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"
~.Y.S.
Real Enate
Iran.fer Tax
$1.520.00
'FHIS INDENTURE. mwk the 24th day of Fabruary . 2004 and
BE11WEEN ANN T. KROM. rea~d~n8 at 1280 Paeonie Bay Boulevard. Laurel. New York
11948 and LAURIE ANN KROM. raa~d~n8 at 1280 Paeonie Bay Boulevard. Laurel.
Naw York 11948
us ex.ecu[('u 8 or
Barney S~dor. late
who died on the 23rd
pany of the Ona pan. and
New York 11935
of Suffolk County.
day nf May
CHERYL FORMAN. residing
2003
at 36020 Ma~n
the last willl1nd testament ",r
.._..J-
und (~'1~~olg~e i~2~ill!65:
Road. Cu~Ctio8ue,
pany of the second pan.
WITNESSETH, thar whereas leller' terculmcntury weN i,,;ued to the pany of the fir-a part by the ~LnT\lgah:'!I
Cnurt. Suffolk County. Ncw Ynrk. nn July 16. 2003 and hy virtue
IIf the power and authority ,i"cn in and by :cuid IU$' will and tC!litumcnla andlnr h)' Ankle II of the EaiUttcs. Powc",
and Trust. Low. and in conoiderutlon nf THREE HUNDRED EIGHTY THOUSAND and 00/100-----------
-----------------------($380.000.00)-....:-----------------------------doUars.
paid by 1m: pliny or the lu:~ond pun. doc!lI hel'C'by grant and
rch:.a5C: untu the pany of tM ~eC'ond part. the difiitribulc."Cs (If "UCC~I50n and auians or, the Ifiltty,br,he ~cund part
t'are,.'cr. ' .
. .., . ~ t-
, .. .,.." ... \
Aldolbeo t~at ~ertain plu.. g~c'iU.'i!\~lffh'b'il~n'1t~i~~ 'f8ah...~f''\j8WeR'.S'l'~..l!8flilll!9"..!l'tdS*l!flh''in.lnd
an ang.....othe-
State of New York, bounded and described as follows,
. . ',' ...,....'; ...r
BSGJ:NNJ:NG at a \IIC>>lument on the'I\Ortll.e",ly s>:de of Main Road (S.R.
#2S) at the southeasterly corner of the premises to be descr~be4-..nd the
southwesterly corner of land of Rutkoski, runn~ng thence along the
northerly side of Ma~n Road (S.R. #25) the following two (2) courses and
d~stances, (1) South 760 40' 30. West 235.35 feet to a monument, and
(2) South 770 35' 50. Weet 16.80 feet to a point, runn~ng thence through
land of the party of the first part the following three (3) courses and
dietances, (1) North 350 15' 10. West 105.80 feet, (2) North 350 04' 10.
West 195.42 feet, and (3) North 640 00' 00. East 293.76 feet to land of
Rutkoski, runn~ng thence along said laet mentioned land South 260 00' 00"
Bast 353.00 feet to a monument on the northerly s~de of Main Road
(S.R. #25) and the point or place of BBGJ:NNJ:NG.
,J'
TOGI:-rHER with all right. title and intcre5t. if any. of the rarty of the fil"5t ran in and 10 any streeu; and roac.Is
abullinB the above described premises; to the center lincs thcn."()f; TOCiETHER with the appunenanees. Dn~ als~ all
the estate then:in. which the rarty orthe fiBt p.an hos or h." power 10 ('on~y or di5po5e of. whcther indivitJuully. ur
hy vinue of Kaid will or otherwiloC: TO HAVE AND n> HOLD tM pNmi~" berein 1!ranlcd untu the party of the
~colld pan. the di5trihute".s ur 5U,,'CCI5Urs and DKsipns uf the puny nf the 5econd l1un fOJ'e\.-er.
. '
AND the P.1rty of the Ont pan clIvcnants th.llthc pany or the tint pan has nOI: ckme or 5uffered unything wherehy
.he said premi5C~ have heen incun,hered in uny way whulever. except U!o urul"C'Juid.
Suhject tCl the trust fund pNvi$oion$ of sectiun Ihineen ur tm: Lien Luw.
The: wurd "pany- shall be cOrLIlrued :all if it read "p:anies" whenever the sense of this indenture l';~ R."l.{uin:s.
IN WITNESS WHEKEO.... the purty uf tho: lin.. part h.. duly executed thio deed the day and year Ii",t ahn,'e
wrinen.
/~
C2- -_ -r: ~~
Ann T. Krom. Ex cutor
-4 u.:~ A", AA Jl &7Y)
au1"1. Ann 1:1"0"', ~x cutor
Page 2 of 3
AcknowfedgallMllt taklll'lln .... York State
AdcnD.....d.4IW.nt taken In NMwYork State
S.a.s 01 NawYork, County of Suffolk
, ss: State of Naw York, County of
, .8:
On the 24th day 01 February. In tha _r2004 . balora ma,
.he undersigned, personally appeared ANN T. KROll. and
LAURIE ANN ItROM
personally known to me or proyed to me on the basis of
sallslBClDfy BYldence to ba the In_usl(s) whoea namala)"'"
larel sub8crlbad to the wtthln Inlllrument and acknowledged to
me that -IMIeheIthey executed the same In IttWherlthelr
CIIpacltyllaa), and 'hat by ,,_lIhalr algna'urela) on .he
instrument, tha Indlvtdual(a) or tha person upon _K 01 which
--'~~
N~~ Public
'.1MIl
-z;_. -:-a1__
... ._-
'Q.._.W...__I'I.1iJ.1
Ack_~~n..... by Subscribing _ .......In_
York BtBle
On the day 01' , In the year
Iha undarslgned, personally appeared
. before me.
personally known to me or proved to me on the basis of
saHaIacIory BYldence to ba Iha Indlvldual(a) whose namaCa) Is
lare) subac_ to the within Instrument end ackI-'edged to
me that he/she/they executed the same In hls/herllh..r
capeclty(lesl. and 'ha' by hislherllhslr algnaturela) on the
InlIIru..-t. tha IndlvtduBlla) or tha person upon _K 01 which
the Indlvtduslla) acted. _ed the InlIIrumant.
_..-.......... outalda _ York IhBle
S.a.e of New York. County of
, a: . State of . County of . S8:
. (or In..rt District of Columbia, Territory. Poueaslon or
Foreign Country)
On Ihe day 01 . In the year
the undersigned. personally appeared
, before me.
.he ...-ng _ 10 the Ioregolng InBtrumBnl. with whom
I am personally BCquslnl8d. who baing by ma duly sworn, did
depose and aay, thet hefshB/lhey reskle(s) In
lhat helshelllley know(sl
to ba tha Indlvtdual _bad In and who executed the
Ioregoing InBtrumenl; thai said subecrlblng __ was
present and saw said
execute the ..me: and that said wltn... at the ume time
IlUl>8crl>etl hlslherllhelr name(s) 8B a witness thereto.
Mark Abstract COip
42-40 Bell Blvd
Bayside NY 11361
(718) 279-8700
TltJeNo.:-.5q1~ '30'1(
ESTATE OF BARNEY SIDOR
TO
CHERYL FORMAN
Distributed by
ChIcago TItle Insurance Company
Pa<>e 3 of 3
I
I
I!l
!l
~
2 .
,
." i: ;,
..~
On Iha day 01 , In Ihe year
lI1e undaralgned. personally appeared
. before me.
personally known 10 me or prond to me on the basis of
saUalactory _nee to ba the Indlvldual(.) whose namels) Is
(are) aubacrlbad to the within Instrument and BClcnowledgad 10
me Ihal hBlahelthay axecuted 'he same In hlslherllhelr
capacltyllea). 'hal by his/her/their slgnalurels) on Ihe
InsIrument, lite Indlvtdusl(s) or tha person upon _K 01 which
the IndlYldualla) _. _ad the In_ and thai such
_ rnadtt such _mnee baIore the undenIIgned In the
ladd the city or polltlcBl subdlvtskln and the _ or counlry or
other p1aoa the acknowledgemant was taken).
/)/r11l!l&r / H-()
SECTION II S-
BLOCK ;.-
LOT '1.~
COUNTY OR TOWN .5Ot.t.<f!,,/ Ii-
S'TFlEETADDRESS I, 'lOr !II..ln Iftl
At!TU1lN BY MAIL TO:
STEPHEN S DANETZ ESQ
SUITE 316
118-21 QUEEllS BOULEVARD
FORF:ST HILLS NY 11375
Zip No.
11111111111111111111111111111111 ~IIIIIIIIIIIIIIIIIIIII
I111I11111111111111111111
SUFFOLK COUN'r! CLERK
RECORDS OnICE
RECORDING PAGE
Type of Instrument: DEEDS/DDD
Number of Pages: 3
Receipt Number : 04-0028599
~RANSrzR ~AX NUMBER: 03-33527
Recorded:
At:
03/13/2004
02:00:00 PM
LIBD:
PAGE:
D00012307
092
URNEY SIDOR
CHERYL I'OmIDT
District:
1000
Deed Amount:
Section: Block:
115.00 02.00
EDNINED AND CIlARaBI) AS roLLOWS
$380,000.00
Lot:
009.002
Received the 1'01lowinq Fees For Above Instrument
Exempt
NO
NO
NO
NO
NO
NO
Page/Filing
COE
EA-CTY
TP-584
RP'1'
Transfer tax
$9.00
$5.00
$5.00
$5.00
$30.00
$1,520.00
Handlinq
}fiS SacHG
EA-STATE
Cert.Copies
SCTH
COIIIIII.Pres
Fees Paid
$5.00
$15 . 00
$50.00
$0.00
$0.00
$4,600.00
$6,244.00
Exempt
NO
NO
NO
NO
NO
NO
TRANSFER TAX NUHBBR: 03-33527
THIS PAGE IS A PART 01' TBB IHS'l'lWMBN'l'
THIS IS NOT A BILL
Edward P.Romaine
County Clerk, Suffolk County
I
. '.
I'
Number oC paae.
'IORReNS
Ccnificale #
RECORDED
2004 ....r 13 02,(XhOO PK
Edward P._I".
Q.ERK OF
SlFFOLK COIMN
L Doool2307
P 092
DTI DJ-m27
Serial #
Prior Ctf. #
Dc<.-d / Mongalle In.tru"",nt
Dco>d / Mungagc Twr. Stamp
"EllS
Recording / Filing Stallll'"
.3
G1'IIJICITotal
1[;.4 .
dII
Mongage Amt.
\. Basic T...
2. Additional Tax
Sub TOIllI
SpccJAssit.
or
Spcc./Add.
'IOT. MTG. TAX
Dual Town _I)ual CounlY -
Held Cor Appointment
TransfcrT-~x. ~ =-
MallSi"" 1'W<
The pnlpeny covered by this monl!alle i..
or will he improved hy a one or tWU
ramily dwelling only.
YES ur NO
UNO. ... appropriate \lIll. clause on
pall" # oC this instrument.
P'dge / Filing F....
Handling
S. ..Q!L
TP-S84
Nutation J
,J
EA-S217ICounlYI_- _ SahTotal
HA-S217 (Stale)
Comm. or Ed.
./2.;/L--
s. J1!L
R.P.T.S.A.
Anidavil
Ccnificd Copy
NYS Surcharge
Oth.r
IS. 00
Sub Total
4
\1:;.00
SectIon
B~~~O
~~9.002
5 eomauudt,- PnllHfttioJl lPwad
R.alPropcl1y
Tux Servic.-c
^Ilcncy
Verificlltion
1000 11500 0200 008002
Consideration Amount $ 380.000.00
CPF Tax Due
S 4.600.00
Imprm'cd X
VacllDt Land _
6 SatisCoctiollS!Dischlll'lJCslRelcascs List Property Ow........ Mailinll Add....
RECORD'" RETURN TO:
TO
TO
10
STEPHEN S DANETZ ESQ
SUITE 316
118-21 QUEENS BOULEVARD
FOREST HILLS NY 11375
TD
7 Title Com n Information
Co.Na e Mark Abstract Cor.
Title II 597-S-3098
8
SutTolk Count Recordin
& Endorsement Pa e
This palJe Corms pan oC the attaehedExecutor . s Deed
(SPECIFY TYPE OF INSTRUMENT)
made hy:
ESTATE OF BARNEY SIDOR
1bc premises herein iK silua'~ in
SUFFOLK COUNTY. NEW YORK.
TO In the Township or Southold
CHERYL FORMAN In the VILLAGE
or HAMLET oC Mattituck
BOXE.'; 6 THRU 8 MUST BE TYPED OR PRINTm) IN BLACK INK ONLY PRIOR'IO RECORDING OR FILING.
(uvc:-r)
page 1 of 3
.
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: hnp:11 www.orps.state.ny.us or PHONE (518) 473-7222
REAL PROPERTY TRANSFER REPORT
FOR COUNTY USE ONLY
C3. Book I
1'1 (>-3, g, 8,11
I .3 I 1.3 Ie: 1'1
Month Day yo-
I, o? 30, )IC4 Pa.ol d, fI, ~,
ci. ~WIS Code
C2. Date Deed Rec~rded
PROPERTY INFORMATION
1. Property I
LOGation
17905
Main Road
ST~EETI'lAME
Snu;:Hi'fUMIE'"
Southold
O1'IO!\,('Wi!t
2. Buver
Name
Forman
lAST NAME I COMP-ANY
LAST NAME I COMPANY
3. Tax Indicate where future Tall Bills are to be sent
Billing if other than buyer address {at bottom of form)
Address
LAGTNAMC/COMrANY
STflEET NlIMllEFl AND STREET NAME
*
" -
. w
" ' ,i
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
KP_SJ17Kn3197
Cheryl
fIIU!TNA,..,
Mat1;.bt~ck
VIl.l.AG~
L 11952
ZlPCODJ:
FIRSTNAW
1 I # of Parcels OR D Part of a Parcel
CITV QP; TOWN
4. Indicate the number of Asseslitrlent
Roll parcel. t,.naferred on the deed
5. D.ed
PTopertv
Size
I X I
~Pnl
I Dol
FIIONTFHT
6.Sallar
Nama
Sidor
LAST NAME' / COMPAW
"------.-..
LAST NAME tCOMPANI'
ACRES
1. 0 0 I
FI"STNAMf
STATE
ZIP CODE:
(Only II Pert of a Parcell CheGk 811 they apply:
4A. Planning Board with Subdivision Authority Exists D
48. Subdivision Approval W8S Required tor Transfer D
4C. Parcel Approved for Subdivision with Map Provided 0
Estate of Barney
AflSTNAME
7 Check the box below which most accurately dHcribtls th. usa of the proparty at tha time of .ala:
FIIlSTNAMl':
A~ On8 Family Rl;Isidential
B 2or3Family Residential
C ResidentIal Vacant land
D Non-Resid90tilll Vacent Land
E~Agricult\.Jr<l1
F Commercial
G Apartml;lnl
H Entertainment' Amusement
SALE INFORMATION
n. Sala Contract Date
9
Mcnth
30
0.,
I 03
Year
I
12. Data of Sale' Tran..f"r
2
24
0",
I
I
MOrlth
13, Full Sale Price
14. Indicate tha value of p.nenal
property included In the sale
~ Commurlity Service
J Indu8trlll
Public Service
L Forest
Check the box.. below as they lIpply
8.. OwnQr:.Jhil) TYl)tI hi CumJu01inium
9. New Con&truction on Vacant land
10A. Property located within an Agricultural District
10B. Buyer received a disclosure notice indicating
that the proparty is in an Agricultural District
o
o
o
o
04
16. Check OMl or miDN' oIttMH conditions a. appMcable to transfer:
Sale Between Relative8 or Former Relatives
Sale Between Related Companies or Partners in Business
One of the Buyers is also a Seller
Buyer or Saller is Government Agency or lending Institution
Deed Type not Warranty or Bargain and Sale (Specify Below)
Sale of Fractional or LeIS5 than Fee Interest (Specify Below)
Significant Change in Property Between Taxable Status and Sale Oates
Sale of Buslnes8 i8 Included in Sala Price
Other Unusual Factora Affecting S,le Price (Specify Below'
None
Y.ar
ASSESSMENT INFORMATION -
, , ~ 0 I 0 I
Data should reflect the latest Final Assessment Roll and Tax Bm
Executor's Deed
,38,0 ,0,0 .00,01
, , .
(Full Sale Price is thl;l total amount paid lor tha property including p."onai property.
This payment may be in the form of cllsh, other property or goods, or the assumption of
mongagas or other obligations.) PlesS8 round to the neareBf whole dollar amount.
N/A
16. V_r of Assessment Roll Irom
which information taken
10
3
17. Total A~ Value (of all parcelS In transfer) I
Mattituck - Cutchoque UFSD
18. Property Cia..
2 ,1 ,0 l-U 19. School Oiatrict Name I
115
9.2
20. Tax Map Idantifier!s}, Rollldentitier(.) III more than four, attach sheet with addltlonalldentifjarlsU
2
6 ,4
,
o
o
I CERTIFICATION
I certify t:bal all of the items of inforrnadon entered on this form are true MIld cornd (to the best of my knowledge and beUet) and I understand thai the making
(If any willful false statement of material facl herein will subject me to the ......wicinnl: of the oenallaw rel8tlve to the maldng aad tiling of false instrumenllL
BUYER BUYER'S ATTORNEY
24/04
~
heryl orman
!/d~,.l(CJaJ.
/ 7 q~~ I
~lTn~~T NUM~~n
/nath--l--a--e,j-2-- )
CITYOATO N
4:;;1
5T"
) / 9.s-
ZlPCOO!
By
ESTATE OF BARNEY
/1 ~,
~/
SELLER
SIDOR
~~
2/24/04
",n
Sl':LLEfl S'GN"T1JIl~
Ann T. Krom, Executor
Danetz
lAST NAME
718
AAEACODC
Stephen So
FIRST NA"'~
575-0045
TLLCrI!ON( HUM~EA
NEW YORK STATE
COPY