusement L
1---- / / ~
"""~ Do' Yo&
08 /..;).f / 03
Mon," Do, y~,
12. Date of Sale I Transfer
, 0.0.01
, , .
{full Sale Price is the total amount paid tor 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 obligation5.) Please round to the nBBfflst wholtJ dollar amount.
13. Full S.I. Price
Community Service
Industrial
Public Service
Forest
FlRSTNAME
{OnIV if Part of a PlIreell Cheek as they apply:
-4A. Planning Board with Subdivision Authority Exists D
49. SuIJdivision Approval was Required for Transfer 0
4C. P8reel Approved for Subdivision with Map Provided 0
Check the boxes below as they apply:
8. Ownership Type is Condominium
9. New Construction on Vacant Land
10A. Property Located within an Agricultural District
108. Buyer received II disclosure notice indicating
that the property is in an Agricultural District
o
o
o
o
15. Check ~ or more of these conditions as appliCable to transfer:
A
B
C
D
E
F
G
H
I
]
14. Indicate the value of parsonal I , O. 0 . 0 I
propertV Included in the .ele , a
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill
16. Year of Assenment Roll from I 0 I, 021 Total ASHSSed Value (of Ill! parcelaln transfer) I
which information tllken 17.
18. Property Clasro
2
1
q-u 19. School Dlrotrlct Name I MATTITUCK-CUTCHOGUE
,
Sale Between Aalative!! or Former Relatives
Sale Between Related Companiea or Partners in BuSiness
One of the Buyers is also a Seller
Buyer or SeHer is Government Agency or Lending Institution
Deed Type not Warranty or Bargain and Sale (Specify Below)
Sale of Fractional or Less than Fee Intllrllst (Specify Below)
Significant Change in Property Between Taxable Status and Sale Dstes
Sale of Business is Included In Sale Price
Other Unusual Factors Affecting Sate Price ISpecify Below)
N~ ..
M&<ti L~ ~J20b:iL
,
3 4 0 0
,
20. TRX Map Identifler(_11 Ron Identifier(s} It' more than four, attach sheet with additionalldenl1fier(s))
1000-107-09-008
CERTIFICATION
I certify that all of the it~ of infoonation entered lKI this fonn are tnJe and wrred (to the best of rn)' knowledge and belief) and I under.ltand that the rnakiJt&
of 8IlY wDlful raise stateJnenl of meterial ract herein wiD subject me 10 the provisions or the Denal law relative to the making and fIling ur raIse in"ltruments.
~
~~r?r (j?;2Q~~:s
OO1\Rtm~ET. BERGEN DAn I
3655
WICKHAM AVENUE
STAEETNUMBEA
STA~H NAME !AFTER SALEI
MATTI TUCK
INY
STATE
ZIPCOOE
11952
CITY Oft TOWN
~ SELLER
,,.._1t.~rJ< c?f -I? ~~~_f ,-, (03
WICKHAM
BUYER'S ATTORNEY
ABIGAIL A.
LAST NAME
FIRSTNAM~
631
298-8353
AREACOOE
TElEPHOIIIENUMBER
NEW YORK STATE
COpy
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