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BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S
ACTS (INDIVIDUAL OR CORPORATION)
STANDARD NYBTU FORM 8007
CAlmON: TillS AGREa11:."NT SHOULD BE PRF.PARIlIJ (IY AN AlTORNl:'"Y AND RF..VmwED nY ATJ'ORN~'V5 FOR SF.1.LI:R AND
_~JkC'II^5F.:H UI!FURI! SltJ"Nlhu.
,;a"B- ""'I .ro-
THIS INDENTURe, made the ~ UJrI:.(, juno, 2003
between -0-
KAREN PE'ITEHSEl", III to a 1 % inle......l. ......Idlnl al 401 Bay Rd.,
North Ferrlsbury, Vermonl 05473 and THOR B. PElTERSEN.
as to a 99% inl........ .....iding.t 1120 J.ckson', Landini.
Manituck, NV 11952, as tenants in comon "itbont rlabt ohun'ivorabip
pany of Ihe filSl part. and
_ .61 C.
(1"" TIlEODORE"MART7" ~-
.....iding..t 145 Reycraon Av..
Manorville. NY 11949
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ro( -. '\
{ (7"
pany of the second part,
WITNESSETH, lhat Ihe party oflhe filS! pan. in <onsid.nolion of Ten Dollars and od,er lawful
eonsideration. lawful money of Ihe Uniled SlaleS, paid by the party of the second part, docs hereby grant and
release unlo Ihe party orlh" second part. Ihe heilS or SueecSSOIS and assigns orlhe party oflh.. second part
forever.. ALL thai eenain plot, piece or pare.1 "fland, with Ihe buildings and improvemenls Ih.."",n
..rected. silUate. lying and being at Maniluck, Town orSoulhold, Counly nfSutTolk and Slale or New York.
SEE SCHEDULE 'A' ATTACHED HERETO AND MAUE A I'ART HEReOF
The gl'"dnlor h..rein i. th.. sam.. person and the grantee in Deed daled Ocrober 16, 200 I. reeoided
Nov..mber 3.200 I in !.ib.r 12151 ep 229.
TOGI::THER wilh all right, tide and inleresl. irany, onhe pany or the filSt pan in and 10 any .t...,.,ts and
mads abulling the above described premises to Ihe eentcr lines thereot:
TOGETHeR wilh Ih.. appunenane... and all the eslate and righls onhe party onhe filSl part in and to
said premises.
TO HA VE AND TO HOLD the premi""s herein granted unlo the party of the second pan. Ihe heirs or
.uc....s""rs and assillns oflhe party orlhe second pan forever.
AND the party of the first part, covenants that Ihe pany of Ihe filSt pan has not done or surr....d an)~hing
whereby the said pn:mi~ have been encumbel'ftl in any \\-'DY whatever. except as aforesaid.
AND the pany ohhe first pan. in complianee wilh s..'Clion 13 orlh.. Lien Law, covenants thallhe pany
orthe first pan will re....ive Ihe consideralion lor this c"n\'eym.ec and will hold the right to receive sueh
consideration u a trolil fund to be applied first tor th~ purp05e afpaying the cost of the improvement and will
apply Ihe same tilS! to the paymenl of the c,,"1 orlhe improvemenl before usinll any part of the tOlDl orlhe same
ror any olher purpose_
The word "party" shall ~ construed as if it read "p3nies" whenever the ROSC of this indenture so
requires.
IN WITNESS WHEREOF, the pan)' or the first pan has duly eX<'Culed thi. _ Ihe day and Y"ar filSl
above written.
(f.A "ALl jJJ;1;t7~
. AREN PETTERSEN
1"~ ~_ tP~rz.,-
THOR B. PElTERSEN
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NYSnA Kcsidmli:al Real ElIlale ~rms.m IIntIJnclI (CM'IO)
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("''fI)'riJlld CapIOOI. ne\Ckll'ftlCl1l
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Fidelity Nationai'Title'lnsuranee Company of New York
TITI.E NO. 02-3104-47794-SUI'I'
SCHEDULE A-I (Imcr/plhm)
ALL that certain plot. piece or parcel of land. silUale. I}'ing and being in die Town of Southold. Counly of SulTolk and
State of New York, known and designaled as Lot No.9 on a cenain mal' enlilled, "Jackson's Landing" and filed in the
Office of the Clerk oflheCounty orSulTolk on March 28. 1969 as Map No. 5280.
TilE POLlcr TO BE ISSUf.'D IInder Ihis commllmelll ..,ill Insllre Ihc lille 10 .....h blllldillgs tmd ImJ"O"CtIH!nIs 011 lire premul!S ..."iI:h
/:0." latI, COfUIII/IIC rem pro~rl)'.
FOR CONI'f."Y ANCING ONL Y: Together wilh alllhe righI, IIlle and IlNtrest of/he porty oflhe finl port, of I" undlO the 10"" 1)'ing
in the _, i,,/rom of and udjol"lng .aid prem/sd
:,CIIFJJUI.E A'/I/1rB:riptlon)
, ..
;r.
STATEOI' VEIUIONT l
COUNTY OF ~. ~[)"'" ~ SS.:
I.,b.. June
On the , day of Hrtrt:'fo. 2003, betore me. .he undersigned. personally appeared KAREN
PElTERSEN. personally known tn n,e or proved to m~ on the bosis of so.isfactory evidencc \() be the
individual(s) whose name{s) is (arc) subscribed to the within instrument and acknowledged to me that she
executed the some in her capac:ity(ics), and that by her signature(s) on th~ instrumcnt. the individual(s). or the
person upon behalf of which .he individual(slacled, executed the instrument, and that such individual madc such
appearu e before th~ undersigned in the ~ I;) UN"""'" 0 P I:!. HI "T"T"oS I\) 005"", ~T'".. ate '1/"'-'
)ro/
LORI'
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NOTARY PUBL C
STATE OF HfIW/7mK VERMONT :l
')sS"
COUNTY 01' tJ.1rtrIQU:I tlu 'tf~"h...;) ,
-""'-- June
On the I:) -day of U~Il. 2003, before me. the undersigned. personally appeared THOR B.
PElTERSEN. personally known to me or proved to me on the basis of solisfactory evidenee to be the individual
whose name is subscribed \() the within inltrum~nt and acknowledged \() me that h~ executed the same in his
capacity and that by hillignature on .he instrument. the individual or the person upon behalfofwhich th~
..;~~:-
NOTAR PUBLIC ~
,;II-/t-OR'I fle;;NNS~esY
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DEED
Title No.
PETTERSEN
To
MARTZ
Seetion 113.00
BJork 06.00
Lot 002.000
Counl)' or Town SUFFOLK
Rerum By Mail To:
JOSEPH MCHEFFEY. ESQ.
5 CROSBY ST.
CENTER MORICHES, NY 11934
Reserve This Spaee For Use or Recording Office
NYSIIA Rclidemlal Real ErlIIh: Forms on IloIIloes. (WOO)
'2-
Cop)Tighl ClIpIUlll. Ikwlopmcnl
1111111111111111111111111111111111111111111111111111111
1111111111111111111111111
SUFFOLK COUNTY CLERK
RECORDS OFFICI
RBCORDING PAGE
Type of Instrument: DIEDS/DDD
Humber of Pages: 4
TRANSFER TAX NUMBER: 02-46918
Recorded:
At:
LIBER:
PAGE:
07/15/2003
08:09:40 AM
D00012261
021
Deed AlllDunt:
Section: Block:
113.00 06.00
EXAMINED AND CHARGED AS FOLLOWS
$150,000.00
Lot:
002.000
District:
1000
Received the Following Fees Por Above Instrument
Ex""lpt
NO Handling
NO NYS SURCBG
NO BA-STATB
NO Cert . Copies
NO SCTJI
NO CODIII.Pres
Pees Paid
$12.00
$5.00
$5.00
$5.00
$30.00
$600.00
$5.00
$15.00
$50.00
$0.00
$0.00
$1,500.00
$2,227.00
Exempt
NO
NO
NO
NO
NO
NO
Page/Filing
COE
EA-CTY
TP-584
RPT
Transfer tax
TRANSFER TAX HUMBER: 02-46918
THIS PAGE IS A PART OF THB INSTRtDIEll'l'
Edward P.Romaine
County Clerk, Suffolk County
t'.
Number oC pages
TORRENS
RE<;ORDED
2003 Jul 1508:09.4<) RM
~rd P.Raoaine
tlERf( OF
5I.JFFIl.K COUNTY
L 000012261
P 021
DTI 02-46918
Serial 41
CeniflcalC /I
Prior Clf. /I
Deed . Mortgage InslrUmenl
Deed I Mortgage Thx SlWIIp
Recording I Filing Slamps
3
FEES
Handling
5. JIlL
Mortgage Ami.
I. BlISic:Tax
2. Additionol Tax
Sub TOlal
Spec:. I Assil.
or
Page I Filing Fee
TP-584
Notation
Comm. oC Ed.
5. ..!l!L
Spec:. I Add.
TOT. MTG TAX
Dual Town _ Dual Counly _
Held for Appointment_
Transfer Thx ('I CfI . =-
Mansion Tnx
EA-5217 (County)
Sub TOlDI
EA-5217 (Slate)
R.P.T.S.A.
3,
Grand 10tal
-
The property covered by Ihis motgage is
or will be . proved by a one or IWO
family dwel ng only.
YES or NO
If NO. see .. priate WI clause on
page /I of this inSltUmenL
'1- -0.3
Affidavit
Cenified Copy
Reg. Copy
Olher
Sub 10Ial
4 D~OOP
_strict
J.13..00
Secuon
06.00
Block
002.000
Lot
5
Real
Propcny
Till< Service
Agency
Verification
1000 11300 0600 002000
Consideration Amount
CPF Thx Due $ < \1'1D.
Improved
Vacanl Land ~
6
SalisfaclionlDisc:hargcslReJease Lisl Properly Owners Mailing Address
RECORD & RETURN TO:
TO
In
.
TO
JOSEPH HcHEFFF.Y. ESQ.
5 Crosby St.
Center ~oriches. NY 11934
TO
7
TItle Company InIonnallon
Co. Name FIDELITY NATIONAL TIT
lille II 47794
8
Suffolk County Recordin
This page Corms part of the atlIIChed
DEED
& Endorsement Page
made by:
. (SPECIFY TYPE OF INSTRUMENT)
KAREN PETI'ERSEN ~ -m J 9f.. ""........ The premisis herein is siluated in
.
AND THOR B. PE'l"IERSEN ou "l'b , '/ ~ SUFFOLK COUNTY. NEW YORK.
. , . SOUTHOLD
c:::. TO In the Township of
THEODORE HARTZ \Tit..
I In the VILLAGE
or HAMLEToC triA T"T,T"uc:....J<...
BOXES 6 TIlROUGH 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING
1_...._\
.
rLC"':>t:. I Yt"t: UN t-'Ht:~~ t-IHIVILY WHI::N WHlllNli UN /-UHM
INSTRUCTIONS: htlp:11 www.orps.state.ny.us or PHONE (518) 473-7222
FOR COUNTY USE ONLY
Ct. SWIS Code
REAL PROPERTY TRANSFER REPORT
c~. r:7 "7 .., t9 q
I ( t. I ) ,''' 1(5 // I
71 /SiQ?1
Month Day Year
.""j"
I
"
RI'_Sll7 Rev 3fn
C2. Date Deed Recorded
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
C3. Book 1 /1::2 1;:'1 ('.... I j I C4. Page I
PROPERTY INFORMATION
IOI~ll
.
,. r=:i:1 970
STREET NUM6~1l
Southo1d
crrvOR TO'NN
2. Buy.r Hartz
Name lAST NAME I COMPANY
lAST NAME f COMPANY
Jackson's Landing
smEETNAME
Mattituck
11952
VILLAGE
ZIP CODE
Theodore
FIIlSTNAME
FIASTNAME
3. Tal( Indicate where future Tax Bills are to be sent
Billing if other than buyer address (at bottom of form)
Address
'"/h..eod.o-.. C
FIRST NAME
~
/)'lA-I" T'l....
LAST NAME I COMPANY
STAElN~~NOS:;?~..s~
.4....,
IH.thvcrth 'J1JL-
CITY OA TOWN
I'~~I
"'ATI
tl'l"'ll
ZIP CODE
4. Indicate the number of Assessment
Roll parcels transferred on the deed
LJ
D
D
D
(Only if Part of a Parcell Check as they epply:
4A. Planning Board with Subdivision Authority Exists
48. Subdivision Approval was Required for Trarlsfer
4C. Parcel Approved for SubdIvision with Map Provided
OR D
Part of a Parcel
# of Parcels
5. Deed
Property
Size
lOR 1
.ACRES'
.S.~I
1 X 1
F"O~FEET
DEPTH
6. Seller
Name
Pettersen
L.ASTNAME/COMP.ANY
Karen
FIRST NAME
Pettersen
Thor B.
LASTNAME/COMPA/IlV
FIASTNAME
7. Check the box below which most llccurately das<<ib.. the use of the property at the time of sale:
Check the boxes below IS they apply:
8. OWnership Type is Condominium
9. New Construction on Vacant Land
D
D
D
D
A~ One Family Residential
B 2m3 FlImilyRE!sidential
C Residential Vacantl..and
o Non-ResidE!ntial Vacant I..and
E ~ """""'" I ~
F Commercial J
G Apartment K
H Entertainment! Amusement L
lOA. Property Located within an Agricultural District
108. Buyer received a disclosure notice indicating
thatlhe property is inan Agricultural District
Community Service
Industrial
Public Service
Forest
SALE INFORMATION
15. Check one or more of then conditions as appliclble to transfer:
Sale Belween Relatives or Former Relatives
, 1. Sale Contract Date
12
Month
24
A
B
C
D
E
F
G
H
I
J
0"'
102
y~,
1
Do,
SlIle Between Related Companies or Partners in Business
One of the Buyers is also a Seller
Buyer or Seller is Government Agency or Lending Institution
Deed Type not Warranty or Bargain and SalE! lSpecify Below)
Sale of Fractional or Less than Fee lowrest [Specify Below}
Significant Change in Property Belween Taxable Status and Sale Dates
Sale of Business Is Included in Sale Price
12. Date of Sail I Transfer
'Z
1-. 1
011111
03
Year
/
'"''
1
1 5 0 0 0 0
, , , ,0, 0 1
, , .
(Full Sale Price is the total amount paid for the property including personal proPllrty.
This payment may be in the form of cash. other property or goods. or the assumption of
mortgages or other obllgatlons.l Please round to the neerest whO~ amount
14. Indicate t~e value ~ personlll 1 I 1 ~ I 0 . 0 I
property Includud In thll alia, , .
I ASSESSMENT INFORMATION. Data should reflect the latest Final Assessment Roll and Tax Bill I
13. Full Sale Price
Other Unususl Factors Affecting Sale Price (Specify Below)
16. Year of Assessment Roll from I Oil,. 0.31 17. Total Alsassed Villue (of all parcels in transfer) I
1.::::~~::::"on~;n L I-LJ 19S'hooIDloulotNam.1 IM1T1TTJc:j( hot'
I
20. Tax. Map Identifiar(a) I Rollldentiliel'(8) (If more than four, ettach sheet with additional identifier(sll
C. 001
1000-113.00-06.00-002.000
CERTrFICA nON
I certify tJuIt all or the item."l of infonnalion entered on Ibis form are true and. l1",rrect (to the best of my knowledge ami belleO and I understand Uud the making
of any willful false statement of material fact hemn win subject me 10 the provisions of the oenallaw rclative 10 the making aud filing of "alsc instrumen1s.
BUYER'S ATTORNEY
o
::ro~"
FIRSTNAM~
/J1 c.1k. r .I>e.,
lAST NAME r
eUVER SIGNATU"'~
9~
snl~f;TNUMIlER
~........~ L91
STFtE~TNAMflAFTEFtSALfl
,
fo:J I
~7J"- /373
AFlEACOOE
TELEP'HONENUMBER
~-7><......I:..
CITV OA TOWN
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~ SELLER
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/I. :s-a-
ZlPCODE
NEW YORK STATE
COPY