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FOR COUNTY USE ONLY
Ci. SWIS Code
PLEASE TYPE OR PRE&^s FIRMLY WHEN WRITING ON FORM ~~
INSTRUCTIONS: http:// ww'wb~ps.state.ny.us or PHONE (518) 473-7222
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I t7r I il•- I , I I ~ I REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
~ I RP-5217
6 -•r~eu>,9• nY-521) xev 3/M
C2. Date Deed Ffecorded ~ / ~-~' r / ' -~- I
*' Month Day Vear
J
C3. Book ~ ~L->] r~ 1'' , > ~ C4. Page , I ~t
/ _ 'T'
1. Property -. / ~ / r,' ~. ,- '~( C j, r
LOGat100 STREET NUM8E8 STREET NAME
CITY OR TOWN T~
~yj r l
Name AST NAME/COMPANY
~~>i I X79- ill/
AflEA CODE TELEPHONE NUMBER
3. Tax Indicate where future Tax Bills are to be sent
Billing if other than buyer address tat bottom of form)
Address LAST NAME /COMPANY FIRBT NAME
~ ~ I I I
STREET NUMBER AND STREET NAME CITY OR TOWN STATE ZIP CODE
6. Indicate the number of Assessment ~ (Only 'd Part of a Parnell Check as they apply:
Roll parcels transferred on the deed N of Parcels OR ^ Part of a Parce l
4A. Planning Board with Subdivision Authority Exists
- 4B. Subdivision Approval was Required for Transfer
. -
5. Deed /
/ ~ 1 ' ~ X ~ ~- OR
P
ert Parcel Approved for Subdivision with Map Provided
4C
rop
y
mONT FEET DEPTH ACRES
Size .
'J ~ `
Y
r
i
` -~ ~ ,: / / l )ta i i~~
~
6. Seller ~ /- /
NBMa LABT NAME/COMPANY FInST NAME
I I I
LAST NAME /COMPANY FIRBT NAME
7. Check the box below which most accurately describes the use of the property at the time of sale: Check the boxes below as they apply:
8. Ownership Type is Condominium
A One Family Residential E Agricultural I Community Service 9. New Construction on Vacant Land
R 2 or 3 Family Residential F Commercial J Industrial 10A. Property Located within an Agricultural District
C Residential Vacant Land G Apartment K Public Service 10B. Buyer received a disclosure notice indicating ^
D Non-Residential Vacant Land H Entertainment I Amusement L Forest thatthe property is in an Agricultural District
SALE INFORMATION y 15. Check one or more of these conditions as applicable to transfer:
/~
~ I
~ A latives
Sale Between Relatives or Former R
11. Sale ContraM Date
-~/
/ e
Month Day Vear g Sale Between Related Companies or Partners in Business
C One of the Buyers is also a Seiler
/ l
12. Date of Sale /Transfer l/1 / '--~` / / D a D Buyer or Seller is Government Agency or Lending Institution
Month Day Vear E Deed Type not Warranty or Bargain and Sale (Specify Belowl
F Sale of Fractional or Less than Fee Interest (Specify Belowl
Ci Significant Change in Property Between Taxable Status and Sale Dates
/ /
l-
13. Full Sale Price ~ ~ ~ D ~ 0 H Sale of Business is Included in Sale Price
~ ~
(Full Sale Price is the total amount paid for the property including personal property.
I
Other Unusual Factors Affecting Sale Price (Specify Belowl
This payment may he in the form of cash, other property or goods, or the assumption of J )c None
mortgages or other ohligations.l Please round to the nearest whole dollar amount.
14. Indicate the value of personal
property included in the sale
16. Year of Assessment Roll from ~ ~ ~ D
n 17. Total Asseued Value lof all parcels in transfer) I
which information taken ) ~ >
18. Property Class I~_u 19. School District Name `~ r.~E91 / V
20. Tax Map IdenYdiedsl /Roll Iden£dierls) Ilf more than four, attach sheet whh adddional identifierlsll - ~ ~ ~ ~ ~ _~
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I -1C.1 ~`~~'pU I I ~(;~r'~r%3rOU I
_ CERTIFICATION -- ------
1 certify that all of the items of information entered oo-~hisfotm afe~trueand eerrect (to the best oF~my knowledge and belief) and I understood that th-., e~inaldng : "
of any wBlful false statement of material fact herein wiB subject me to [he provisions of [he cenal law relative to the making and filing of false instruments.
BUYER BUYER'S ATTORNEY
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i~(i ni ~~ c ` ~~~~ ~,~~ /~llC . (a'aiI ~C~ % `~, I %~UV/Ui
BUYER SIGNATURE OATE LAST NAME FIRST NAME
i't
1 / -
STREET NUMBER STREET NAME (AFTER SALE(
~ ~/.y /]~
iYY~~ (~19~,n/G l~l fA'1 /T' I I
*7~" unlcy'~~r~~
LITV OR TOWN STATE ZIP CODE
SELLER
CITY/TOWN ASSESSOR
COPY
I;,
SELLER S16NATUPE UATE
the latest Final Assessment Roll and Tax Bill