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CONillltT YCU. UoWYIlIUIOIU ~ THIS IHSnWlIiDlT - ntIS lII$TlIUIlINT SHOUUI . usa " Uownas GIIU'
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WITNIil3SE1H, lIuollho puIf ollfMllinl pm. m c,uidonlion of
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rMdlo llhuttiq dlc abcm. o...mbed ~ lOlllolI__I_1hm:oI.
TOC.E'I'HEa wilh .. ~ ad aU tho _Ie and rip... 01 tho Jl'Il11 of ... tiUl put 141 and ..
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TO HAVE. .AND '1'0 HOLD tho ~ brnm ~ Ilaw tile put)' 01 .. ~ put, the Wn lit'
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!!!lWl'I'b,. tho ..eI p-m.., Jioon.. -.. j~ ill MY "0) ~. UCf:l9C.... "lid
AND u... patl) .[ lhe lin.lplrt. hi eoo.,u- witIi ~G11 13 01 u... u.. lAw, ___ _Ibo pm)' of
lhe 'nt pan .. m .""".,... !he. ~nIli"" '0' _ _n:r...... aid . hoLIlbo . .,. rollIIlhtI .... COJald..
_iOlll .. Q II..., IllI>d 10 ~ opplk~ lint t<< .. ~ vf pilriq tile 00II 01 .. ~ ud wiD ...,q
th. IIII1lQ nfllt 10 thopl7mMt 01 tho eOlIl 01 tho ''''Fo""""",. lwelllhl wd~ &11) pelt ... me ....1aI of tho __ fo.
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1M ..om "Jiillny" ....11 be .,._....... .. II it -0 "plIltla" "~{ll' tho _ 01 Ihirt ,...fntlnt! 110 ftlliul"",.
IN WITNDS W'H:EREOF. the 1'1117 of tho Am pan hu.o ~. _lc'IIlbia d.or.:Ilbt "-r ud r- 6nl ~
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IlId ... ~ "~Ir s/pIIun:(n OIIIlbe inlInImeftt. lbe iftJi.
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t~ ~ 1O"1he irdYidwal(s, ""'- !lllIml'($} is Ilftl
IIIbti::llbtd II) Ihe wiItIllI ..... ., ~ 10 mil'
lIuit~ tJeCfIIIId __ in ~1bo:1'",*,I'Ylla).
UId dial ~b~ ~1)0III1he iltS/NmtnL lbeindi.
..iduaIU). Of .lbe pcnlOIII WpOIII bdIolr of whidllbo: inllivlclulll(A,
lIt1IId. ~ Ihe ~ IIld tIlllllloldl individ.oolllWlllc
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the subsnibinl wiWll:<(nl1o illc forqoi. .~ wilb
",,110m I - ~I)' lIIt'QII4Iirifl.'d. wIIo. belllll'" me dilly
sworn. dld ~iIIlllI my IMlllef~ ~(.l in ."...
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10 be Ibt iloWvlolwd{s) ~ i!llnd wIIo~ Ihe fotl'.
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~ bi",lb,'lichrtl, 1Il"'''e,.) u.. w~alllll:l\ltQ.
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JtftURN BY lIUJ1. TO,
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rORRERS
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2lX'l2 SIp z.t ~ ZIlll4 fit
Edwarll P.Rouu.
a..EIlJ:: (If
~ COI.MV
l kJl:!Ol221t1
P154
1>" 0Hl905l'l
SrriII'
c~l'fmCIK 11
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Deal I r.tonpp T~ Slmlp
fEES
~inal FlIina SwnJl'l
.
Pap , Fllina Fa
11:md11ll1
TJ>. 584
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~^IIII
IS - W,1<;U!
,----.,
GMNDTOTAL
~'*' $mlA/44
RQI Prnpmy 1&'( Smn<:t .I\pncy' V(1lflmb
...... -..... R II:lCk 1M
02031~ 1000 11100 0600 OOa~Dl
SlAtmp ~
:. ~@
-~ '--'.:-e ...._._
t SaliJCK1~ha!psI!tcfetm Lid Ptoperty Owners Mailing:
RtCORJ)" ltt'fURN TO:
~ut~.i2. "'~'A- ~O~
.pID,~ 1015
~~I NY. lIq~. I
I.~TM
~AdII~~rllll
$\lO T llhll
Sp:cJAslit.
0,
Spc.:./Mit
TOT. loin.. TIlX
DtalT_ Dt:IalC~
T=:~;~_
~0lI TIIlI _
T'hf prupcrty (dUflCd by' dlis ~ it or
\lliU be illlPfovrtll by illl"!:' or Iwo fllllllly
ctwclli", o"'y.
YES or NO
If NO,'1ft" 1!I'JII000i. .. now OIIplIS,C It
oflhilINll_.aIt.
--
Nee_toft
-
;)1
.5- SW Total
g} i:J _
ItJ'U..... ~_...._
<::mmt of Ed. 5 Q.IL...
AffltiavlI t. .-
CmilledC~~ _
~ClIli')'
EA.-'2 t110lunlyt
EA.S2 n (SIll.'
0I"';rr
lC,'
1 Dtc
6 Communi! PreservalionFul1d
COf!llliderllllcm AmplUIl S
Cl'l' Tax I)uc: S
l~
VklI/II.1l.ud
.
TO
lU
Tn
TUle C<napany lnlbnuUoft
Co, NlIme
~
nile #
Suffolk Count Recordin & Endorsement P e
(SPWFY TYI~ OFJNSIRUMENr)
111_' hy.
1"hi$ pille fClml!l pitt oflhft ~
~~~'"\.;:'-P G~~dAJ
The premises hm:in D sitl.lll4Cd in
SUFHll( COOMY, NEW YORK.
l TO In th!:TQ~por L~ ~ ~
-""'..!,~,~ (j?6~) In IhtVIJ.LJ\ClE
::J)..Al-.{ """ ? r,,.J-c^ L. ) orllAMLEl'of_C It' '1a-~:>t:"
UC))(.ES S lHRU 4) MUsT BE TYPED OR. PRIN11!D IN IU.ACK INK UNL Y PRIOR TO RECoRCINGOR flUNG.
I ~II)UI nm III ~1~RllnIIIIDII~_'
I 11,111 1IIIIIml III mil
St1i'E"OLK COONTY CLERk
RECORDS OFFICE
RECORDING PAGE
"rype of Instrument: DE1IDS/ODO
~r of Pagiu: ..
'l'RANSFER 2'AX NUMBER: 02-08058
District:
1000
Section; Slock:
lU.OO 06.00
EXAMINED AND CHARQl:D AS
$0.00
RGoo~:
At:
LJ:BEa:
PAGE :
Lot;
002.001
09/24/2002
O!k28: 14 AM
DOoo12210
754
Deed Amount;
roz..r..ows
Plsge/filinq
COB
u-cn
'l'P-584
iRP1'
T:r,u"lIfer tax
~ived the Il'oUow:tng "ees F'or Abow Inatrumant
Exempt
NO Sandlin;
NO NYS SURCHG
NO EA-STATE
NO cert. Co)n81l
NO SC'l'N
HO Comm.Pr..
FHa Paid
$12.00
$5.00
$5.00
.$5.00
$30.00
$0.00
$S.OO
$15.00
$25..00
$4.00
$0.00
$0.00
$1(16.00
E.xempt;
NO
NO
NO
NO
NO
NO
'l'MNSFER 'l'AX ~R; 02-08058
THIs PAGE IS APAA<f OF THE. mST.Rl.lHENT
Edward P.~1n8
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
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP.S117Rev31'J7
2. Buyer
Name
~~~
3. Tax Indicate where future Tax Bills are to be sent
BIlling if other than buyer address (at bottom of form)
Address
STREETNU E
I C
4. Indicate the number of Assessment
Roll parcels transferred on the deed
l
# of Parcels OR
5. Deed
Property
Size
I~
FRQN ET
IXld~
DE
lOR I
D Part of a Parcel
4A. Planning Board with Subdivision Authority Exists
"LID 48. SU,bdivision Approval was Required for Transfer
'ACR~ J . ~I 4C. Pa"",1 App<oved 10' ~v's'on with Map Provided
I~t~{~~ (-
:'L...J ~
~
D
D
6. Seller
Name
~t2E~
-T'
LAST NAME I COMPANY
FIRST NAME
ne Family Residential
2 or 3 Family Residential
Residential Vacant Land
Non-Residential Vacant land
E ~ Agricultural I ~ Community Service
F Commercial J Industrial
G Apartment K Public Service
H Entertainment I Amusement L Forest
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 a disclosure notice indicating
that the property is in an Agricultural District
D
D
D
D
7. Check the box below which most accurately describes the use of the property at the-time of sale:
B
C
D
I SALE INFORMATION 1
Ifh~/~1
9 1;)1/101 I
Month Day Year
15. Check one or more of these conditions as applicable to 'b'ansfer:
Between Relatives or Former Relatives
11. Sale Contract Date
14. Indicate the value of personal
property Included In the sale
B
C
D
E
F
G
H
I
J
Sale Between Related Companies or Partners in Business
One ofthe Buyers is also a Seller
Buyer or Seller is Government 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
12. Date of Sale I Transfer
13. Full Sale Price 1 I I I I I I I 0 ~O I 0 I
., , .
(Full Sale Price is the total ~unt 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 dol r amount.
,
ASSeS eNTlNFORMATION " o.t. .h~uld r.fl.Cilh. latest FInal ~
16. Year of Assessment Roll from I ....... "'I . I - ff ,~' ~ . ...../.I,~. ,,}
h. h.nfo at. t k l..-)#1\. 17. Total Assessed Value lof all parcels In transferl' .. ,,,;"t:J>(. '). fl :,.'~
WICI rmlonaen ,1-" , ,
la. Property Cia..;> ,I Ol-LJ 19. School Oi....'.. Nama L~"r\ L,#(. I Ct.-t~6. uC:
f
20. Tax Map Identmerls) I Rollldentifierls) (If more than four, attach sheet with additional identifierlsll J II - to -;J \. J
06UU
?)
~
00,;)' UQ I
13
L
/000
I / /(0/)
I ct:RTl~1'I0t4. I" ,/ / ~
I certlfy~t of items tinfo
of any .' f: s Ierne n",~,,bfma
I
'A, /~ /'
. I
~
,
itIon entered on this fonn are true and correct (to the best of my knowledge and belief) and I understand that the making
fact h'?t yf!i ~bjFAe to the nrovisions of the nenallaw relative to the making and tiling of false instnnnenl&
YER 7 /J 1/ D ";).... BUYER'S ATTORNEY
(/
~ 1,(,~E;r,ER
I i~r!ld,RSALE~ A-?I)
If! I !L~
SELLER
11if)^
LAST NAME FIRST NAME
AREA CODE TELEPHONE NUMBER
C:J:S!wfli)t;u~
t/fJ
CITYfTOWN, ASSE~SOR
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