HomeMy WebLinkAboutL 11998 P 746 WC83 Standard N.Y.B.T.U.Form 8007 —Warranty Deed With Full Covenants—Individual or Corporation(Tingle sheet)
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT—THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY.
e
T'`
THIS INDENTURE, made the day of . May nineteen hundred and ninety-nine
BETWEEN J ' Y
`f JOSEPH T. MACARI, residing at 121 Malba Drive, Malba, New York as to an
ft) undivided one-half interest and NISSIM ALHADEFF, residing at 181-35 Midland
Parkway, Jamaica Estates, New York, as to the remaining undivided one-half
interest —
party of the first part, and
JOSEPH T. MACARI, residing at 121 Malba Drive, Malba, New York
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 hereby grant and release unto the party of the second part, the heirs
or successors and assigns of the party of the second part forever,
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate,
lying and being in the
LEGAL DESCRIPTION ATTACHED HERETO AND MADE A PART HEREOF
s
TOGETHER with all right, title and interest, if any, of 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 211 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 part, the heirs or successors and assigns of
the party of the second part forever.
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 consid-
eration 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 othertputpose.
AND the party of the first part covenants as follows: that said party of the first part is seized of the said
premises in fee simple, and has good right to convey the same; that the party of the second part shall quietly
enjoy the said 'premises; that the said premises are free from incumbrances, except as aforesaid; that the
party of the first part will execute or procure any further necessary assurance of the title to said premises; and
that said party of the first part will forever warrant the title to said premises.'
The word "party' shall be construed as if it read "parties" whenever the sense of this indenture so requires.
IN WTINESS WHEREOF, the party of the first part has duly executed this deed the day and year first above
written.
IN,+RFSBNCE OF:
j t
J T
NISSIM ALHADEFF
i
FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
Title No. FNT9922707
SCHEDULE A
AMENDED 10/22/99
PARCEL I:
AI.L that certain plot, piece or parcel of land, with the buildings and
improvements thereon erected, situate, lying and being at Mattituck, in the Town
of Southold, County of Suffolk and State of New York, being bounded and
described as follows:
BEGINNING at a point on the southerly side of Sound Avenue which marks the
division line between lands now or formeily of Peconic Homes Corp. and the
westerly boundary of lands described herein;'
RUNNING THENCE South 72 degrees 49 minutes 20 seconds East 22.40 feet to
lands now or formerly of Edward J. Woessner and Genevieve Woessner;
THENCE along said lands of Woessner the following three courses and distances:
1. South 10 degrees 22 minutes 00 seconds East 150.00 feet;
2. South 81 degrees 30 minutes 40 seconds East 120.00 feet;
3. North 10 degrees 22 minutes 00 seconds West 150.00 feet to the southerly side
of Sound Avenue;
THENCE along the southerly side of Sound Avenue:
1. South 81 degrees 30 minutes 40 seconds East 160.85 feet;
2. South 86 degrees 05 minutes 40 seconds East 203.36 feet;
3. North 75 degrees 24 minutes 20 seconds East 58.24 feet to lands now or
formerly of Janet Jazombeck and others;
THENCE along said lands of Janet Jazombek and others:
1. South 14 degrees 35 minutes 40 seconds East 200.00 feet;
2. North 75 degrees 24 minutes 20 seconds East 108.96 feet;
3. North 14 degrees 35 minutes 40 seconds West 200.00 feet to the southerly side
- continued on next page -
FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
Title No. FNT9922707
SCHEDULE A (continued)
of Sound Avenue;
THENCE along the southerly side of Sound Avenue:
1. North 75 degrees 24 minutes 20 seconds East 109.35 feet;
2. North 71 degrees 47 minutes 10 seconds East 53.08 feet to lands now or
formerly of Genevive A. Woessner, Constance M. King and Barbara C. Boner;
THENCE along said lands of Woessner, King and Boner:
1. South 19 degrees 38 minutes 00 seconds East 203.61 feet;
2. North 64 degrees 54 minutes 00 seconds East 117.92 feet to lands now or
formerly of Peter Sabat, Cynthia M. Schneider and Mark P. Sabat;
THENCE along said lands of Sabat, Schneider and Sabat:
1. South 21 degrees 52 minutes 00 seconds East 103.47 feet;
2. North 67 degrees 09 minutes 00 seconds East 252.29 feet to lands now or
formerly of Barbara B. Sayre;
THENCE along said lands now or formerly of Barbara B. Sayre:
1. South 26 degrees 57 minutes 20 seconds East 353.61 feet;
2. North 63 degrees 02 minutes 40 seconds East 200.00 feet to lands now or
formerly of AABR Realty Facilities Holding Corp.;
THENCE along said lands of AABR Realty Facilities Holding Corp.:
1. South 26 degrees 57 minutes 20 seconds East 84.08 feet;
2. South 24 degrees 01 minutes 50 seconds East 496.97 feet to lands now or
formerly of Barbara Ann Kujawski and William W. Rusch;
THENCE along said lands of Kujawski and Rustin South 20 degrees 53 minutes 50
seconds East 740.80 feet to lands now or formerly of Barbara Kujawski;
THENCE along said lands now or formerly of Barbara Kujawski South 23 degrees
00 minutes 00 seconds East 115.50 feet;
- continued on next page -
FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
Title No. FNT9922707
SCHEDULE A (continued)
THENCE still along said lands of Barbara Kujawski and later along said lands
now or formerly of Marilyn and Walter 'Gatz South 01 degrees 15 minutes 00
seconds West 311 feet;
THENCE through lands now or formerly of Macari:
1. Thence North 88 degrees 45 minutes 00 seconds West 50.00 feet;
2. Thence North 01 degrees 15 minutes 00 seconds East 300.26 feet;
3. Thence North 23 degrees 00 minutes 00,seconds West 105.68 feet;
4. Thence North 20 degrees 53 minutes 50;seconds West 740.35 feet;
5. Thence North 24 degrees 01 minutes 50 seconds West 494.33 feet;
6. Thence North 26 degrees 57 minutes 20 seconds West 32.80 feet;
7. Thence South 63 degrees 02 minutes 40 seconds West 217.48 feet;
8. Thence South 20 degrees 08 minutes 09 seconds East 682.86 feet;
9. Thence North 70 degrees 23 minutes 40 seconds East 205.87 feet;
10. Thence South 20 degrees 53 minutes 50 seconds East 557.08 feet;
11. Thence South 23 degrees 00 minutes 00 seconds East 95.85 feet;
12. Thence South 01 degrees 15 minutes 00 seconds West 193.31 feet;
13. Thence South 28 degrees 38 minutes 00 seconds West 147.91 feet;
14. Thence still southerly along an arc of curve which bears to the left having a
radius of 200.00 feet an arc of 101.27 feet;
15. Thence South 00 degrees 22 minutes 40 seconds East 236.57 feet;
16. Thence Southwesterly along an arc of curve which bears to the right having a
radius of 61.23 feet and an arc of 97.46 feet;
17. Thence North 89 degrees 10 minutes 20 seconds West 130.51 feet to lands now
or fomerly of Anschutz;
i
continued on next page -
i
FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
Title No. FNT9922707
SCHEDULE A (continued)
THENCE North 64 degrees 41 minutes 20 seconds West 55.28 feet to land now or
formerly of Thomas Gorman;
THENCE North 35 degrees 33 minutes 20 seconds West 55.13 feet to lands now or
formerly of Namrog Holding Corp.;
THENCE along said lands North 13 degrees 54 minutes 20 seconds West 72.03 feet
to lands now or formerly of Donald Shapiro;
THENCE North 00 degrees 25 minutes 10'seconds East along said lands now or
formerly of Shapiro 101.67 feet to lands;nbw or formerly of Bradley J. Belz and
Janet B. Belz;
THENCE along said lands now or formerly of Bradley J. Belz and Janet B. Belz:
1. North 04 degrees 58 minutes 20 seconds East 78.09 feet;
1. Along an arc of curve which bears to the left having a radius of 165.75 feet an
arc of 159.72 feet to lands now or formerly of Marion E. Smith Family Trust;
THENCE along said lands now or formerly of Marion E. Smith Family Trust:
1. North 50 degrees 14 minutes 20 seconds West 72.00 feet;
2. North 57 degrees 53 minutes 20 seconds West 65.00 feet to lands now or
formerly of Donald Rosen;
THENCE North 65 degrees 53 minutes 20 seconds West along said lands 210.00
feet to lands now or formerly of Marjorie Schalkham;
THENCE North 57 degrees 08 minutes 50 seconds West along said lands 166.00
feet to land now or formerly of Joseph and Patricia Maida;
THENCE along said lands now or formerly of Maida North 60 degrees 08 minutes
50 seconds West 60.00 feet to lands now or formerly of Steven Brautigam;
THENCE along said lands now or formerly of Steven Brautigam:
1. North 79 degrees 27 minutes 10 seconds West 90.00 feet;
2. South 88 degrees 34 minutes 30 seconds West 100.00 feet to lands now or
formerly of Stanley Weisz P.C. Retirement Plan;
- continued on next page -
i
FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
Title No. FNT9922707
SCHEDULE A (continued)
THENCE along said lands now or formerly of Stanley Weisz P.C. Retirement
Plan:
1. South 16 degrees 13 minutes 10 seconds East 23.00 feet;
2. South 73 degrees 46 minutes 50 seconds West 75.00 feet;
3. North 16 degrees 13 minutes 10 seconds West 43.34 feet;
THENCE North 41 degrees 23 minutes 40 seconds East 455.22 feet;
THENCE South 70 degrees 23 minutes 40 seconds West 826.27 feet to the westerly
side of lands now or formerly of Peconic Homes Corp.;
THENCE Northerly along the easterly side of lands now or formerly of Peconic
Hames Corp.;
1. North 09 degrees 09 minutes 40 seconds East 50.00 feet;
2. North 13 degrees 02 minutes 20 seconds West 285.00 feet;
3. North 30 degrees 04 minutes 00 seconds West 61.00 feet;
4. North 22 degrees 04 minutes 00 seconds West 232.49 feet;
5. North 14 degrees 59 minutes 00 seconds West 265.00 feet;
6. North 10 degrees 20 minutes 30 seconds West 741.14 feet to the southerly side
of Sound Avenue, the point or place of BEGINNING.
TOGETHER with benefits and subject to the burdens of a right of way to and
from Sound Avenue over a 20 foot right of way known as Laurel Lake Drive and a
25 foot right of way known as Laurel Way, and a 25 foot right of way known as
Crescent Way.
EXCEPTING therefrom the following 2 parcels:
EXCEPTED PARCEL N1 OF 2 FROM PREMISES
BEING the lands now or formerly of The Joan Ryan Family Trust:
BEGINNING at the northeast corner of a,25 foot right of way known as Crescent
- continued on next page -
L
FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
Title No. FNT9922707
SCHEDULE A (continued)
Way and the southerly line of a 25 foot right of way known as Laurel Way;
RUNNING THENCE northeasterly on a curve which bears to the right having a
radius of 9.65 feet a distance of 22.42 feet;
THENCE along Laurel Way along an arc of a curve to the left having a radius of
11.2.0 feet a distance of 149.23 feet;
THENCE still along Laurel Way North 61 degrees 45 minutes 40 seconds East
76.00 feet;
I ,
THENCE Southeasterly along an arc of a cprve which bears to the right having a
radius of 8.54 feet a distance of 17.57 feet;
THENCE South 00 degrees 22 minutes 40 seconds East 267.33 feet to the
northerly side of Crescent Way;
THENCE Southwesterly along an arc of a curve which bears to the right having a
radius of 36.23 feet a distance of 57.67 feet;
THENCE along the northerly and easterly side of Crescent Way:
1. North 89 degrees 10 minutes 20 seconds West 125.09 feet;
2. North 64 degrees 41 minutes 20 seconds West 43.36 feet;
3. North 35 degrees 33 minutes 20 seconds West 43.85 feet;
4. North 13 degrees 54 minutes 20 seconds West 64.11 feet;
5. North 00 degrees 25 minutes 10 seconds East 97.53 feet;
6. North 04 degrees 58 minutes 20 seconds East 78.07 feet to the point or place of
BEGINNING.
EXCEPTED PARCEL N2 OF 2 BEING THE LANDS NOW OR FORMERLY OF
JUDITH A. GRECO:
BE at a monument set at a point of deflection in a 25 foot right of way
known as Laurel Way which said monument marks the southeast corner of said
lands now or formerly of Judith A. Greco;
RUNNING THENCE Northwesterly along said lands and along an arc of curve
- continued on next page -
_ r
FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
Title No. FNT9922707
SCHEDULE A (continued)
which bears to the left having a radius of 292.52 feet and an arc of 112.32 feet;
THENCE
1. North 50 degrees 14 minutes 20 seconds West 73.67 feet;
2. North 57 degrees 53 minutes 20 seconds West 68.42 feet;
3. North 65 degrees 53 minutes 20 seconds West 186.48 feet;
4. North 24 degrees 06 minutes 40 seconds'Edst 9.74 feet;
5. South 81 degrees 23 minutes 10 seconds East 375.33 feet;
6. South 05 degrees 39 minutes 10 seconds West 199.78 feet to the monument, the
point or place of BEGINNING.
PARCEL II:
ALL that certain plot, piece or parcel of land, situate, lying and being at
Mattituck, Town of Southold, County of Suffolk and State of New York, being
bounded and described as follows:
BEGINNING at a point on the southerly side of Crescent Way described in Parcel
I herein at the division line between lands to be conveyed to Suffolk County Water
Authority and premises described herein and;
RUNNING THENCE South 30 degrees 19 minutes 40 seconds West along the
division line between lands conveyed to Suffolk County Water Authority and
premises described herein 236.95 feet to the waters of Laurel Lake;
THENCE North 75 degrees 43 minutes 00 seconds West 26.01 feet along Laurel
Lake to lands now or formerly of Michael Ryan;
THENCE North 30 degrees 19 minutes 40 seconds East along said lands now or
formerly of Michael Ryan 230.00 feet to the southerly line of Crescent Way and
Parcel I herein;
THENCE North 89 degrees 10 minutes 20 seconds West along the southerly side of
Crescent Way 28.72 feet to the westerly side of lands to be conveyed to the Suffolk
County Water Authority, the point or place of BEGINNING.
(1000-121.00-04.00-part of 009.001)
- continued on next page -
i
FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
Title No. FNT9922707
SCHEDULE A (continued)
PARCEL III:
ALL that certain plot, piece or parcel of land, with the buildings and
improvements thereon erected, situate, lying and being at Mattituck, in the Town
of Southold, County of Suffolk and State of New York, being bounded and
described as follows:
BEGINNING at a point on the northerly side of Laurel Lake which marks the
division line between lands now or formerly of NOFO Associates and the easterly
line of lands now or formerly of Macari,,described herein;
RUNNING THENCE along the northerly,side of Laurel Lake:
1. North 32 degrees 27 minutes 10 seconds West 94.40 feet;
2. North 75 degrees 43 minutes 00 seconds West 31.04 feet;
THENCE North 30 degrees 19 minutes 40 seconds East 236.95 feet;
THENCE South 89 degrees 10 minutes 20 seconds East 1.79 feet;
THENCE Northerly along an arc of curve which bears to the left having a radius
of 61.23 feet a distance of 97.46 feet;
THENCE North 00 degrees 22 minutes 40 seconds West 236.57 feet;
THENCE Northeasterly along an are of curve which bears to the right having a
radius of 200.00 feet a distance of 101.27 feet;
THENCE North 28 degrees 38 minutes 00 seconds East 147.91 feet;
THENCE North 01 degrees 15 minutes 00 seconds East 193.31 feet;
THENCE North 23 degrees 00 minutes 00 seconds West 95.85 feet;
THENCE North 20 degrees 53 minutes 50 seconds West 557.08 feet;
THENCE South 70 degrees 23 minutes 40 seconds West 205.87 feet;
THENCE North 20 degrees 08 minutes G9 seconds West 682.86 feet;
THENCE North 63 degrees 02 minutes 40 seconds East 217.48 feet;
- continued on next page -
i
11998PC746
FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
Title No. FNT9922707
S C H E D U L E A (continued)
m
THENCE South 26 degrees 57 minutes 20 seconds East 32.80 feet;
THENCE South 24 degrees 01 minutes 50 seconds East 494.33 feet;
THENCE South 20 degrees 53 minutes 50 seconds East 740.35 feet;
THENCE South 23 degrees 00 minutes 00 seconds East 105.68 feet;
THENCE South 01 degrees 15 minutes 00 Seconds West 300.26 feet;
i
THENCE North 88 degrees 45 minutes 00'Seconds West 50.00 feet;
THENCE South 01 degrees 15 minutes 00 seconds West 388.60 feet to lands now
or formerly of SCWA;
THENCE South 48 degrees 52 minutes 50 seconds West 16.94 feet;
THENCE South 40 degrees 35 minutes 00 seconds West 420.00 feet to Laurel
Lake, the point or place of BEGINNING.
TOGETHER with benefits and subject to the burdens of a right of way to and
from Sound Avenue over a 20 foot right of way known as Laurel Lake Drive and a
25 feet right of way known as Laurel Way, and a 25 foot right of way known as
Crescent Way;
2ffEAE7
3 RECORDED
11998PC746 Nov IiNumber of pagesTORRENS 99P.Serial# OLEP.t, OF
AXFOC:OtIkYCertificate#
Prior Ctf.# 14518
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
4 1 FEES
Page/Filing Fee Mortgage Amt.
Handling _ Z I. Basic Tax
TP-584 J� 2.Additional Tax _
Notation Sub Total
EA-5217Coun s/
( tY.I Sub Total Spec./Assn.
EA-5217(State) Or
Spec../Add.
RP.T.S.A. pyCiS �/ TOT. MTG.TAX
ti �t Dual Town Dual
Comm.of Ed. 5 00 Held for Apportionment
Affidavit + �ti_., � Transfer Tax
�INOL�
Mansion Tax
Certified Co _ i" � ✓ � —
The property covered by this mortgage is or
Reg.Copy will be improved by a one or two family
Sub Total dwelling only.
Other YES or NO
GRAND TOTAL If NO, see appropriate tax clause on page #
of this instrument.
Real Property Tax Service Agency Verification' 6 Community Preservation Fund
counry Dist. Section B lock Lot Consideration Amount $,t}aal—cco—
S//tam" ll9d0 IO2 / . H e�f, (}Q Qp �0 CPFTax Due , $ —® —
)Ja1e�� IREC"IVI? proved
I
Inin s _ jaant Land 1/
7 Satisfactions/Discharges/Releases List Property Owners Mailing Addr s NOV 04 1997 D /D
RECORD&RETURN TO:
7k f ,
ID D
I
Z/04mac.
8 Title Company Information
I � �2 7
/'J�J Co. Name r
J Title #
Suffolk County Reccr, ing & Endorsement Page
This page forms part of the attached
made by:
(SPECIFY TYPE OF INSTRUMENT)
The premises herein is situated in
_ �T- �7- dAlt-t, SUFFOLK COUNTY,NEW YORK.
TO In the Township of `/�( 2(x�
7- 7� . In the VILLAGE
v ^ u
or HAMLET of
BOXES 5 THRU 9 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
PLEASE TYPE OR PRES T"IRMLY WHEN F�ITING ON FORM
INSTRUCTIONS: http://wArmorps.state.ny.us or PHONE (518) 473-7222
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
"P 17 Rev 39]
1.Property I Sound Avenue
Location STREET NUMBER STREET NAME
Southold I Mattituck I I
CITT'OR TOWN VILLAGE ➢P CODE
2.Buyer I MACARI I JOSEPH T.
Name LAST NAME/COMPANY FIRST NAME
I-AST NAME/COMPANY 1 FIRST NAME
3.Tax Indicate where future Tax Bills are to be sent I I
- Billing if other than buyer address(at bottom of form) I
Address LAST NAME I COMPANY FIRST NAME
L STREET NUMBER AND STREET NAME I CITY OR TOWN I STATE I ZIP CODE
4.Indicate the number of Assessment / ❑ (Only if Part of a Parcel)Check as they apply.
Roll parcels transferred on the deed #of Parcels OR Part of a Parcel 4A Planning Board with Subdivision Authority Exists ❑
.. S.Dead 4B.Subdivision Approval was Required for Transfer ❑
Property X I I OR I 4C.Parcel Approved for Subdivision with Map Provided ❑
Size FRONT FEET DEPTH ACRES
6.seller I MACARI JOSEPH T. 50% interest
Name ✓(-`'T NAME/COMPANY FIRST NAME
�AL.HADEFF I NISSIM 50% interest
LAST NAME/COMPANY FIRST 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 El- $ ?,pr 3 Family Residential F Commercial J " Industrial 10A.Property Located within an Agricultural District F-1C 'Residential Vacant Land G Apartment K Public Service 10B.Buyer received a disclosure notice indicating
' D Non-Residential Vacant Land H Entertainment/Amusement L Forest that the property is in an Agricultural District El
15.Check one or more of these conditions as applicable to transfx.
11.Sale Contract Date -
b / 99 A Sale Between Relatives or Former Relatives
Month Day Yeer B Sale Between Related Companies or Partners in Business
C One of the Buyers is also a Seller
12.Date of Sale/Transfer 105 / 10 199 1 D Buyer or Seller is Government Agency or Lending Institution
Month Day Year E Deed Type not Warranty or Bargain and Sale(Specify Below)
F Sale of Fractiol pl or Less then Fee Interest(Specify Below)
4 3 3 0 Q Q 0 0 G Significant Change in Property Between Taxable Status and Sale Dates
13.Full Sale Price y' 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 Below)
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.
14.Indicate the value of personal 0 0
property Included in the nle
16.Year of Assessment Roll from I 1 %117 Total Asaaed Value(of all parcels in transfer) 1 �• ��
which information taken u 7 7 7
18.Properly Clan I I' 19.School District Name L- H J K t h A ) ( / c
20.Tax Map kfentiil lsl/Roll Identffkr(s)(R more than four,attach sheet with additional identifier(s))
I I I 1
I certify that all(d the items of infort➢ation entered on this form are true and correct(to the beat of my kilowledge bell"and I understand that the making
of any wMW false statement of material fait herein will subject me to the provisions of the penal law relative to the making and filing of false instruments.
BUYER BUYER'S ATTORNEY
`7
TjD/ MACARI I LOUIS J.
E R SIGN RE DATE / LAST NAME FIRST NAME
L/(
121 I Malba Drive 718 1 44"31Z
STREET NUMBER STREET NAME AFTER SALE) AREA MOE TELEPHONE NUMBER
Malta„ New York I I � '
Cm'Ofl TOWN STATE ➢P CODE
SELLE
SE R SIGNp DATE
_�km