HomeMy WebLinkAboutL 12197 P 354
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Tax Map
Designation
Dist.
Sec.
Blk.
Lot(s)
NY005 - Bargain and Sale Deed with Covenant against Grantor's Acts Individual or Corporation (Single Sheet) (NYBTU 8002)
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT - THIS INSTRUMENT SHOULD BE USED BY LA WYERS ONLY
THIS INDENTURE, made the ?/J day of;114~
BETWEEN HAROLD W. OLSEN and HILDA FLAN;lR OLSE:N,
645 Beachwood Drive, Cutchogue, New York 11935,
, in the year 2002
his wife, both residing at
as tenants in common
I l&- Lt.-la, I
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party of the first part, and GARY FLANNER OLSEN, residing at 660 Oakwood Road, Southold,
New York 11971; JANET MYRIN, residing at 40 Grange Avenue, P.O. Box 177,
Little Compton, Rhode Island 02237, and RICHARD WALLACE OLSEN, residing.at
7 Royal Oak Drive, N.York-Ontario M3C 2Mi, Canada, each owning a one-th~rd
interest as tenants in common
party of the second part,
WITNESSETH, that the party ofthe first part, in consideration ofTen 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 ofland, with the buildings and improvements thereon erected, situate,lying
and being in the
SEE SCHEDULE "A" ATTACHED HERETO.
TOGETHER with all right, title and interest, if any, of the party of the first part of, 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 part, 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 been incumbered in any way whatever, except as aforesaid.
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" shall be construed as ifit read "parties" whenever the sense of this indenture so requires.
IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above
written.
IN PRESENCE OF:
~~ tV Ok..&(
HAROLD W. OLSEN
/~L~(j)~
SCHEDULE "A"
PARCEL #1:
~ l(., -4--(2-
ALL that certain plot, piece or parcel ofland, with the buildings and improvements thereon
erected, situate, lying and being in the Village of Cutchogue, Town of Southold, County of
Suffolk and State of New York, more particularly described as follows:
BEGINNING at a point on the Westerly side of a Private Road known as Creek Road which
bears South 00 01' 30" East and is distant 75 feet from a point which in turn bears South 890
58' 30" West a distance of314.16 feet and thence South 680 46" 20" West a further distance of
48.62 feet from the intersection of the Northerly and Easterly boundaries of said land of
Schelker and Palmer also being the Northeast comer ofland conveyed to Walter G. Schelker,
Jr. in deed Liber 4761 Page 370 as described therein as Parcel C and from said point of
beginning; running thence along said land South 780 00' 00" West 180.00 feet more or less to
the ordinary high water line of Rail's Creek; thence Northerly along the mean high water line
of Rail's Creek on a tie line bearing North 11049' 40" West a tie distance of 41.61 feet to the
center line of a gutter; thence Easterly, partly along the center line of said gutter, on a tie line
bearing North 680 46' 20" East a tie distance of 198 feet to the westerly side of a Private Road;
thence along the westerly side of said Private Road South 0 degrees 01 minutes 30 seconds
East 75 feet to the point or place of beginning.
BEING AND INTENDED to be the same premises conveyed in Deed dated July 23,1990,
and recorded at Liber 11115 at Page 069 on August 3, 1990 at the Office of the Clerk of
Suffolk County.
Parcel #1 being a part ofSCTM #1000-116.00-04.00-012.001
PARCEL #2:
\\&1-4-/\
ALL that certain plot, piece or parcel ofland, with the buildings and improvements thereon
erected, situate, lying and being the Village of Cutchogue, Town of Southold, County of
Suffolk and State of New York, and all being parts of and within the lands described and
included upon a certain map entitled, "Map of Meadowland ofW. G. Schelker and H. S.
Palmer, situate at Cutchogue, Suffolk County, New York," surveyed January 12,1927 by Otto
W. VanTuyl, Licensed Surveyor and filed in the Office of the Clerk of the County of Suffolk
in Riverhead, on March 12, 1927 as Map No. 819, bounded and described as follows:
BEGINNING at a point on the westerly side of a private road known as Creek Road which
bears south 0 degrees 01 minutes 30 seconds east and is distant 75 feet from a point which in
turn bears south 89 degrees 58 minutes 30 seconds west a distance of314.16 feet and; thence
south 68 degrees 46 minutes 20 seconds west a further distance of 48.62 feet from the
intersection of the northerly and easterly boundary of said lands of Schelker and Palmer as
shown on said Map No. 819; running thence south 0 degrees 01 minutes 30 seconds east along
the westerly side of said Creek Road a distance of 50 feet to the northerly line ofland now or
formerly of Olsen; thence south 78 degrees 00 minutes west along the said lands 141 feet,
more or less, to the easterly bank of Ralls Creek; thence northerly along the easterly bank of
Ralls Creek along a tie line bearing north 1 degree 43 minutes 10 seconds West 49.70 feet to
the southerly line of lands now or formerly of Wines; thence north 78 degrees 00 minutes east
along said last mentioned line 145 feet, more or less, to the point Dr place of beginning.
BEING AND INTENDED to be the same premises conveyed in Deed dated July 23,1990,
and recorded at Liber 11115 at Page 067 on August 3,1990 at the Office of the Clerk of
Suffolk County.
Parcel #2 being a part ofSCTM #1000-116.00-04.00-0]2.001
PARCEL #3:
\ (&-1--10
ALL that certain plot, piece or parcel ofland, with the buildings and improvements thereon
erected, situate, lying and being at Cutchogue, in the Town of Southold, County of Suffolk,
State of New York, being bounded and described as follows:
BEGINNING at a point on the westerly line of a private road 20 feet wide at the southeasterly
comer of Parcel No. V heretofore conveyed by Howard S. Palmer to Walter G. Schelker;
RUNNING THENCE along said private road South 0 degrees 1 minute 30 seconds East 50
feet to the northerly line of Beach wood Road;
THENCE along said northerly line of Beach wood Road South 78 degrees West, 165 feet more
or less to Hall's Creek;
THENCE northerly along said Creek about 59 feet to the southwesterly comer of said Parcel
No. V heretofore conveyed by Howard S. Palmer to Walter G. Schelker;
AND THENCE along said last mentioned land North 78 degree:s East 141 feet more or less to
the point or place of BEGINNING.
TOGETHER with all the right, title and interest of the party of the first part of, in and to said
Beachwood Road and the private road abutting Parcels No.5 & 6 hereon on the east.
Said premises being more particularly bounded and described as follows:
ALL that certain plot, piece or parcel ofland with the buildings and improvements thereon
erected, situate, lying and being at Cutchogue, in the Town of Southold, County of Suffolk and
State of New York, being more particularly bounded and described as follows:
BEGINNING at a point on the westerly line of a private road 20 feet wide at the southeasterly
corner of Parcel No. V heretofore conveyed by Howard S. Palmer to Walter G. Schelker:
RUNNING THENCE along said private road South I degree 1 minute 30 seconds East 50 feet
to the northerly line of Beach wood Road;
THENCE along said northerly line of Beach wood Road South 78 degrees West 191 feet to
Hall's Creek;
THENCE North 13 degrees 15 minutes 20 seconds East along a tie line 54.08 feet to the
southwesterly comer of said Parcel No. V heretofore conveyed by Howard S. Palmer to Walter
G. Schelker;
AND THENCE along said last mentioned land North 78 degrees East 178.5 feet to the point
or place of BEGINNING.
TOGETHER with all the right, title and interest of the party of the first part of, in and to said
Beachwood Road and the private road abutting Parcels No.5 & 6 herein on the east.
BEING AND INTENDED to be the same premises conveyed in Deed dated July 23,1990,
and recorded at Liber 11115 at Page 074 on August 3, 1990 at the Office of the Clerk of
Suffolk County.
Parcel #3 being a part of SCTM #1000-116.00-04.00-012.001
PARCEL 4:
u Cst -.4.-. pf 1'7.1
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon
erected, situate, lying and being in the Village ofCutchogue, Town of South old, County of
Suffolk and State of New York, being a part of and within the lands described and included
upon a certain "Map of Meadowland ofW. G. Schelker and H. S. Palmer, situate at
Cutchogue, Suffolk County, New York," surveyed January 12,1927 by Otto W. Van Tuyl,
licensed Surveyor, and filed in the Office of the County Clerk of Suffolk County on May 12,
1927 as Map No. 819, being particularly bounded and described as follows:
BEGINNING at the northwest comer ofland now or formerly of Palmer on the southerly side
of a private road known as Beachwood Road, which point of beginning is 1630 feet, more or
less westerly, as measured along the said southerly side of Beach wood Road from the
intersection of the southerly side of Beachwood Road and the westerly side of New Suffolk
Avenue; running thence along the southerly side of Beachwood Road the following two
courses and distances:
1) South 780 00' West 65 feet; and 2) South 540 00' West 90 feet to Hall's Creek; thence
southeasterly along Hall's Creek, as it winds and turns, a distance whic\1 when measured along
its tie line is South 530 17' East 87.9 feet to the land now or formerly of Palmer; thence North
29000' East along the land now or formerly of Palmer; thence North 290 00' East along the
land now or formerly of Palmer a distance of 136 feet to the point or place of beginning.
TOGETHER with all the right, title and interest of the seller, if any, of, in and to the land
under the waters of Hall's Creek (also known as Mud Creek) abutting the above described
premIses.
TOGETHER with all the right, title and interest, of the seller, if any, of, in and to an easement
for ingress and egress to and from the above described premises and the public road known as
New Suffolk Avenue over and upon the aforesaid private road known as Beachwood Road.
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 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 part, 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 been encumbered in any way whatever, except as
aforesaid.
BEING AND INTENDED to be the same premises conveyed in Deed dated July 23,1990,
and recorded at Liber 11115 at Page 059 on August 3,1990 at the Office of the Clerk of
Suffolk County.
Parcel #4 being a part ofSCTM #1000-116.00-04.00-020.001
PARCEL 5:
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon
erected, situate, lying and being in the Town of Southold, County of Suffolk and State of New
York, at Cutchogue, bounded and described as follows:
BEGINNING at a point in the southerly line of a private road leading easterly in front of the
hereinafter described premises to New Suffolk Avenue, said point being situate in the
northwesterly comer of premises heretofore conveyed by Ethel B. Mulford to Harold W. Olsen
and Hilda F. Olsen, his wife, by deed dated January 22, 1948 and recorded in the Suffolk
County Clerk's Office on February 17, 1948 in Liber 2800 of deeds at page 154; running
thence from said point or place of beginning along the westerly boundary oflands last
Ii (; - -4 'pl 1"1.1
mentioned South 18 degrees 40' West 190 feet, more or less, to the highwater mark ofPeconic
Bay or a tributary thereof known as Halls Creek; running thenee northwesterly along said
highwater mark of said Halls Creek 70 feet, more or less to the easterly line of land described
as Parcel IV in deed by Howard S. Palmer and Ethel B. Palmer, his wife, to Walter G.
Schelker dated October 19, 1927 and recorded in said Clerk's Office on October 26,1927 in
Liber 1312 of deeds at page 459; running thence along the easterly line ofland last mentioned
North 29 degrees 00' East 159 feet, more or less, to the southerly line of the private road above
mentioned; running thence South 81 degrees 55' 50" East along the southerly line of said
private road known as Beachwood Road to the point or place of beginning.
TOGETHER with all right, title and interest, if any, of the parties of the first part of, in and to
Halls Creek lying in front of and adjoining the above described premises on the south.
TOGETHER with an easement for ingress and egress to and from the above described
premises and the public road known as New Suffolk Avenue over and upon the aforesaid
private road.
TOGETHER with the perpetual right-of-way over the rear 10 feet of neighboring and
adjoining premises which were formerly owned by Walter G. Schelker for the purpose of
entering thereon, laying, installing, maintaining and repairing underground pipes or conduits
for water, gas, sewer and wires for electric light or telephone service, either on poles or
underground.
BEING AND INTENDED to be the same premises conveyed in Deed dated July 23,1990,
and recorded at Liber 11115 at Page 062 on August 3, 1990 at the Office of the Clerk of
Suffolk County.
Parcel #5 being a part ofSCTM #1000-116.00-04.00-020.001
PARCEL 6:
I /G> -4--28
ALL that certain plot, piece.or parcel ofland, with the buildings and improvements thereon
erected, situate, lying and being at Cutchogue, in the Town of Southold, County of Suffolk and
State of New York, and described as follows:
BEGINNING at a point on the southerly line of a certain strip of land jointly owned by Walter
G. Schelker and Howard S. Palmer, being the northwesterly comer of Parcel No. ill and
conveyed by deed dated October 19,1927, by the said Walter G. Schelker to Howard S.
Palmer, running thence along the westerly line oflast described land south eleven (11) degrees,
twenty-five (25) minutes west 220 feet, more or less, to Great Peconic Bay; thence
northwesterly along said Great Peconic Bay, 65 feet, more or less, to the southeasterly comer
of parcel No. IV which was conveyed by deed dated October 19, 1927 by Walter G. Schelker
to Howard S. Palmer; then along the easterly line oflast described land, north eighteen (18)
degrees, forty (40) minutes east 190 feet, more or less, to the southerly line of said jointly
owned strip above mentioned; then along said southerly line of said strip, south eighty-one (81)
degrees, fifty-five (55) minutes, fifty (50) seconds east 33 feet to the point of beginning.
SUBJECT to a perpetual right of way to Howard S. Palmer and Walter G. Schelker, their heirs
and assigns, over the rear ten (10) feet of said premises for the purpose of entering thereon,
laying, installing, maintaining and repairing underground pipes or conduits for water, gas,
sewer and wires for electric light or telephone service, either on poles or underground.
SUBJECT also to a public right of way for pedestrians only, over a strip of land ten (10) feet in
width running along the shores of Great Peconic Bay and Hall's Creek above the highwater
mark.
SUBJECT also to restrictive covenants and agreements of record, if any, that are still in force
and effect.
TOGETHER with the right to use a certain right-of-way in common with others over adjacent
land now or formerly of John Downs to New Suffolk Avenue.
BEING AND INTENDED to be the same premises conveyed in Deed dated July 23,1990,
and recorded at Liber 11115 at Page 071 on August 3,1990 at the Office of the Clerk of
Suffolk County.
Parcel #6 being a part ofSCTM #1000-116.00-04.00-020.001
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Number or pnges
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TOHHENS
RECOf;:[:,m
2002 Jul 15 03:27:33 Pr'l
Edl.,.!.3 r-d P. POlna in€"
CLEF.:V OF
SUFFOLK COUtH\.1
L D0001219?
F'354
C'T# 01-4:::2t:2
Scriclll
Certificate /I
PriorCtf.1I
Deed / Morlgage Instrument
Deed / Mortgnge Tax SiamI'
Recording / Filing Slamps
.,
FEES
l'f1ge / riling ree :JLJ
I hHldlillg 5
TI'.5R4 ~
Noltltioll
EA.52 17 (Collllly) 5 SlIb Tolal
EA.5217 (Slole) d-S ~
IU'.T.SA ..\- \ ~-
COlnl\1. of Ed. 5Q~
Aflidavil
L/__
MorlgAge Amt.
I. Dasic Tax
2. Addilioncl Tax
Sob Tolal
3CJ. ..-/
Ulhcr l-J4."::,
15
SlIhTolal qq.
GRAND TOTAL, _J 3 <?
---
Spec.! Assit.
Or
Spec. / Add.
TOT. MTO. TAX
Onal Town Dual Counly
held for Apporlionmenl ~
Trnnsfer Tax h
Mnnsion Tax
The properly covered by Ihi. mortgage i. 01
will be Improved by a one or Iwo fam i:
dwelling only.
YES or NO
I f NO, see approprinte tax clause 011 pnge
of Ihls instrument.
Heg.Copy
c;:,
Itenll'roperly Tax Service Agency Verificalion
Di.l. S~clion Block
1.01
6 Communit Preservation Fund
Cunslderation Amounl $ -0-
Slalllp
1 )
2)
1000 11600 0400 012001
1000 11600 0400 020001
cpr- Tax Due
$ -0
Dale
Improved 2) X
1
Sulislilctions/.
0'-- ------.--~ ......o>~. I VI-">;'; 1 11 VWIIl.:I::i IVlHlIlIlg Address
HECOHIJ & HETUHN TO:
Vacanl Lund.l.l-.X.
\"a
TD
TD
TD
IlIilinls
Marcia Z. Hefter, Esq.
Esseks, Hefter & Angel
108 East Main Street
P . O. Box 27 9
Riverhead, New York 11901
'Illis pnge forll1s pml of the allnched
8 Title Company Information
Co. Nallle N/A
Tille 1/
Suffolk County Recording & Endorsement Page
9
Deeds
Harold W. Olsen and Hilda Flanner Olsen
(SPECIFY 'IYPE OF I NS"IRUMENT)
lIIode hy
lhe premises herein is silualed in
SUFrOLK COUNIY, NEW YORK.
TO
In the Township of Southold
Gary Flanner Olsen, Janet Myrin and
In (he VILLAGE
or HAMLET of Cutchogue
Richard Wallace Olsen
!lOXI'S 5 TllllIl l) tvlUST lJE TYI'ED OR 1'R1 N rED IN IlI.ACf< INK ONf,Y PfUOR TO ImCORDING OR FJUNO.
IOVFI?'
//11///111/11111111/1111111 111/111111111111111111111111
//11/1111111111/111111111
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORl;)ING PAGE
Type of Instrument: DEEDS/DDD
Number of Pages: 8 ,
TRANSFER TAX NUMBER: 01-48282
District:
1000
Section: Block:
116.00 04.00
EXAMINED AND CHARGED AS FOLLOWS
$0.00
Recorded:
At:
LIBER:
PAGE:
07/15/2002
03:27:33 PM
D00012197
354
Lot:
012.001
Deed Amoun t:
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $24.00 NO Handling $5.00 NO
COE $5.00 NO NYS SURCHG $15.00 NO
EA-CTY $5.00 NO EA-STATE $25.00 NO
TP-584 $5.00 NO Cert.Copies $4.00 NO
RPT $50.00 NO SCTM $0.00 NO
Transfer tax $0.00 NO Comm.Pres $0.00 NO
Fees Paid $138.00
TRANSFER TAX NUMBER: 01-48282
THIS PAGE IS A PART OF THE INSTRUMENT
Edward P.Romaine
County Clerk, Suffolk County
t'U:A::;t:: I Yt't:: OH t'Ht::::;::; ~IHML Y WHEN WRITING ON FORM
http:// www.orps.state.ny.us or PHONE (518) 473-7222
REAL PROPERTY TRANSFER REPORT
1. Prope.rty I
location
645
Beachwood DrL'.re
STREET NAME
STREET NUMBER
Southold
CITY OR TOWN
2. Buyer
Name
OlseI"::.
\1~!~PJVIE I COMPANY
.>.:y In
Olsen
LAST NAME I COMPANY
3. Tax
Billing
Address
Indicate where future Tax Bills are to be sent I Olsen
jf other than buyer address (at bottom of form) LAST NAME I COMPANY
1645 lleachwood Drive
STREET NUMBER AND STREET NAME
Cutchcgue
CITY OR TOWN
4. Indicate the number of Assessment
Roll parcels transferred on the deed
1.
# of Parcels
5. Deed
Property
Size
I X I
lOR I
FRONT FEET
DEPTH
6. Seller
Name
Olsen
LAST NAME I COMPANY
Olsen
LAST NAME I COMPANY
VILLAGE
STt"n::.
STATE OF NEW YORK
",- 'Jr REAL PROPERTY SERVICES
FIRST NAME
7. Check the box below which most accurately describes the use of the property at the time of sale:
2)
A~~{' One Famijy Residential
B 2 or 3 Family Residential
C Residential Vacant Land
D Non-Residential Vacant Land
E ~ Agricultural
F Commercial
G Apartment
H Entertainment / Amusement
I ~ Community Service
J Industrial
K Public Service
L Forest
1)
SAlEfJ'll' I!!!\!
11. Sale Contract Date I n/.s. I
Month D.y Year
12. Date of Sale / Transfer 5 I 30 I 2002 I
Month Day Year
-0-
13. Full Sale Price I I , 0 I 0 I
, , .
(Full Sale Price is the total amount 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.
riP - 5217
RP-5217 Rev 3197
Cutchogu€
11935
A
B
C
D
E
F
G
H
I
J
ZIP CODE
Ga,ry Flannar
FIRST NAME
Janet
Richard '!I>iallace
FIRST NAME
Herter
I)
1000-116.00-04.00-012.001
20. Tax Map ldentmer(s) /Rollldentifier(s} (K more than four, attach sheet with additional identifier{sll
l'~ '0 1 ~.1
I naro..u.,i w ~
FIRST NAME
d_nd Hilda Flu-nner
OR 0 Part of a Parcel
1) 5 .5
2) 6 5
, .
ACRES
Harold Ii'.
IN :r
STATE
I 11935
ZIP CODE
(Only if Part of a Parcell Check as they apply:
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
Eilda Flanne-r
FIRST NAME
Check the boxes below as they apply:
8. Ownership Type is Condominium
9. New Construction on Vacant Land
lOA. Property Located within an Agricultural District
lOB. Buyer received a disclosure notice indicating
that the property is in an Agricultural District
o
o
o
o
15. Check one or more of these conditions as applicable to transfer:
Sale Between Relatives or Former Relatives
Sale Between Related Companies or Partners in Business
One of th~ Buyers is also a Seller
Buyet or Seller is Government Agency or Lending Institution
Deed Type not Warranty or Bargain and Sale (Specify Below)
Sale of Fractional or Less than Fee Interest (Specify Below)
Si!~nificant Change in Property Between Taxable Status and Sale Dat
Sale of Business is Included in Sale Price
Other Unusual Factors Affecting Sale Price (Specify Below)
None
14. Indicate t~e value ~f personal I I -,0- I I 0 I 0 I
property Included In the sale, , .
tA_~ee~~;~1~;~ltli$'tl!~~ifll!IA$$'.''''~'ltlfult.nllr.l(eB~jeI
660
STREET NUMBER
On,kWf,)od RO<:.lQ
STREET NAME IAFTER SALEI
16. Year of Assessment Roll from 100 ,0 11 I
which information taken . . . 17 . Total Assessed Value (of all parcels in transfer) L-......,
3 1 1
I 2 1 01 LJ I Southold
18. Property Class L:':-....L~- 19. School District Name' .-. ..
;
1 9
;
()
o
,
2)
1000-116.00-04.00-020.001
11(P-LT- 12./
I
leCilli\lFl@y~';1
I certify that aU of the items of infonnation entered on this fonn are true and correct (to the best of my knowledge and beliet) and I understand that the making
of any willful false statement, of material fact herein will subject me to the provisiom of the penal law relative to the making and filing of false instnmtents.
BUYEll BUYEll'S ATTOllNEY
BUYER SIGNATURE
Gary G1an-a.er OJ. :.:>e:D.
5/30/02
DATE
SouLllo1d
~y
1e1971
CITY OR TOWN
STATE
ZIP CODE
SELLEll
H,~ro-hi---;W-;-~'-~~--'--"-
5/30102
T'T . ., --AEl.LEPrSlGNA.TURE.,~ ('>.-1
"TO
MarCl8 Z.
LAST NAME FIRST NAME
ES8t:~ks, Hefter is: Angel
369-.1700
AREA CODE
631
TELEPHONE NUMBER