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BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANTOR'S
ACTS (INDIVIDUAL OR CORPORATION)
STANIlARI) NYBTU FORM 8007
CA.lITIO!'ll: THIS AGREEME..'lT SHOULD DE PREPARED BY AN ATTORNEY AND REVIEWEIl Ity AlwroRNJ;YS J;OR SELLtiR AND
PURellASER DEFORE SJ(lN'INCi.
\ ,;: 1-'"'
August -.::J
THIS INDENTURE, made the
hetWt!eD
2003
ELEANOR PEDERSEN, a. TrWlt"e (lfTb" EleoDor Ped""'''D Living Trust
dated May 1,2001
",siding at 21115 Sigsbee Rd.
Matrituek, NV 11952
p3rty Clfthe first part, and
NANCY J. RODlLOSSO
residing Ht 30 Meadow Court
Soutbold. NV Ilenl
party Clf tbe second part.
WITNESSETH. that the party (If the tirst part, in consideration of Ten Dollars and other lawful
consid'l:ration, lawful money ofthe United SIBtC'S. paid by the pany of the second Part. docs hereby grant and
release! unto the party of the second part, the heirs or successors and assigns of the party oflhe second pun
forevcl;.
ALL thut certain plOl, piece or parcel of land. with the buildings and improvements thereon erected.
situale., lying and bring al MaUiluck, Town of Soulhold, County of Suffolk and SIDle of New York.
SEE SCHEDULE 'A' A1TACI.IED HERETO AND MADE A PART HEREOF
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Premises are the same 3S dcseribed in deed dated 9/19101 recorded 1011210] in
Liber 12146 Page 685. Together wf.th all the seller's r1.ght I t:i.tle and l.nterest
to rf.ghts of ways set forth 1.0 Liber 2364 Page 230.
TOGETHER with all righI, title, and inleresl, ifuny, oflhe party ofthe filSl part in and 10 any slreets and
roads ~,butting the above described premises to the center lines thereof,
"
TOGETHER with the appurtemlOces and all the eslDle 3nd rishts ofthe party uflbe first part in and 10
said pr'l[:miscs..
TO HAVE AND TO HOLD thc premises herein granted unto the party of the second part, lhe heirs or
successors and assigns of the party ofth,= second part forever.
AND the party of the first part, c:ovenants that the party of the first part has not don~ or suffered anything
whereby the said premises have been encumbered in :my way whatever. eKcepr as aforesaid.
AND the' party of the tirst pan~ in compliullce with Section 13 orthe Lien La"'.'~ ~llv~mmlS that the party
of the tirsl part will receive the consideration for this convc}'ance and will hold the right to reccive such
consid(~ration 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. orthe cost oflhe improvement bcfore using any part or the total of the same
for any other purpose.
The won! "party" shall be construed as if it read "parties" whenever the st:nse of this indenture so
requires.
IN WITNESS WHEREOF, the p3rty of the first part h.as duly execuled this deed .he day and year lirst
above ,.nitten.
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~\lOR PEDERSEN
NYSRA RcsidelutiaJ Rt'w EslG1le Forms on t1otDocs". (91OO)
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Cop)"righl Cap.son" Ikvelopmcnl
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STATIEOF NEWYORK
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) 55.:
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COUNTY OF SUFFOLK
On the l J day of August, 2003. before me. the undersigned. personally appeared ELEANOR
PEDERSEN, personnlly known to me or proved to me on the basis of satisfactory evidence to be the individual
whose name is subscribed to the within instrument and acknowledged to me thol he executed the same in his
capaci1:y, and that by his signature on the instrument. the individual, or the person upon behalf of which the
individlual acted, executed the instrumcrlt.
Ll J 1/ c
NOT,~RY PUBLIC
DEED
VICTORIA CHARCZUK
Notary Public, Slate of New YorK
No. 48f;0488
Qualified in Nassau County 1"\ I
Commission Expires January 20. 2O-J.L.'"
Jritle No.
I'I!:DERSEN
To
Section 126.00
Block 06.00
Lot 003.001
County or Town SUFFOLK
IRODlLOSSO
Return By Mail To:
RUDOLl>H H. BRUER, ESQ.
55000 MAIN RD.
SOUTHOLD,N\' 11971
Resenle This Space For Use Of Recording Offiee
NYSDA RlI:'sidenli~ RcDl ES.lll.1C' I'onnsun llolllocs. {91OO1
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COI,)"ri!;h1 capsof!... Ikvdopmenl
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.1: 5& 7&52752
PAGE B4
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TITLE NUMBER: 641-5-02219
SCHEDULE "A" DESCRIPTION
ALL that certain plot, piece or parcel of land, situate, lying and being at .
Mattituck, In the Town of Southold, County of Sl,Iffolk and State of New York.
known and deslgnateC: as and by the Lot Number 115 and part of Lot 107A, on .
a certeln Map entitled, "Amended Map of Property of Matt/tuck Park,
Properties, Inc., Mllttituck, N.Vo", made by Daniel R. Voung, Surveyor, and
which said Map was filed In the Office of tlte Clerk of the County of Suffolk on
1/12/26 as Map t#801. which Lot and part of LQt which taken together are more
particularly bounded and described as follows:
BEGINNING at a point on the easterly side of Sigsbee Road distant 100 feet
southerly as measured along the easterly side of Sigsbee Road from the
comer formed by the intersection of the easterly side of Slgsbee Road and the
southerly side of Peconlc Bay Boulevard; from said point of beginning;
RUNNING THENCE North 65 degrees 07 minutes 40 seconds East 140.39 feet;
THENCE South 20 degrees 38 minutes East 104.55 feet;
THENCE South 66 degrees 59 minutes West 140.13 feet to the easterly side of
Slgsbee Road;
T~ENCE North 20 degrees 38 minutes West along the easterly side of Slgsbee
Road, 100 feet to the point or place of BEGINNING.
;.
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Number of pages
TORRENS
Serial #
Certific.1.1e #
Prior Of. N
Deed. Mongage Instrument
Deed I Mongage:rax Stamp
.:I:C:
FEES
Page I Filing Fce
Hundling
5 JllL.
TP-584
Notation
EA-5217 (County)
Sub 1"0[0.1
EA-5217 (Stale)
R.P.T.S.A.
~
Camm. of Ed.
5. ..!XL
Affidavit
..Certified Copy
. Reg. Copy
.'
Sub Total
Grond T010I_\ a 7. --
3.1
Lot
Other
1000 ----rl26
4 District~Section
Real
Propcny
Tax Service I
Agcncy
V~ific:ltion :
I B~OCk
.,.....,
03035861 1000 12600 0600 003001
~~
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. . - - - - . - . ___. ~. .1
~'acliOnlDiSCh3rgeslReleasc List Propeny Owners M3iling Address
RECORJ) & RETURN TO:
Rudolph H. Bruer. Esq.
55000 Main Rd.
SouthllId. NY 11971
7
Co. Name
Tille #
~
RECORDED
2003 Sop 15 05:48:26 PM
Edward P.Romaine
CLERK OF
SUFFOLK COUHTV
L 00OOI22n
P 216
on 03-06194
Recording J Filing Stomps
Mongagc Amt.
I. Basic Tax
2. Additional Tax
Sub Total
Spec. I As.!Oir.
or
Spec. I Add.
TOT. MTG TAX
Dual Town _ Dual County _
Held for Appointment _
Transfer T"" ao L\. () .-- _
Mansion Tax
d'
~he properlY covered by this motgage is
or wi1l be i mpro,,'ed by a one or two
family dwelling only.
YES __ or NO
If NO. see appropriate tax ctause on
page # of this instrument.
S Communit Pl"escr\'ation ."und
..
Consiueration Amount S
CPF Thx Duc"
Improved <
V3c~ml Land
TD
10
TD
TD
Title Company Information
Pecon1c Abstract, Inc.
This page fonns part of the attached
Suffolk County Recording & Endorsement Page
641-S-02219
1)'I;'17T"1
(SPECIFY TYPE OF INSTRUMENT)
made by:
ELEANOR PEDERSEN. AS TRUSTEE OF THE
ELE:l!'l.H8R P88ERSSlJ l.r.'ING TRI:l'St The premisis herein is situ:ucd in
TO
SUFFOLK COUNTY. NEW YORK.
In the Township or SOUTHOLD
,
)f.Al{C'Y T RQDX"r O~in
In (h~'VILLAGE
or HAMLET or
"OXES 6 THROUGH 8 MUST BE TYPED OR PRII'ITED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING
(over)
('
1111111111111111I1111I111111111111111111111111111111111
11111111111111111111I1111
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of: Instrument: DEEDS/DDD
Number of Pages: 4
TRANSI~R TAX NUMBER: 03-06194
Recordeei :
At:
LIBER:
PAGE:
09/15/2003
05:48:26 PM
D00012272
216
Distric:t:
1000
Sect~on: Block:
126.00 06.00
EXAMINED AND CHARGED AS FOLLOWS
$510,000.00
Lot:
003.001
Deeei AIIIIOunt:
Page/Filing
COE
EA-CTY
TP-584
RPT
Transfe,r tax
Received the Following Fees For ACo". Instrument
bempt
NO Banciling
NO NYS StJRCBG
NO EA-STATB
NO Cart. Copies
NO SCTH
NO CDIIIIIl. Pres
Fees Paiei
$12.00
$5.00
$5.0Cl
$5.00
$30.00
$2,040.00
$5.00
$15.00
$50.00
$0.00
$0.00
$7,200.00
$9,367.00
Exempt
NO
NO
NO
NO
NO
NO
TRANSFER TAX NUMBER: 03-06194
THIS PAGE IS A PART OF THE INS'1'RtJMZNT
Eeiwarei P.Pnm~ine
County Clerk, Suffolk County
FOR COUNTY USE QNL Y
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE 15181 473-7222
I
t!1i.5 Z 3 C:L
C2. Date Deed Recorded I q / is- / 6~
\ 1"'"'\ ~'\ .~onth Day yea,
C3. Book L~ C4. Page ~ \ \.n
PROPERTY INFORMATION
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C1. SWIS CClde
1. Property ~~15
location HREET NllMElER
Sigsbee Rd.
STREET NAME
L Southold
f;I1YOHTOWr-..
MATTI TUCK
VILLAGE
2. Buver Utodi 1 os so
Name l.AST NAME I COMPANY
Nancy J.
fiRST NAME
L__
LAST NAME I COMPANY
FIRST NAME
3. Tax
Billing
Address
Indicate where future Tex Bills are to be sent
if othnr than buyer address (al bottom of forml
L-
LAST NAME I COMf>AI'fY
L __
STFlfH NUMBER AND STR~H NAME
CIN OR TOW',!
4. Indicate the number of Assessment
Roll parcels tr;lnsferred on the deed
I # of Parcels OR 0 Part of a Parcel
5. Deed
Property
5i:.:e
10RL
iiin.n,,~ I X
f ON'TFEET
L
ACRES
.
OEP1H
6. Seller
Name
LJ?edersen
LAST ~AM~ I COMI'ANY
Eleanor
~1f\STNAME
L .._
I.ASTNAME!COMPANY
~IRST NAME
7 Check the bOl< below which most accurately describes the use of the property at the time of sllle~
A~ One Fa'T1iiy Residential
B 2 or3 FlImilvResidenlial
C Residential Vacant lar.o
D Non-Residential V,lI;:ant Lend
~~
Agriculturel
Commercial
Apartment
Entertainment/Amusement
~~
Community Service
Industrial
Public Service
f.oresl
I SALE INFORMJ:,TION
11. Sale Contract Date
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP_$217 KnJ/'J7
.-J
11952
ZIf>CODE
.-J
fiRST NAME
STATe
ll.DCDDE
IOnly if Part of .a Parcel) Check as they apply
4A. Planning Board with Subdivision Authcrity Exists D
48. Subdivis-on Approval was Required for Transfer 0
4C. Parcel Approved for Subdivision with Map Provided 0
(as Trustee of the Eleanor ~ed~rsen
Living Trust)
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Check the boxes below as they apply
8. Ownership Type is Condominium
9. New Construction on Vacant Land
10A. Property Located within ar Agricultural District
108. Buyer received a disclosure notice indicating
that tho property is in an AgriculturClI District
o
o
o
o
15. Check one or more of these conditions as applicable to transfer:
7 3 I 03
Month 00' Year
8 I; I 03
Month wo, Year
A
B
C
o
E
F
G
H
I
J
12. Date of Sale I Transfer
13. Full Sale Price , 5 , 1 I 0 I 0 . 0 ,0 0 , 0 I
, , .
(f-ull 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 c,ther obligations.! PleBse round to the nearest whole dolfar amount.
14. Indicute the value of personal ,0 0 I
property incll~ded In the sale ; e
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill
16. Vear of A&&elisment Roll from
whieh information taken
b:3 I 17. Total Ass&ned Value (of all pareels in trarwferll
18. Property Cf41MI
I ';;;/~-L.J 19. School DistrHrt N41me I
#-/2-
20. Tax Map IdentiflerlsJ I Roll Identiflerlsl llf more than four. attach sheet with additionelldentifierlsl)
1000-126-6-3.1
L-
Saia Bat\Aieen Relatives or Former Reiatives
Sale Between Reiated Companies or Partners in B'-Isiness
One of the Buyers is also a Salla!
Buyer or Seller is Government Agency or Lending Institution
Deed Type not Warranty or BClrgain and Sale (Specify Below!
Sale of Fractional or Les5 th<ln Fee Interest :Specify Below)
Significant Change in Property Be;,ween Taxable Status and Sale D<ltes
Sale of Business is Included in Sale Price
Other Unusual Factors Affecting Sale Price (Specify Below)
None
, - ,
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1'-!U.V'110-
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I CERTIFICATlorU
I certify that aU of the ilems of information entered on this fonn are true and cor~t (to the best of my knowledge and belief) and I understand that the making
of any ,,"llfill false statement of material fact herein will subjed ~ to the DrovL-lIons of the oena! la\\ relatil-e to the makin~ and fili~ of false instruments.
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SELLER
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BUYER'S ATTORNEY
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