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PLEASE TYPE OR PRESS FIRMLY-WHEN WRITING ON FORM _
INSTRUCTIONS: http:// www.orps.state.ny.us or PHONE (518) 473-7222
FOR COUNTY USE ONLY
~`~q ~ q' REAL PROPERTY TRANSFER REPORT
cf. swls coda I ~ ~~.31;3 I.rS I ~ I
STATE OF NEW YORK
~. BWrdBd x ~ STATE BOARD OF REAL PROPERTY SERVICES
.~---~"''°~'R _ ntn Day year RP - 5217
~.,,~~ -
-~~° k i. I~ I ~, of <~ I ~.. Pa9a I I I c I ~I s71
wsm v... Rnrr
1. Property I 602 I lteydon Drive I
LOCat100 STREET NUMBER STREET NAME
I sDUthola I Southold I 119711
z. Boyar DeFriest I Panels J.
Name WST NAME/COMPANY FIRST NAME
3. Tax Indicate where future Tax Bills a~ to pe ser~ ", r ''
Billing. if other than buyer addiess hn ortt of for I •Y '•` ,' i ,I
Addre55 LAST N ME / COMPA Y FIRST NAMe,'
STflEET NUMBER ANO STREET NAME CITY OR TOWN STgTE 21P CODE
4. Indicate the number of Assessment ^ (Only'd Part of a Parcel) Check as they appy:
Roll pamels transferred on the deed Q O 1 # of Parcels OR Part of a Parcel
aA. Planning BOerd with Subdivision Authority Exists ^
5. Deed I8. Subdivision Approval was Required for Transfer ^
Property I X OR I 1 • 1.7 /C. Parcel Approved for Subdivision with Map Provided ^
$Re FRONT FEET DEPTH ACRES
,.
S..Sener I DeFriest I D avid E. I
'~~~., L45T NAME I COMPANY
I FIRST NAME
I
LAST NAME/COMPANY FIRST NAME
7. Check the boz below which most accurately describes the use of the property at the time of sale: Check the boxes bebw as they apply:
8. Ownership Type is Condominium ^
~~ A ~.' One Family Residential E Agricultural I Community Service S. New Construction on Vacant Land ^
$ 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 108. Buyer received a disclosure notice indicating ^
D Non-Residential Vacant Land H Entertainment /Amusement L Forest that the property is inan Agricultural District
SALE INFORMATION 15. Che ck one or more of these conditions ~ applicable to transfer.
11. Sale Comract Date ~~~ I / / I A Sale Between Relatives or Former Relatives
Month Day year $ Sale etween.Re
9 fated meanies or Partners in Business
- ~ ' ' C One of'the $uyers is al o a'Seller'
12. Date of Sale /Transfer I OS / ' S / O2 D Buyer or Seller is Government Agency or Lending Institution
Month Dey year $ Deed Type not Warranty or Bargain and Sale (Specify Belowl
F Sale of Fractional or Less than Fee Interest (Spaciry Belowl
G Significant Change in Properly Between Taxable Status and Sale Dates
13. Full Sale Price O ~ 0 0 I H Sale of Business is Included in Sale Price
7
(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 be in the form of cash, other property or goods, or the assumption of J None
mortgages or other obligations.) Please round to the nearest whole dollar amount.
D ilrerce Settlement
14. Indicate the value of personal O , 0 0 - '
A.• _
. . ... ..
1a. ~palkMA eameM Roll from 0~ /a 1j Tot61 Assessed Value lot ell pamNa in transfarl l t 7 O , O , O I
-which Information taken ~ ~ ~
- 1a. Property sass 12 , 1 , 0 I-U 19. School District Name I Southold 1
20. 7az Map IdentNerlal /Roll Identi8erlsl Ia more then four, attach sheet with additlonal idemf8erls1) 1 / ~ L~ 1 • I ~,
I 1000-079.00-05.00-014.006 I I I J I
- ~ -
I certVy that all of the items of information entered an this form are true and correct (to the best of my knowledge and be8ef) and I mlderstand that the making
of any willful false statement of material fact herein will subjeM me to the provisions of the cenal law relative to the making and filing of false instruments.
.r
BUYER I BUYER'S ATTORNEY
_~~ ~
`E YER SIGNATURE \ DATE
Pamel J. DeFriest '
'~` `R'702.. Reydon Drive
\~, STREET NUMSER EET NAME IAFIER SALE(
SouthoYtl~~=.~„_ ~ NYY ii971
..< I
CITY OR TOWN STATE ZIP COOE
SELLER
w
Foster & Vacldeluwryh~ LLP
LAST NAME FIRST ryAME ~ -
63i I 288-5550 _
AREA COOS TELEPHONE NUMBER
Davs€t4ERE:NAD'@EFr ie s t DATE
CTI'Y/TOWN ASSESSOR
COPY
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