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JULIUS BLUMBERG, INC.. LAW BLANK PUBLISHERS
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT - THIS INSTRUMENT SHOULD BE USED BY LA WYERS ONLY
THIS INDENTURE, made the Iff 1'"11 day of r'G M.4A ~i
BETWEEN
:Y~flrll'l;r A"-f6P-i Rlr-srPrtf6
6050 ?e ':;>"A5-11 ,! Vc: ,
CWTCHDt;;U1:-i N'{ Ilq3S-
TeD.::> rllO((GflriiJ TiDO
, nineteen hundred and
\ l CJ
--
"
A,
party of Ihe first part, and
fLI"35t<i-l?OStVER...
f/rlO f(f5/0UVb A-r
~%~/N ~t!1tlJ~:+~Ave;
C L{-rCIi Ct; '-{'IE, /'JY'1193~
party of the second part, "
WITNESSETH, that the party of the first part; ,in consideration of Ten Dollars and other valuable consideration
paid by the party of the second part, does h(.'!rebygrant and release unto the party of the second part, the heirs
or successors and assigns of the party of the; secoqd part forever,
ALL that certain plot, piece orwparceLof land. with the buildings and improvements thereon erected, situate,
Iyin~ and being in the -r tI u:> N,' ~ 1'- , 50 I.{ -rH e> L. oj;) (Ii C 1-<' CfI qyu ~ Gal{ '" ry <:) F
71A F'-FOL- K ~ 5'1A-f;~o F..dr- fU Y O~~ 1<, 1'30'0'1 O€..fJ !'I~ {J tJL~cf<? 1(3'€.P
A -0 'FotLCJlOS '. .. ,
<5 1i- ~ '$d.H~ /) tfL., ~ ",4 h ./ N 1'/ ILl( -IE [)
(3611'/ <f t (I'/TJE-rl O'E-p Ie> 6e.- ,H E- 5"M~
"F -rIIP f?4Rrti;" 0'::- -rHe:. FIf(S, 1':41<.-r
{~,eor"rI/ XI?., CfI-rE-]J ()6jc;2.-/"19
HEte~ 10.
;?f(EA'5~S l7iK5c/(16I1l!o II'{ rH4. DF~
f/~R.EI7'I 13,/ tl-EE.P F.RtM( _,oHr(C',
TOGETHER with all right, title and interest, if any, at the party of the first part in and to any streets and
roads abutting the above described premises to the center 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 premises herein granted unto the party of the second parL the heirs or successors and assigns of the party of
the second part forever.
AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby
the said premises have heen encumbered in any way whatever, except as a.foresaid.
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 hold the right to receive such consideration as a
trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to
the payment of the cost of the improvement before using any part of the total of the same for any other purpose.
The word "party" :;;:ha/J be construed as if it read Hparties" whenever the sense of this indenture so requires.
IN WITNESS WHEREOF, Ihe party of Ihe first part ha. duly execuled this deed Ihe day and year firsl ahove
written.
TN PRESENCE OF:
x
.
UNIFORiv[ FORM CERTlFrC.UE OF ACKJ'iOWLEDGMENT
State of New York )
ss:
County of.:sUFfDLL)
On the 2O-H:Jay of
personally appeared_
Q.rch in the year zo:z..before me, the undersigned
I - +
,personally known to me or proved to me.on the basis
of satisfactory evidence to be the individual(s) whose name~ is/are-subscribed to the
within instrument and acknowledged to me that l.e/she/4q executed the same in
~/her/tftetrcapacity(~, and that by fM5/her/!1teH signature~,on the instrument, the
individual(~, or the person upon behalf of which the individual(~ acted, executed the
instrument.
P!G9~su.t~yOlk
NolalY. ~I!!~~ SIIlIdk CoInlY
. -- No.O~ ~ugus\.C:JO
~
r-l~ 2
Number of pages
6
RECOR[)E[)
2002 t'i.ar 20 03: 17:06 PP1
Edl..Jard F'. ~:om.aine
CLERK OF
SUFFOLK COUt.1 TV
L DOOOi2175
P ?l0
DT# 01-31620
TORRENS
Serial #
Certificate #
Prior Ctf. #
Deed I Mortgage Instrument
Deed I Mortgage Tax Stamp
Recording I Filing Stamps
4
FEES
Page I Filing Fee
Mortgage Am!.
Handling
TP-584
I. Basic Tax
2. Additional Tax
Notation
EA-52 17 (County) 5 Sub Total
~-
EA-5217 (State) dS'
_-30-T
RP.T.SA
Comm. of Ed. _---.2. O~
Affidavit
Certified Copy
Reg. Copy ---
Sub Total
Other ---
GRAND TOTAL
Sub Total
-30
Spec.! Assi!.
Or
Spec. I Add.
TOT. MTG, TAX
Dual Town Dual County
Held for Apportionment
Transfer Tax
.~
&0
qo
Mansion Tax _
The property covered by this mortgage is or
will be improved by a one or two family
dwelling only.
YES or NO
If NO, see appropriate tax clause on page #
of this instrument.
Real Property Tax Service Agency Verification
Dis!. Section Block
Lot
6 Community Preservation Fund
Consideration Amount $
Stamp
1000 11000 0300 025000
)0
CPF Tax Due
$
-h
Date
Improved
Vacant Land
-/
Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD & RETURN TO:
~I'/"'A- A.....--l'~R..1
5O~O ~b::;>'<A9t/- AVE.-
C V. -r-G/-IOG- ...~ iff /l93S-
TD If)
TD-/-
TD tT--
8
Title Company Information
Suffolk Count
Co. Name
Title #
& Endorsement Pa e
TIus page forms part of the attached
J),F PI",/{ A
,4L{J#_it,
(SPECIFY TYPE OF INS1RUMENT )
made by:
The premises herein is situated in
SUFFOLK COUN1Y, NEW YORK
TO In the Township of )()I{TJI()LO
:!it:::L.I... r In the VILLAGE
911/ f:.--L. or HAMLET of ~((-rC /teA;:; l{ i3:-
BOXES 5 THRU 9 MUST BE TYPED OR PRINIED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
(OVER)
?7,::~4
.
. .
1111111111111111111111111111111111111111111111111111111
1111111111111111111111111
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEEDS/DDD
Number of Pages: 5
TRANSFER TAX NUMBER: 01-31620
Recorded:
At:
LIBER:
PAGE:
03/20/2002
03:17:06 PM
000012175
710
District:
1000
Section: Block:
110.00 03.00
EXAMINED AND CHARGED AS FOLLOWS
$0.00
Lot:
025.000
Deed Amount:
Received the Following Fees For
Page/Filing
COE
EA-STATE
Cert.Copies
SCTM
Comm.Pres
$15.00
$5.00
$25.00
$0.00
$0.00
$0.00
Above Instrument
Exempt
NO Handling
NO EA-CTY
NO TP-584
NO RPT
NO Transfer tax
NO
Fees Paid
$5.00
$5.00
$5.00
$30.00
$0.00
Exempt
NO
NO
NO
NO
NO
TRANSFER TAX NUMBER: 01-31620
THIS PAGE IS A PART OF THE INSTRUMENT
$90.00
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
REAL PROPERTY TRANSFER REPORT
STAn; OF NEW YORK
STAn; BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP-5117 Rev3J<)7
1..'0......10050 l'1ia....AS-I/ AVErYlA. ~
Loca1.on I C,,~u;,~ HI) l# I-( ~m "M' 50 If r /I I) L.. f}
A Z"p E f<.- -r -i5~ '" Ii >4
7{"';;':;;;Efl- FEA:/ 55~
LAST NAME I COMPANY FIRST NAME
2. Buyer
Name
3. Tax Indicate where future Tax Bills are to be sent
Billing if other than buyer address (at bottom of form) I
Address
LAST NAME f COMPANY
STREET NUMBER AND STREET NAME
CITY OR TOWN
4. Indicate the number of Assessment
Roll parcels transferred on the deed
I
# of Parcels OR 0 Part of a Parcel
(Only if Part of a Parcell Check as they apply:
5. Deed
Property
Size
/00 Ixl /1S'
A"2f6(?;"~ DEPT"
.
'ACRES
lOR I
6. Seller
Name
LAST NAME I COMPANY
LAST NAME I COMPANY
I
1//13s-1
ZIP CODE
FIRST NAME
ST~TE
ZIP CODE
4A. Planning Board with Subdivision Authority Exists
48, Subdivision Approval was Required for Transfer
4C. Parcel Approved for Subdivision with Map Provided
o
o
o
o. 'i (),
:J)E3:-A N tI/r
FIRST NAME
FIRST NAME
Community Service
Industrial
Public Service
Forest
Check the boxes below as they apply:
8. Ownership Type is Condominium
9. New Construction on Vacant Land
o
o
o
o
7. Check the box below which most accurately describes the use of the property at the time of sale:
j
"( I
Year
'1 g, J.-.
/ . I I
Year
~ . b>-..{)8
~,6,(j,&, 6l,O, <9.5, do, 0 I
, , .
(Full Sale Price is the totaiamount 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 dollar amount.
/! J
14. Indicate t~e value ~f personal I , I},' / 1 (') , '~ I::" ) I 0 1 0 I
property included In the sale , " , .
~"""~l~_~~~.
17. Total Assessed Value (of all parcels in transfer) I . " ., , ....~ 6, 0.,0 1
I . / ., .' , .-'
; j DLL~_~ ...1...:'- t~ .
~J"f'T4( / ,~S;L,-'t"GIfCj 6/
I/()- 3-.LS""
A~ One Family Residential
B 2 or 3 Family Residential
C Residential Vacant Land
D Non-Residential Vacant Land
E ~ AgdculM,1 I ~
F CommerCial J
G Apartment K
H Entertainment / Amusement L
l /
Di' 8-
/(;)
11. Sale Contract Date
" v /
Month
/3-
12. Date of Sale I Transfer
1..Li it<
Month
D',
13. Full Sale Price
16. Year of Assessment Roll from
which infonnation taken
(.'} ["j
i. il
~,~ ,t'\ ,
( ':
3 <d'L
18. Property Class
-,
"
I-U 19. School District Name I
10A. Property Located within an Agricultural District
108. Buyer received a disclosure notice indicating
that the property is in an Agricultural Distri~
15. Check one/f)r more of the!\8 coridi ns as applicable to transfer:'
A Sale Between RelatiJ..~ or Former Relatives
B Sale Between Related Companies or Partners in Business
C One of the Buyers is also a Seller
D Buyer or Seller is Government Agency or Lending Institution
E Deed Type not Warranty or Bargain and Sale (Specify Below)
F Sale of Fractional or Less than Fee Interest (Specify Below)
G Significant Change in Property Between Taxable Status and Sale Dates
H Sale of Business is Included in Sale Price
I Other Unusual Factors Affecting Sale Price (Specify Below)
J None
20. Tax Map IdentifierlsJ I RollldentifierlsJ tlf more than four, attach sheet with additional identifier(s))
flo, - 3-d.-S'
BUYER SIGNATURE
].;
"2- I~.
JDJr ~,'~
ME;- ,
U~.
j'~
S"C>5'O
/.f'e;aL(A~1
STREET NAME (AFTER SALEI
STREET NUMBER
SELL SIGNATURE
,
L.my knowledge and belief) and I understand that the making
reJa,liv"l<J.;.the~king and filing of false instruments.
.,BIivERJs ATTORNEY
/;;;-~
, .
-;t:f/ ON E
LAST NAME
FIRST NAME
t
,
//
TELEPHONE NUMBER
AREACODl!')
1-
- -? .
1 ~.('
;
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