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QUITCLAIM DEED (INDIVIDUAL OR CORPORATION)
STANDARD NYBTU FORM 8009
CA,mo~: TillS Ac.;:RF.F.~F~"T $HOlll.o at: PIU:PARKD BY A.N ATI'OIINEY A..~D REVIEWED BY ATrORNEYS f'ORsa....&Il AND
I'URCllASER BEFORE SlClIrI"lNG.
~ THIS INDENTURE. made IIH: ::l L\- day of November in the Year Two ThOllSlllld Three,
W1betweal R"'P"'l.D"'HnIi/~.........~~.i''''~~~ll~''I''~ .AJ~ Inh-
puny of the first part. and A
A. if-
J"cq"""_ frI,u d" J_,,"""e l.DlIIIMrtll, 'IHI.Ye_ OriN, Stlllllu1ItI N"", y",* 11971
party of IIH: """ond part.
WlTNESSETlI. lhat!he party of the first part. in c:cmsidcrariOD of one dollar. lawful money of the
United StaleS, paid by \he party of the second part, doc8 ~by remile, reJcuc: and quilClaim Wlto the party of
!he second part. the heirs or SUCCCllllOrlI ond assigns of the party ofthc second part forever,
ALL hi. undivided one-half intcn:at in that lot or parcel of land, with \he buildinp ond i......onmcnts
tben:on, situate. lying and beilla in the, Town ofSouthold, County ofSutfo1k ond Stste of New Yorlc, known and
designated as LoIl/48, as shown OD a c:ertain map entilled "Map ofYennccott Park", filed in the Suffolk COWlty
Clerk's Office on Oclober 9. 1968 as Map No. Sl87 Slid lot being more particularly bounded and cleacribed as
follows:
BEGINNING nl the comer formed by the intencction oft"" Soulhc:rly side ofYennecDtt Drive with the
Westerly side of Tulhill Rond; RUNNrNG THENCE alema: the Westerly aide of Tulhill Road, South \ degrees
34 minutes 20 seconds West. \ S6.48 feet to land now or fonnerly of Mofla!; THENCE along said land South 88
degrees S7 minutes 30 """ODds West 138.46 feet; TllENCB North I dearee 4\ minutes 30 secooda.East. 163.07
fee' \U lhe SoulhLTly side of Yennecoll on",,; THENCE along the Southerly side ofYennecoll on"" South 88
degrcc:s 18 minules 30 sceonds East 137.98 feet to the point or place of lIBGINNlNG.
BEING AND INTENDED to he the SIlII1t! premises conwyed by deed dated September 29, I99S. to
Ralph Lombardi nnd Jnequeline Lombardi. hi. wife and duly n:cordc:d in the Suffolk County Clerk's office on
October 6. 1995 in Libcr 11744 cpo 864.
S.4lD PREMISb.'S ARE KNOWN AS: 900 Ycnnecolt on"", Southold New York. SCTM No. 10000SS-
6-7.
TOGBTHER with an right, ritle and interest, ifany, of the party of the first part in and to any streets and
roads abutting the above described premiSL'S to the ccoler lines thereof:
TOGETllER with lhe appurtenances and an the estate and rigbts of the party of the fint part in and to
said prmUses.
TO HA VE AND TO HOLD the premises herein ......ted WIlD the party of the secODd part. the heirs or
successors and assigns of the party oflhe second part f"revcr.
:'Il1'YSRA PRACTICE FORMS JJ9S
-..
,
.L. -.
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A.ND the party of the first part, in compliance: with Section 13 of the Lien Law, covcnanu that the puty
of the fust part will receive the consideration for rhis conYCyU1Ce and will hold the riaht to receive 511Ch
consideration as a lTuIt fimd 10 be applied firs! for rhe purpose of paying rhe costa of lhc improvement and will
apply the same fi...tto the payment of the cost oflhe improvemenl before usin. any pari oflbe IOml oflhe IIIUDC
for any olher PIU'JIO&C.
The word "J1Ilrly" shall be construed as if il read "pulies" whenever the sense of rhis indenture so
requires.
IN WITNESS WHEREOF. the puty of the first pari has duly exccuted rhis deed lhc day and year first
above written.
IN PRESENCE OF:
A.CKNOWLEDGMENT
STATE OF NEW YORK )
) BB.:
COUNTY OF SUFFOLK)
On !he ':ll$ day of November in lhe year 2003 before me, rhe undersigned. personally appeared R.."
I_HnII~n.IlY known to me or proved to me on the basis of satiBfactorY evidence: to be lhc individual
whose name iB subscribed to the wirhin instrument and acknowledged to me WI he executed lhc same in his
capacity, and Wt by hiB Bignature on the instrument, the individual, or the person upon behalf of which lhc
individual DCted. C'xecuted the instrument.
"-~
REN7.G1
-2_
AR1KR J. GIORGN
NcICIY Pl.EiIC - SIaI8 oINl1W'ltn
No. OlGl 14423llll
MtCu~=~\'~
NVSIIA PRACTICI!: FOIlMS JIM
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l.!. 2
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.
SerialU
REalRDfD
2004 Jan 06 08'09,06 AM
Edw.af"d P. RolDai ne
ClERK (oF
SUFFOLK COUNT\'
L DOOO1~
PQ~
Dr. 03-23425
NumberOfpal&c:s0
TORRENS
Certificate 1#
Prior Of, #
Deed I Murtpac InslrUment
Deed ~ Mortpgc Tax Stamp
FEES
Recordinl/l'i1inll Stamps
4
Page: / Pilin. Fcc::
Monaaar AmI.
I. Basic: Tax
nandling
TP-514
2. Additional Tax
Notation
Sub Tolel
!!A-52 17 (Coonl)"
Sub Total
GRAND TOTAL
IdA.
S"edAssiL
0,
Spec. IAdd.
TOT, MTG. TAX
Dual Town_Dual Cnunty_
IlekJ air AppC'Inionment _
Transfer Tax -e-
Mansion Tu.
The propeny c:ovtftd by this mortglg&: is or
will be inlproved by 8 une ar two ranlil)"
dwelling only.
'. YI;S orNO_
If NO. Ice aprropriate laX clause: un page"
_oflhb in.ldnImenL
EA.S217 (Statc)
R.I':I:SA
ba-
Camm. of Ed.
5 <llL-
Affidavit
Certified <:opy
Reg. Copy
Other
Sub ToIal
R<:al Property Tax Service AaencY Verification
Ilist. Section B loc:k
Lot
6 Communit J:trcscrvation Fund
CCJnRidera.tion Anlounl S. -9-
Slamp 04000522 1000 05500 0600 007000
~. '~=~ :.
Inilu""
7 Salistilctio.nSIDisCfiarseSlKeleases-~IS' rlupcllY \;'WII"'la I...........o..dd
RF.CORD. RETURN TO:
<.....PF Tax Due
$ --'? -
Impro.ed .....-
Vacanl Land
Clare~~l & Dempsey
737 Roanoke Avenue
Riverhead. New York 11901
TO /0
'I'D
TO
8 Title Company Information
Co. Name
1'itl,,/I
at- a.__....oI,..Jlft 1'J14..,-=- Tns..._Cc.....
9
Suffolk Count Reconlin & Endorsement Pa e
01 his pogc rOmlS pan of the ullachcd
I
-..;
_ . __ IIIAlIc by:
(SPECIFY TYPE 01' INSmUMENT)
Ra~ph Lombardl.:J"CL-
TO
'Ihe premises herein is situ....'t1 in
SUI'I'OI.K COUNIY. NEW YORK.
In thcTO\\nshipor <;.'" lot $C11 J
In the VILLAGE
or HAMI.ET of So .. 11+" I d.
.T'U''!(;l'ulill 4 nt=! Field aka
~.B~Q.~iR. ~~.~Q~
III 'XES 5 THRU 9 MU!>". BE TYPED OR PRINTED IN BlACK INK ONLY PRIOR TO RECORDING OR FILING.
(OVERI
IIIIIIIIIIIIII~IIII~ IIIIIIIIIIIIIIIIIIIIII~IIIIIIIII
1111111111111111111111111
SUFFOLK COUNTY CLBlUt
RECORDS ORICE
RECORDING PAGE
Type o~ Instrument: DEEDS/DDD
Number of Pages: 3
~SI'ER TAX NUMBER: 03-23425
Recorded:
At:
LIBER:
PAGE:
01/08/2004
08:011:06 AM
D00012294
033"
BALl'B LQMBlUU)I
JACQUELINE A FIELD
District:
1000
Deed Jlmoun t:
Section: Block:
055.00 06.00
UAMIHED AND CBARGED AS FOLLOWS
$0.00
Lot:
007.000
Received the Followinq Fees For Above InstZ'UllUlnt
ElUIIIIpt
NO
NO
NO
NO
NO
NO
Paqe/I'ilin;
COE
BA-CTY
TP-584
RPT
Transfer tax
$11.00
$5.00
$5.00
$5.00
$30.00
$0.00
Handling
NtS SRCHG
lA-STATE
C8rt . Copies
SC'l'M
COIIIIIII. Pres
I'_s Paid
$5.00
$15.00
$50.00
$0.00
$0.00
$0.00
$124.00
Exempt
NO
NO
NO
NO
NO
NO
TRAHSI'BR TAX HUMBER: 03-23425
THIS PASB IS A PART OF THE IHS'l'RUHBHT
THIS IS NOT A BILL
Edward P.Ralllaine
County Clerk, Suffolk County
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (5181 473-7222
FOR COUNTY USE ONLY
11,7,.3,&, '&/11
C2. Date Deed Recorded l I / f? I tJ L( I
ror/h Dey Yesr
C3. Book I j, "?'dl , 1 , II C4. Page I tI ,--7, -:2,
REAL PROPERTY TRANSFER REPORT
C1. SWIS Code
....
I' I
.... .:. ...
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RI'.~217 II.~,. .V'J7
PROPERTY INFORMATION
1. r::I~~ I
900
Yennecott Drive
smHT"UMBE~
STIlEETNAME
L...fu1uthold
CINORrowN
111971
ZIPCQOE
ViLlAGE
2. Buyer
Name
Field
LAST NAME ICOMPANV
Jacqueline
F1IlSTNAME
lAST NAME I COMPANY
FIRST NAME
3. Tax
Billing
Address
Indicate where future Tax Bills lire 10 be sent
jf other than bl.lyer address lat bottomofiormJ
FIRST NAME
______.J
lASTNAMEICOMPMIV
STREET"UMOCRANOSlHHTi'lAME
Zlrco[)[
crTY OR TOWN
/ I # of Parcels OR D
STATE
IOnly if Part of a Parcell Check as they ilpply:
4A.Planning Board with SUbdivision Authorily Exists
48. SutJdivision Approval was ReqUIred for Transfer
4C. PlIrcel Approved for Subdivision with Map Provided
4. Indicate the number of Assessment
Roll parcels transferre-d on the deed
L
PlIrtofllPlIrcel
D
D
D
5. Deed I X I
Property
Size FRO"TFEH OEf'TH
.. SaUer T'l?I1\h~~i "Sit
Name LA AMEI PANV
. -S II
lOR I
ACRES
R'i}sP~Me
LAST NAME ICOMPANY
~IMrNAME
7. Check the boliC below which most aocurately describes the use of the property atthe time 01 sale:
Ch..:k the boxes below as thlY apply:
8. Ownership Type is Condominium
9, New Construction on Vacant Land
lOA. Property Locatl!d within an Agricultural District
108. Buyer receivl!d a disclosure notice indicating
lhatthe property is in an Agricultural District
D
D
D
D
A~DneFamilYReSidential
13 2or3FamilyResidentiei
C ReSiderltial Vacant Land
o Non-Resident'al Vacant Land
E~A"""'''''' I~
F Commercial J
G Apartment K
H EOlertainment/ Amusement L
Community Service
Industrial
PubiicService
Forest
SALE INFORMATION
15. Ckeck one or more at thll$O conditions ilS ilPplic:able to tf'llns~r:
11. Sala Contract Data
~ ('">"Ie. ( q~ I
Montll Day Yaar
Sale Between Related Companies or Partnars in Business
One a/the Buyers is also a Seller
Buyer or Seller is Government Agency or Lending Institution
Deed Type not Warranty or BargalO and Sale (Specify Below)
Sale of Fractional or Less than Fee Interest (Specify Below)
Significant Change in Property Between Ta><1lble Status ;md Sale Dates
Sale 01 Business is Included in Sale Prioo
Other Unusu(ll Factors Affecting Sale Price (Specify 6elowl
None
e~.+hR>~ th,>~ ~....b..., Lt.
"'t>
A
B
C
o
E
F
lJ
H
T
J
Sale Between Relatives or Former Relatives
12. Date ot Sale I TrBllsfer
II
")..'i( O~I
Ye"r
Month
0.,
. O. 0.0,0 I
, , a
(Full Sale Price is the tOlal amount paid forthl! property including personal property.
This payment may be in thc form of cash. other property or goods. or the i1ssumpticn of
mortgalles or other obligationsJ Ple6se round to the nearest whole dollaf IImount.
13. Full Sale Price
14.lndieatethevalue olplrsonal I
property inCluded in the sale
, 0 0 I
, , a
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill
16, Year of Ann.mant Roll from I _ 2. I
which information taken ~
I;) ( OI_LJ
la ~O q
,
17, Total Assessed Value {of all parcels in transfer' I
"irs-
5",J-h,\<:\
18. PropertyClu$
19_ SchoOl District Name I
20. Tax Map idantifierlsll Roll Identifier!s) (H more than four, attach sheet with additional identifier{s))
IOOD
55-,f,-1
CERTIFICATION
I certify that IIlI of the items of infonnation entered on this lurm lire true and correcl (10 the best or my knowledge and belicl) and I undcl"Ntund that the making
of any willful faLw statement of material fllct ht!n:in \\-iU subject me 10 the uroviorions of the uenallaw relative to the making Mnd filing of false instnuncnlli.
BUYER
BUYER'S ATTORNEY
~j~t::7~b'
SIG URr::
~VO_L_~-J.'J"i!.077
STREHNAME'AHEASAI.E)
~""f'6F'"
LAST NAME
,
~;;e,c, 4-
I, II j;, .,-j"
OArEI I
1\2
FIRST NAME
STREOTNUM8E:R
~
~J;"""'O(,
AREA CODE
TEI./iPHONE N\!M~EA
NY;
STATl'
/;97/
ZIPCOOE
'>
ClTV OR TOI/IIN
I i(Ji#/
SelLER
NEW YORK STATE
COpy
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