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BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S
ACTS (INDIVIDUAL OR CORPORATION)
STANDARD NYBTU FORM 8007
CAUTlOl'o:': nn."i AGREEMENT :C;HOUI.D DE PMUPAlWD BY AN ATlllRNEY ANn RI::Vn:;WED BY A,1TORNEVS ".UR SELLER AND
PURCHA.~I~R BEI:ORE SKr'"NING.
THIS INDENTURE, made the J I day of ..JU" V
, 2004
bch\oeen
RICHARD T. STAPLETON, ...,aiding lit 400 Glade Road, Apt. 402,
Grapevine, TX 76051
party of the first part, and
JANE S. OLIVER AS TRUSTEE OF RICHARD STA1>LETON TRUST.
Dated Marcb 5, 2004, reald,lng at 4321 Wood glen Drive. Grapevine, TX 76051
party of the second part.
WITNESSETH, that the party of the first part. in consideration of Ten DollalS and other lawful
consideration, lawful money oflhe United States. paid by the party of the second part. docs hereby grant and
release unto the party of the second port. the heirs or successors and assigns of the party of the second part
forever~
ALL that certain plot, piece or pareel of land. with the buildings and improvements thereon erected,
situate, lying and being at Mallituck. Town of Southold. County of Suffolk and SlBte of New York, known and
described as lot No. 77 on a cenain map entitled "Subdivision Map Section One of Property of George I. Tuthill
and others, situated at Laurel. Town of Southold, NV" surveyed March 28, 1928 by 0110 W. Van Tuyl,
Greenpon, N.V., surveyor, and filed in the office of the Clerk of the County of Suffolk on the 15 day of January
1929 as Map No. 86 J.
The grantor herein ia the same pelSOn as the grantee in Deed recorded 7125/49 in Liber 2937 Page 476.
TOGETHER with all right. title and interest, if any. of lhc party oflhe 1ilS' part in and to any streets and
roads abutting the above described premises to the center lines thereof,
TOGETHER with the appunenances and all the estate and rights ofthe party ofthe first pan in and to
said premises.
TO /LA VE AND ro HOLD the premises herein granted unto the party of the second pan. the heilS or
successors and assigns of the pany of the second p::ln forever.
AND the party of the filSt part, covenants that the party of the filSt part has not done or suffered anything
whereby the said premises have been encumbered in any way whatever, except as aforesaid.
AND the party of the filSt part, in compliance with Section 13 of the Lien Law, covenants that the party
of the first pan 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 ofthc: improvement and will
apply the same filSt to the payment of the cost of Ihe improvement before using any pan of lhe lolal of the same
for any other purpose.
The word "pMty" shall be construed as if it read "panics" whenever the sense of this indenture so
requires.
IN WITNESS WHEREOF, the pa~ of the first part has duly executed this deed the day and year first
above written.
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RICH 'ROJT. STAPLETON
~
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~.SRA Rnhlential Rc.1 Es"-Ic Form5 on HoIIJOCS" (9100)
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Cop)nalu C8pson i- l)cyclnpmcnl
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STATE OF TEXAS )
. .-:L +- Iss.:
COUNTY OF -\ wr IJII/v} )
On the 'if I day of ~ v.V , 2004, before me. the undersigned, personally appeared
RICHARD T. STAPLETON, pe"'nally known to me or proved to me on the basis ofsatisfaetory evidence to
be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed
the same in his capacity, and that by his signature on the instrument, the individual. or the person upon behalf of
which the individual aeted_ execuled the instrument, and that such individual mode such appearance befo.... the
undersigned in the'
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NlARCH 7.:ZOOT
DEED
Title No.
ST APLKTON
Section
Block
Lot
County or Town SUFFOLK
To
OLIVER, AS TRUSTEE
Rfturn By Mail To:
OLSEN & OLSEN, LLP
I'. O. BOX 706
CUTCHOGUE. NY 11935
R""ervc This Snace For Use Of Recordin2 Omce
.1
~VSUA RJ:sldential Real E.'litlllc I'orms 00 HnlDoesiS, (9100)
.2.
Copyrip,t CapsoR'" OI."VC1t'lpmmt
j
....
.~
Number of pages
Seri:J.1 if
Cenific;ne /I
PriorClf.1I
TORltENS
G::2
c3-
4
Deed I Mortgage Instrument
Page I Filing Fec
Handling.
TP-584
Notation
EA-52 ) 7 lCounty)
EA-S217 (SEate)
R.p.T.S.^.
Camln. of Ed.
AFlid:lvit
Certified Copy
Reg. Copy
Olher
I
Sl~:np
Da..
Initials
Sub Total
_3o~
5~
Sub TOlel
Deed I Mortgage Tax Stamp
FEES
GRAND TDTr\L
Real ProperlY Tax Service Agency Verification
Dist. . Seclion _....!!.Iock _ _ _Lo.t..
1000 12600 0700 020000
RECORIjED
2004 Sap 23 09:33:57 API
Edward P.RoDine
. CLERK OF
SUFFOLK CGUHTY
L DOoo12345
P 008
Dn 04-08258
Recordingl Filing Stamps
'!)
Mortgage Amt.
TOT. MTG. TAX
Dual Town Dual County _
Held for AP:Jor[iOI1l1~en(
Transfer Tax _ _
Mansion Tax _
TIle propcl1}' covered by IhlS l11orlg~ge is (II'
will be ilnproved by OJ olle QI two family
dwelling. only.
YES__orNO_
If NO, see appropl"ialc [OX claus..: on p:l.gc 'I
_ Oflhis inslrument.
CPF Tax Due
Improved
-IJ t/
6 Community Pl'escrvar;on Fund
Consideration Alllount $
7
Snlisfnctiol1s/DischargesiReleose.s List Property Owners Mailing Address
RECORD & RETURI'i TO:
9
OLSEN & OLSEN UP
1l48l1IAUI........
PO 1IOlC-'&-
CllTClfciillf.'" II.
I. Basic Ta.'(
2. Addilional Tax
Sub Tolal
Sprc./Assit
Or
Spec./Add.
s
VaClUlt Land
T~ /0
TO
TO
8 Title Comp:.lIlY Illforl11:.ltioll
Co. Name C~mrea1'th
Tille II Cd>
Suffolk COlmty Recording & Endorsement Page
1l1is p:lge forms ""rt "f .he attached Deed
lUCRARD T. STAPLETON
TO
(SPECIFY TYPE OF INSTRUMENT )
TIle premises herein is sirualed in
SUFFOLK COUNTY. NEW YORK.
l.&tlR c: nl TV... A'!il: TRIIST'RR: 0. IIT~HARn
STAPLETON TRUST
In the Township of
In ,he VILLAGE
or J-L'\MLET of
SOUTJlOLD
made: by:
130XES :; ll-IRU 9 MUST BE TYPED OR PRJNTl::D IN BLACK INK ONLY PRIOR TO RECORDING OR FlUNG.
(OVER)
,
1111111111111111111111111111111111111 111111111111111111
IIII~IIIIIIIIIIIIIIIIIII
SU!TOLK COON'll CLERK
RECORDS OFFICE
RECOltDING PAGB
Type of In.trument: DBBDS/DDD
Number of P&ge.:' 3
Receipt Number : 04-0105297
TRANSrzR TAX NUMBER: 04-08258
Record8d:
At:
09/23/2004
09:33:57 AM
D_d Amount:
Section: Block:
126.00 07.00
BDMIIIIED AND CBARGBD AS FOLLOWS
$0.00
tIBlR:
PAGE:
Lot:
020.000
D00012345
008
District:
1000
Received the Following I'_s For Above Instrwaent
Bv-apt
NO
NO
NO
NO
NO
NO
Page/riling
COE
EA-CTY
TP-5U
RPT
Tranafer tax
$9.00
$5.00
$5.00
$5.00
$30.00
$0.00
Handling'
NYS SRCHG
EA-S'rATB
Cert. Copi..
SC'l'H
COIIIIII.Pres
hes Paid
$5.00
$15.00
$75.00
$0.00
$0.00
$0.00
$U9.00
Bxempt
NO
NO
NO
NO
NO
NO
TlWfSrBR TAX WHBER: 04-08258
THIS PAGB IS A PART 01' TO INSTatlNlN'r
THIS IS NOT A BILL
Edward P.Romaine
County Clerk, S~folk County
~L~A:;E TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473.7222
FOR COUNTY USE ONLY
C1, SWIS Code
REAL PROPERTY TRANSFER REPORT
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RI'-521711,"JI'lJ
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
C2. Date Deed Recorded I OCl I ,;;2 3 jOy
Monf~ Day Y~ar
C3. Book I /~.)., ),7< )iC4. Pagel ,0.0,::5
PROPERTY INFORMATION
RP - 5217
1. Property L...2QlO
location S~REH ~U\IBER
Bray
STAEETNAME
__ .J
SOltthnld
ClrvOR TQI'm
T :lI1TPl
VfllA<:E
l1QAR
ZIP CODE
2 Buyer
Name
01 iVPT
lASTNM.lf CO.'1PANY
Jane S. as Trustee of
Richard Staplet~n
Trust
'IRST"-"",';;
L--.-
lASTNO,ME/COMPANY
FIRST NAME
3. Tax
Billing
Address
InCicatewhcrc rUlureT~x Bills are to be senl
ifotherth/!!n buyer <lddress lal bottom offorml
Ju
LAST NAME !COMPA~~Y
FIR$TNAME
5TREETNu~"aERA"lDSTRHTNAME
CHV OR TO'''''''
STATE
ZIPCO:)E
4. Indieat~ the number of Assessment
Roll parcels transferred onthe deed
.'
.J # of Parcels OR 0 Part of a Parcel
(Only if Part of a Pllrl:el) Check a.. they appty;
4A, Planning Board with Subdivision AuthNity Exists 0
4B.Subdivision ApplOval was Required tor Transfer 0
4C. Pllrcel Approved fer Subdivision with Map Provided 0
L
5. Deed
Property
Size
t
'-:-,-0
OEPTH
AC'H'S
--~ Ixl
FRON1FEET
lOR I
.
..J
6. Seller
Name
Stapleton
LAST NAME -COMPANY
Richard T.
,,pST'.A'.'E
L
_.J
LASTNIIME,'COMPANY
l=:IlSTNAMe
7. Cne<::k 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
9. New Construction on Vacant Lana
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
A~oneFamilYReSidential
B 20r 3 Family Residential
C Residential Vacant land
o Non-Res'dential Vacant land
E~A9ricultural
F Commercial
G Apartment
H Entertainment i Amusement
I ~ Community Service
J Industmll
K Public Service
L FOlesl
SALE INFORMATION
15. Check one or more of these conditions as applicable to trander:
A Sale Between Relatives or Former Relatives
B Sale Between Related Companies or Partners in Business
COne of the Buyers is also a Seller
D Buyer or Seller is Government Agency or l()r)ding Institution
E Deed Type not Warranty or Bargain and Sale (Specify Below)
F Sale of Fractional or less than Fee IntereSl (Specify Below)
G Significant Change in Property 8etween Taxable Status and Sale Oates
H Sale of Business is Included in Sale Price
r Other Unusual Factors Affecting Sale Price ISpecify Below)
J X None
Transfer from owner into Trust
11. Sale Contract Date
/
Month D., Yeal
7 / i.{ 04
Moo. Yea.
- 0
0 , o I
12. Date of Sale !Transfer
13, Full Sale Price
l , .
iFullSllle Price iSlhe lotal amount paid for the property including personal property.
This oaymant may be in the form of cash. other property or ~oods. or the aSsvmplion of
mortgages or other obligations.l Please round to riM neilres{ whole dollar amount.
14. Indicate the value of perSOl'lol
property included in thasa!!'!
u , 0 t
, , .
ASSESSMENT INFORMATiON - Data should r@f1ectthe lat@stFinal Ass@ssment Roll and Tax Bill
16 Year of Assessment Roll from ~
which information taken 17.
Total Asussed Value lof oil parcels in transfer) I
1, /...., /)
/~
"'=.::.:~--i... I ! '
18. PropertyCJlIss
~ I ,UI-LJ
19. Schoof District NlIme I
20. Tall Map Identifier!sl I Rollldentjfier[s) (If more than four, IIttlleh shell'l: with additional identifier!s)]
L . /OOQ..=/.:2? - 7 -d<.o
I CERTIFICATION
I <'ertif~' that all of the itl'm~ of infomlation enlen:d on Ihi~ form are true and {"orrecl (to the be.~l of my knowil>dge and bellcO and I understand that the making
of an~' willful ral~e statement of material faCl herein "ill .~uhjecl me to the prO\ision~ of the Denal law relathe 10 the making and filing of flllsl' lnstnllllellK
BUYER
BUYER'S ATTORNEY
~l>f-'~_ & {Lv<. ~
B~~RSICNATOAE
d. 03D &n./. {/i
S~~HNUMBH S~REHNAMfUERSAll:~.'
iVi
17 /31 Jo,!
DATE
\r' I C/Vs~7U /.-A.?
tJ/-sd
lAST NAME
UISTNAr,1,
/,$/
AREACOOE
76t/-7~~~
TElliPMONENUMSER
.,q .'d'
./ i f,~
ZIPCOOE
c
~jC
CITY OR TO....N
STATE
r-:EW YORK ST.::l
L COpy ~
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