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C:ON8ULT YOUR LAWYER BEFORE S1GN_ naa _TRUIIENT-THIS INSTRUIIENT SHOULD BE USED BY LAWYERS ONLY
'r~ls INDENTURE, made the ,~ dey of June, 2004
IIETWEEN HARVEY DONENFEI_D, residing at 2355 Delmer Drive, Leurel, NY 11948
1+.
,'erty of the first part, end RICHARD E. JERNICK end MA~)iA JERNICK, husbBnd end 'f~' both residing et
NO "iF mAIN .s:T., P. Q. .csoX, 11/ cr~ fI1Arn"h.l~, IIJ.., tl'/<;J"a-
IlSrly of the second pert,
IMTNESSETH, that !he perty of the first part. In consideration of TEN Bnd noll DOlhs ($10.00) dollers paid by
the perty of the second pert, does hereby grent end releese unto the party of the BBCond perl, the heirs or
llUcceBS0r8 end lI8Slgns of the party of the second part forever,
.... JU-L thet certain plot, piece or percel of lend, with the buildings end Improvements thereon erected, slluele,
lying Bnd being et Laurel, In the Town of Southold, County of Sull'olk end SIeIe of New York. known and
designated 88 Lot No. 17 on e certein mep antlled, "Mep of Laurel Country Estetes", end filed In the SuII'oIk
C::OUnty Clerk's OfIIce on June 22, 1970 es Map No. 5486. bounded end dBBCrtbed es follows:
BEGINNING et e point on the southwesterly side of Delmar Drtve dlslent 255.57 feet northwesterly as
Ineesured elong !he southwesterly side of Delmer Drive from the axtreme northwesterly end of !he src of e
C:lJrve connecting the southwesterly side of Delmer Drtve and the northwesterly side 01 Joseph Street;
I~UNNING THENCE Soulh 71 degrees 23 minutes 40 seconds West, 151.75 feel to e point;
'rHENCE North 18 degrees 38 minutes 20 seconds West, 140.00 feet to e point;
'rHENCE North 71 degrees 23 minutes 40 seconds Eest, 150.00 feet to the southwesterly side of Delmar
Drive;
'rHENCE south88sterly Blong the southwesterly side of Delmer Drive tha following TWO COUrsBS and
distances:
'I. South 18 degrees 38 minutes 20 BBConds East, 38.28 feet to e point; and
:1. Along the 8I'C of e curve to the left having a radius of 2958.13 feet a dislence of 101.74 feel to the point or
piece of BEGINNING.
IIEING AND INTENDED TO BE the seme premises conveyed to Hervey Donenfeld end Elizabeth H. C.
l:>onenfeld by deed mede by Mergeret T. Pupplo dated Merch 31, 1980. recorded April 4, 1 B80 In Llber 8601
c:p581.
TOGETHER with ell right, title end In_t, If any, of the party of the first pert in end to eny streets end roeds
,_ng !he ebove described premises to the center lines thereol; TOGETHER with the appurtenances end all
lhe _ end rights of the perty of the first part in and to BBid premises; TO HAVE AND TO HOLD !he
,'remises h_ln grented unto the perty of the second pert, the heirs or successors end essigns of the party of
Ihe second part _er.
,!\ND the party of the first part covenants that the party of the first pert h88 not done or suffered enything
".hereby the BBId premises have been encumbered In any way whetever, except es efonsSBld.
.!\NO the perty of the first part. In compliance with SeelIon 13 of the lien Lew, covenents that the party of the
tirst psrt will receive the conslderetlon for this conveyance and wUI hold the right to receive such consideration
liS e trust lund to be epplied first for the purpose of paying the cost of the Improvement and will apply the ssme
lirsl to tha payment of the cost of the Improvement before using any pert of the totel of the BBme for eny other
l'Urpose. The word "party" shall be construed es If It reed "parties- whenever the sen88 of this Indenture so
r&qulres. .
IN WITNESS WHEREOF, the party of the first perl hes duly executed thle deed the dey end year first ebove
written.
IN ~ESENCE OF:
~l)~
,
.
. .
as:
TO BE USED ONLY WHEN THE ACkNOWLEDOIIENT IS MADE IN NEW YORK STATE
.
Stale or N_ York, County of Suffollc
On the I.&L day of J..... In the year 2004
- me, the undenIIgned, I>lnOI>8IIy appeal1ld
HARVEY DONENFELD
PB""",eUy known 10 _ or proved 10 me on tile bull of
satisr,1ICIOIy _ ,_ 10 be tha Indivldual(.) _ neme(.) Ia
(-) IUbIIcrIled Ib the within lnelrument and -..ow1ldgecllo
me that heIaheIlhey ltJl8CUted tile ...... In hlelherllhelr
_:Ity(ieII). and that by hlalh8l1lhelr e1gnature(.) on the
lnalrument. the 1nd1vIduaI(,), or the _ upon _ or which
the lr>ilMdual(.) _, eX8CUleclthe lnetrument.
~~ a~ o".:'.;M:d~'1ak1ng eclcnowtedgment)
NOTARY PUBLIC
LINDA.J,~.
~~--
_1bjIl_1h. mberS~
SIlIIe of N_ York, County of
On the day of In the year
Befont me, the und81S1gned, pereona/ty _red
pereonaIIy known III me or proved III me on the -. or
aaIIIIfactory evldenee 10 be the Indlvldual(.) _.. name(.) Ie
(ere) eubecribed III the within lnetrument and ~ III
me thet heIaheIlhey ltJl8CUted th. ..me In hlalherllhelr
capecIty(-), and the! by hlelherflhelr .Igneture(.) on the
lnelrumenl. the Indlvtcluel(.), or the PBI1IOn upon behen of which
the 1ndIvtdue1(.) _, """"uted the InnumenL
as:
(lIlgneture and ofllce of individual taking eclcoowledgment)
Stale (or Dlatrfct of CoIumbl.. TerrtlOry. or Foreign Country) of
TO BE USED ONt Y WHEN THE Al!IfNnWI .nt!IIENT 18 II~E OUTSIDE NEW YORk STATE
Onthet
deyof
In the year
as:
before me, the underelgned, pereonaHy oppeered
pereorl8lly known III me or proved III me on the _ of ..-.:lory evtdonce 10 be the IndIvldual(o) __ no_(o) 10 (orel
.ubocrlbed III lhe within Inolrwnent and -r>owIedged III me thot heIoheIIhey ltJl8CUted the _In hlalherllhelr cepoc/ty(leo), ond
that 1>1' hlelherllhelr .Ignalure(o) on the Inlllnlment, the Indlvldual(o), or the person upon beh8n or which the Indlvidu8J(.) _,
ellllCUled tholn.lrumenL .nd that .uch Indvtduel made ouch _renee before th. undereIgned In the
In
(ond ...... tile _ or Country or other place lhe acknMIedgmtll1l_ Iaken)
(in'lWI the COy or other poItUc:aI'_ionj
BARGAIN AND SALE DEED
WITH Cl:lVENAHT AGAINST GRANTOR'S ACTS
TIlle Nel.
HARVEY DONENFELD
TO
RrCHA~iD E. JBRNICK.nd MARTIJA JERNIC'K. husband
and wife
STAHDARDFOIUI Of' NEWYORKIIOARDOPTn'LE UN.............1&IUI
~~
o Com~~~.._"y
Cc.~M.'EALTH LAI'\o"D TlTI.e INIIl.'llANCECoMPANY
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(.Igne.... and 01f1C8 of individual laking _odgmonl)
DISTRICT 1000
SECTION 127.00
BLOCK 04.00
LOT 004.000
COUNTY OR TOWN
STREET ADDRESS
Recorded at Requnt of
COMMONWEALTH lAND TInE INSURANCE COMPANY
''''411 Tn.
WILLIAM A. SULAHIAN. ESQ.
P.O. Box 386
Sheller 1018nd Helghla. NY 11965-0386
[1'"2
]
Number of pages 3
TORRENS
Scriall/_
REaJlDED
2004 Jun 17 03,34,27 Pt'I
Eduard P. Rouine
CLERK IX'
SUFFOLK COUll rv
L 1>00012325
P6n
D7. 03-47677
Cenificate N _
Prior Of. 1#_
Deed / Monpg. Il1Slrumenl
Deed / ~e Tax SllIInp
FF.ES
Recording / Filing Slamps
JJ
Poge / t'iling F.,e
Illmdling
TP-S84
Mottg_ Amt.
I. lJasic Tax
2. Addition.ITax
Notation
Sub 1'018.
!;A-52 17 (County)
IlA.S217 (5181")
Sub 1'_1
Reg, Copy
Other
Sub 1'_1
Spec J Assi..
Or
Spec./Add.
TOT. MTO. TAX
Dual l"OWR_ Dual Counly_
Held for Appurtiunmenl _._
Tl1lIISferTu lifQ/J.
Mansion T
The proper! covered by .hi. mort.!. i. or
will be im roved by . one or two family
dwelling on ,
V. orNQ
If NO. see propri.te tax clause on p88C" U
_ofth irulrummt.
R.P.T.S.A.
---:-"7tr
Comm. or Ed.
Affidovit
S~
Certified Cop)'
ORAN[) TOTAL
5
Real PlupenyT"" Service Agenc:y Verilicslion
DisL Section . ,=,.lcx:lr.
Lot
1
7
- .
Sali.factionslU..clulrgesIRel..... Li.1 Property Owner. Mailing Add
RECORD" RETURN TO:
1000 12700 0400 004000
CPF '-ax Due
Stamp
D81e
Improved
x
Inil ials
Vacant Land
10
William A. Sul.hi.n, Esq.
P.O. 80'" 386
Shelter Island Hts., NY 11965-0386
TO
TO
TO
This IIl'I8C forms purt or 1hc a1tached
B Title Company Information
Co. Name .A-n'ON1i:\L
Title # ~
Suffolk County Recording & Endorsement Page
Deed
mac1cb)":
~
(SPECIFY 'IYPE OF JNS'IRUMEN'I' ,
HARVEY DONENFELD
The premises ....'l'Cin is silLl1lcd in
SUFFOLK COUNIY. NEW YORK.
In the To,",nship of Southol d
In lhe VILLAGE
or HAMLET of
Laurel
TO A.
RICHARD E. JERNICK and MARTHA JERNI€K,
husband & W1fe
BOXES 5 THRU 9 MUST BE lYPED OR PRINlTD IN BlACK INK ONLY PRIOR TO RECORDING OR FII.lNG,
lOVER)
1111111111111111111111111111111111111111111111111111111
1111111111111111111111111
SUPPOLlC COUNTY CLERK
RECORDS OPPICB
RECORDING PAGE
Type of Instrument: DBEDS/DDD
Number o,f Pages: 3
Receipt Number : 04-0068885
TRANS PER TAX NUMBBR: 03-47677
Recorded:
At:
06/17/2004
03:34:27 PM
District:
1000
Section: Block:
127.00 04.00
UAMINED AND CHARGED AS POLLOWS
$350,000.00
LIBBR:
PAGE:
Lot:
004.000
D00012325
672
Deed Amount:
Received. the Following Pees For Above Instrument
Exempt
NO
NO
NO
NO
NO
NO
Page/Piling
COE
BA- CTY
TP-584
RPT
Transfer tax
$9.00
$5.00
$5.00
$5.00
$30.00
$1,400.00
Handling
NYS SRCHG
BA-STATB
Cert.Copies
SCTM
Comm.Pres
Pees Paid
$5.00
$15.00
$50.00
$0.00
$0.00
$4,000.00
$5.524.00
Exempt
NO
NO
NO
NO
NO
NO
TRANSFER TAX NUMBBR: 03-47677
THIS PAGE IS A PART or THE INSTRtlXENT
THIS IS NOT A BILL
Bdward P. Romaine
County Clerk, Suffolk County
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE 1518) 473-7222
FOR COUNTY USE ONLY
REAL PROPERTY TRANSFER REPORT
C1. SWIS Code
'7", ?,3,-$?, 'f4J
STATE OF NEW YORK
STATE BOARD OF AEAL PROPERTY SERVICES
*
C2. Date Deed Re<corded ! Vb I /? / ~~v i
MDnth Day VaT
C'.'iook 1/..2 :?,d<" S~..p.g.L, 0',?,2.l
PROPEBTY INFORMATION I
RP - 5217
Rr-52l7Re,-J/97
1. r:~;il:~ 1
2355
--.J
Oelmar Orive
STRHT~UMaER
STREETttAME
L.2outhol d
CITY OR TOWN
Laurel
VIUAGE
111948
ZIPCODF.
2 Buyer
Name
Jernick
lAST NAME I COMPANY
Richar:d. F.
FIRST NI\ME
;:t
Jernick
Martha
_..--J
lAST >lAI>4E I COMPANV
FIASTAAME
3. Tal( Indicate where fulure Tax Bills are to be sent
Billing if other than buyer address lat bottom of form) L
Address
._J
LAST NAME I COMPANY
fIRST NA,M~
I.
STREH NUMBER AND 5TAEET"NAME
STATE
ZIP CODe
CITY OR TOWN
4 Indicate the number of AS$e5$mlllnt
Roll pan::el$1rllnl;ferred on the dee-d
I # of Parcels OR D Part of a Parcel
(Only if Part of a Pan;ell Check as they apply:
4A. Planning Board with Subdivision Authority Exists
48. Subdivision Approval was Required for 1 ransler
4C. Parcel Approved for Subdivision with Map Provided
o
o
o
.1
5.0eed
Property
Si:lB
lOR I
AC"'ES
o .4 . R I
,_--.J X I
~~Ot'>THET
OEPTH
6. Seller
Name
Donenfeld
Harvey
FIASTNAME
LAST N"M~ltOMPAHY
L"ST N..",Ei COMPANY
FIASTNAME
Cneck Ine box below which most accurlrtely describes the use of the property at the time of sale:
Check the boxes below as they apply:
B. Ownership Type is Condominium
9. New Construction on Vacant land
lOA. Property located within an Agricultural District
108. Buyer received a disclosure notice indicating
that the property isin an Agricultural District
o
o
o
o
A~ One Family Residential
B 2 or3 Family Residenlial
C Residential Vacant Land
o Non-Residenti~1 Vacant lend
I SALE INFORMATION I
11. Sale Contract Date
E~Agricultural
F Commercial
G Apartment
H Entertainment I Amusement
I ~ Community Service
J Industrial
K Public Service
L Forest
15. Ch.-ek one or mora of these conditions as applicable to transfer:
I 04 / 08 04
Moolh Do, Y!!ar
L 06 / q / 04
"~. Do, Year
A
B
C
D
E
F
G
H
I
J
Sale Between Relatives or Former Relatives
Sale Between Related Companies or Partners in Business
One of the Buyers is also a Seller
Buyer or Seller is Government Agency or Lending Institution
Deed Type not Warranty or Bargain and Sale (Specify Belowf
Sale of Fractional or Less UllIn Fee Interest ISpecify Below)
Significant Change in Property Between Taxable StalUs and Sale Oates
Sale of Business is Included in Sale Price
Other Unusual Factors Affecting Sale Price ISpecify Below)
None
12. Date of SilllllO/ Transfer
13. Full Sale Price , 3 , 5 , 0 , 0 , 0 , 0 , 0 , 0 I
, , .
IFul1 Sale Price is the 10tal amount paid for the property mcll,lding personal property.
This payment may be in the form of cash, other I'rOl'8rty or goods. or the assumption of
mortgages or other obligalicns.) PI6ase round to the near6st whole dollar amount.
14. Indicate the value of personal l 0 , 0 I
property included in the sale - , , ~
I ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill I
16. Year of Assessment Roll from ~ 17. Total A_sid Value lof all rulrl;:els in transfer) L_.>-
whic;h information llaken ,...-
4 900
,
18. Property Class
i2
Mitttitllr:k-r.utr.l1ogIlP
1 Ol-U '9. Sl;:hool District Name I
20. Tax Map Identifier!s) I Rollldentifillr(sJ III more than four, attach sheet with additional identifier(s]l
1000-127.00-04.00-004.000
L
I CERTIFICATION
I certify that aU of tht! items of infomuttion entered on tlnis fonn are true and correct (to the best of my kno'<\'lcdg,' and belief) IInd I understWld that the making
of any willful fallie stalement of material fact herein will !;ubjct:l me to the onr\oisions or the oenw law relative to the making and nling or falM' in~trumcnts.
BUYER
BUYER'S ATTORNEY
r2!,d!~~,#~-
;135'3- t"YUI,b? J:,;e
STIlEHNUMOEA SHIEHfIlAMEI.o.FTtRSAL[1
Sul ah i an
Will iam
LASfNAM[
FIRST NAME
(631)
749-1402
ARE"COOE
rHEPHONENV\'IBEA
J4/f:g~7
I/ql/?
ZIP CODE
~ y"'",m :
COpy
/I1Y
STATE
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