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21m Au, 1.51h341:J3 lit
Edward P.Roui..
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Suffolk Count Recordin & EndorsementPa e
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llOXES 5 nuw 9 MUsT BE lYPEDORPlUNmDJN BLt.CK lNK(H.Y PRIOR TOlBXlRDINOOltmtNO.
IOV!JU
ThillJlll&C'IClml pILr1of~1Ilbll:hl:d 11. ""ro'll Cl'ld 'S.. ~ 1>.....1 w,l.J. t:.u'r.....1)
(S1'EaFY TYPE Of lNS11tUMe1T)
J........l L. &0('''' .,.J \!.rend}' l. iT,""",,", ~~"'iu,t1ll11edin
SUl-'fOlK COUNIY, NHWVORK.
In~TOY.Ill&hipot ~OiJ#.o/J
J'rl+t~ t..v<<" In tile WJ.AOE
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RECORDS VEil" .LCI
RECORDIJG PACD
Type of In11tJ:'U\llGnt: DlIrOS/PDO
NwIlbetl: of Pages: 3
TRANSFER TAX NUMBER: 02-02405
-.co~f
Ml
LIBBlh
PAGI: :
08/15/2002
1b34:33 AM
D00012203
611
District:
1000
Seat1on: Bloat:
111.00 0".00
EXAKINlD NfD CHARGED AS i'OLt..OWS
$0.00
Lot:
Qa4.000
l:l4Mld Mount:
Page/Filing
COB
&A-en:
TP-5$~
IU'1'
'franlilrer !:ax
Following Fee. For Above InIJtrument
Exempt
NO lfandllno
NO moB stIKCKG
NO EA.-STAn
NO Cert.Cop1_
NOSC'IH
NO CCllIIIl. Prell
Feu h1d
$9.00
$5.00
$5.00
$5.00
$$0 . 00
$0.00
$5.00
U5.00
$25.00
$4.00
to.CO
.$0.00
$103.00
........,t:
HI)
NO
110
NO
HI)
NO
RliIoelved tilQ
TRA1i18FER TAX ~R: 02-02405
THIS PAGS IS A PAat Ol!' 'fIfE nlS'!""'"
EdwardP.~J18
County Clerk. Suf't'olk county
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.~ '" ......PLEASETYPEORJI!Rl;.p'F1RMI.".WH~NWal.o~p..r'.~;.,
INSTRUCTIONS: http://www.orps;state.ny.us or'fiHQt4E (518)473-7222
"""-"'l''JI(<,;:
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REAL PROPERTY TRANS~R REPORT
STATE OF NEW WlRK
STATE BOARD oF _PROPERTY SERVICES
R1li':"5217 "
~-5217 Rn 3m
',r::=1 ~E~u2~ I ~~:t.VVafe~
I 4fc nOliUe..
CfTVORTOWN J
2. Buyer UOfA'"
Name LAST"NAAt I~OMPANY
~ ~.J:::;.,tf,tv
3. T.x _, In~wherefutureT8X Bills are to be sent UR ,_
Billing ,ifmherthan buyer address (at bottom offorml ~ ~ P
Ac:IcIrn4l, . LAST NAME I COMPANY
./'.m.J'if vd 0>", ... Co' +
STREET NUMBER AND STREET NAME
VILLAGE
I /J'f 3f; L
ZIP CODE
UJt~ir . ~~~:.l
"RST N
\)'",,'"'C)
FIRST NAME
l)oq"";t
FIRST NAME
5. Oeed
Property
Size
FRONT:FEEr-
Ixl
OEF'TH
lOR I
'ACRES'
.7. t?1
(Only ff Part of . _I ChacIi.. thav ..".."
4A. Pfanning BOlIrdwith Subdivision Authority Exists 0
.s. Subdivision Approval was ReQuired for Transfer 0
4C.Parcel Approved for SubdiVision With Map Provided 0
4. Indlcete the number of Assessment
RoD parcels tnn'ulferrikl on the deed
# of Parcels OR 0 Part of a Parcel
6. Seller
Nam.
1<.0 (/)4-
LAST NAME I COMPANY
Wt~'v
FIRST NAME
,f. )::)""';tl
-
--'UIP
LAST NAME I COMPANY
FIRST NAME
,L~.~eck thitbDX below which most accurately describes the use of the prope~ at the time of sale:
A~ne Family Residential E ~ Agricultural I ~ Community Service
B 2 or 3 Family Residential F . Commercial J. Industrial
C . Residentiaf.Vacant Land G Apartment K. Public Service
D .' . Non~Residenti81 Vacant Land' H Entertainment I Amusement L Forest
---
~ lhtlloJ!as below "1hOY app/y:
B..Ownership type 'is CondOfllit:lium
"9. New Construction on Vacant Land
o
o
o
o
Mooth
I
Day
I
Year
10A. ProPerty Located within ari Apricultural District
_,1qB. Buyer received ad~I~.~~_-,indicati!Jg
,:_ that the property is in' an '~_COtrG~1 Oisbict
15. ChICk one'or mOre of......~ "-iJ;irtab.~ trMIfer:
A Sale Between Relatives or Former'Rel~s
B Sale Between Related c;pmpaniftSor Pattnersin BUSiness
C "One of the'Buyers is alsoa'SeUer
D Buyer or Seller is ~overnment Agericy or Lending'lnstitution
E Deed Type not Warranty or-B~inJind-Sal~ ~Speeify Below)
F Sale of Fractional or les$th~Feelnterest <<$pec;ty Below)
G Significant Change inPrope7cy~n T8X8ISIe Status and Sale Dates
H Sale of Business is Included in Sale Price
I Other Unusual Factors Affecting Sale PrieS (Specify Below)
J None
11. Sale ContraCt: Date
'2. Data of Sale I Tra_
I D<< IN';
Month Day
10 2-
Ye"
13. Full Sale Price
, ,.c?, 0 , 0 I
, , .
(Full $ale Price is the total amount paid for the property including personal property.
Thj~ payment may be in the form of cash, other property or goods, or the assumption of
mortoages or'Other obligations.) Please round to the nearest whole dofJsr amount.
'4. 1_1l1e...... of parson.1 1 0 0 I"
16. Vear of "n.nment ROil from 1
which information taken
17. Total Assessed Value (of all parcels in transferll
'8. Property C1_
I~, "QI-LJ
'9. School DIs1ric:t Nam. I
/1."1/'/,,,1.:
;
(..,+./'..,,,,
IJ/- 4- Y
13
;
;
20. Tax Map kIentifIerls) I ROllldentlfler(s) (If more than four. attach sheet with addftionallcientifier(s))
/0'750
:0
~
s
__I_.l.-
OLivO
() {./ (/000
L
,,,';"
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I ~,_aD ofllle items of~...tered on lbiSf..... "",true and _ (to thebost of my koowledge 8IId beIi<I) and I ............. thatlileinllklllli
ofllDyWlDluJ ~_ oI....laia!~- wlII subJe<< me to the orovisioMof 1IIe__n!Iativeto the -.klogand lIIiDeor,.... ~ '
BUYER BUYER'S ATTORNEY. "~.~.'
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BUYER SI URE _ /
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DAn;
LAST NAME
FIRST NAME
q
r:: ~ I ( f'Y\ U '-4 rt..J.
STREET NAME \AFTER SALE)
6ULcL
AREA CODE
TELEPHONE NUMBER
STREET NUMBER
Gare/itl\
CITY OR TOWN
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ZIPC E
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SELLER
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