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S"nd8ld N,'V' B.T.U. Form 8002 . BIIrgain and Sale Deed. with Coven.nt..,.I"_ Gr.nIDr'a Ac:Is - Uniform AcknowledQment
Fonn 3210 ,
CONSULT ,rOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD Be USED BY LAWYERS ONLY
THIS INDENTURE, made the l{p~ of July, 2004
BETWEEN
CAROL ,JURGIELEWlCZ, residing at 2650 Barkley Drive, East Villa D, West Palm Beach, Florida 33415,
party of the first part, and
DEBRA '3RANBERG, residing at 735 Wickham Avenue, Mattituck, New York 11952, party of the second
part,
WITNESSETH, that the party of the first part, in consideration of Ten and 00/1oo-($10.oo)-<lollars, and other good
and valuable consideration paid by the party of the second part. does hereby grent and release unto the party of the
~ond !,,:rt, the heirs or successors and assigns of the party of.the second part forever, ~
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 Stele of New York, being more particularly bounded end
described as follows:
BEGINNING at a point on the southeasterly' side of Wlckhem Avenue at the southeast corner of the herein described
premises where the same is intersec:l8d by land now or formerly of Timothy J, Brigham and Barbara S. Brigham: said
point or place beginning being also distance 200.59 feet northwesterly as measured along the southwesterly side of
WICkham Avenue from the corner formed by the intersection of the northwesterly side of Pike Street-Railroad Avenue
with the SI'Uthwesterly side of WICkham Avenue;
RUNNING THENCE from Aid point or place of beginning along land now or fonnerly of Brigham, South 50" 06' 3D"
West. 181.18 feet to a poin~
THENCE North 39" 18' 40" West, 62.02 feet to a point;
THENCE South 49" 19' 20" West, 18.42 flHlt to a point;
THENCE North 42" 19' 50" West, 7.05 feet to the southeasterly side of land of the Long Island Railroad:
THENCE along the land of Long Island Railroad, North 33" 16' 10" Esst 223.92 feet to the westerly side of Wickham
Avenue;
THENCE along the westerly side of WICkham Avenue, South 33" 28' 40" East. 134.52 feet to the point or place of
BEGINNII~G.
BEING J~D INTENDED TO BE the 'same premises conveyed to the party of the first part.
by deed dated April 19. 2002 and recorded in the office of the Clerk of the County of
Suffoll. on May 3. 2002 f.n Lf.ber 12184, page 35.
TOGETHI"R 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 estele 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 01' 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 wey whatever, except as aforesaid.
AND the ~..rty of the first part, In compliance with Section 13 of the Lien Law, covenants that the party of the first part
will racei"", the consideretion 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 COB'I of the improvament before using any part of the total of the same for any other purpose. The word "party"
shall be Cl>nstrued as If II 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:
~~~ .
.....t..u...
". Cnrol Jurg" cwicz ~
F/dL"(."d::!
..:. , ..
BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YORK STATE
State of New York. County of Suffolk. 8.:
On lheltf!!~ay mJL", . in the year 20~.
before me. the undersiGned. penlonatly appeared
CAROL JURGIELEWlCZ
pe~naay known to me or proved to me elln the basis of
aaliolaclor)' evidence to be the individua~a) whose name(a) ia
(are) subsc::tIbed to lI1e within instrument and acknowtadgeclto
me that Ihelshellhey executed the ..."e in hlBlherlthelr
capaclty(ie,,), and that by hllllherllhelr oignatul1l(a) on the
instrument. the lndivldual(s). or the perllOf'l UpoI'1l behalf of which
the I d 1.J181(.) acted. execute~ instrument,
Stale of New York. County of Suffolk n,
On the day of . in the year 200 .
before me, the undersigned. peraonaUy appeared
peraonally known to me or proved 10 me on the ballill of
aati.fac:loly 4Md1lf1Olt to be the individua~.) whoae name(a) ia
(are) subscribed 10 the within instrument and acknowledged to
me that helohellhey executed the same in hlllherltheir
capaciIy(Iee). and thel by hilllherllhelr algnalvl1l(') on the
lnatrument. the indlvidual(a). or the peroon upon behalf of which
the indMduaJ(a) acted. executed the lnalNmen!.
II 0 0 indiVidual taking ac:knowIedAment) , (oignalvl1l and offica of individual laking acknowledgment)
ul~lc r-" AB'CA':' A WIr..KHAM" \
. I Not~ry ~u~;i..:. State of NewVortc.
- ." ~2 -464787'1 ~
. CII'!:;:fi:;.': l.... Sutf(ioI~ ~:ounty ~~" ;
C(,!"M':"';~;,!,:::';:1 ~__'.:>I;C~ S""..~, 30. \9 ~ ~
.-..-
TO BE USED ONLY WHEii'THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE
n:
State (or District of Columbia. Territory. or Foreign Country) of
On the
deyof
. in the year 200.
County of
bafol1l me. the underaigned. personally appeal1ld
personally known to me or proved to me on a'e basia of aallafaclory evidence to be the individual(a) who.. nBme(a) ia (al1l)
.ubacribed to the within inalNmem and acknowlacIged to me that helshellhey executed the aama In hllllherlthelr capacity(iea). and
that by hialher/lheir IIignature(a) on the inalNment. the Indlvldual(a). or the peroon upon behalf of which the Indlvldual(a) acled.
executed the instrument. and th81luch individull made .uch appearance before the undersigned in the
in
(Inse,. llhe City or other poIiticalsubdivieion)
(and in.." the &.Ie or Country or other place the acknowledgment 'MIa t.ken)
BARGAIN AND SALE DEED
WITH CO'I/ENANT AGAINST GRANTOR'S ACTS
Title No.
Carol Jurgielewicz
TO
Debra Granberg
STAN)Nd)FORM OF NBVYORIC BOARDOF' tnLI! UNDI!R'WRITERS
_ D__ by
. Common~~~~.~..>_.",
(','N~l. ,"""'EAI.TII L\:o.:D Trrl.E IlIo'.iUR^'l..:i" c..""cJl.,P,\,S'"
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(signature and ofIIce of Individual t:8k1ng IICknow1edgement)
NoIaty Pubroc
SECTION
BLOCK
LOT
COUNlY OR TOWN
Recorded at Request of
COMMONWEALTH LAND TITLE INSURANCE COMPANY
1 2 I
3
Numberofpog.. .5
T'ORRENS
Serial #_
RECORDED
2004 Rvg 31 04.15,23 PM
Edward P.R~aine
. a..ERK OF
SUFFOLK COUNTY
L 000012341
P 006
DiI 04-05211
Certificate #.
PrIor af. #_
Doed / Mort...a llUItrwnenl
Deed / Mortaaaa Tax sbmp
FEES
Riloonling / Filing Stampl
J]
Page / FUing Fee
Mortaaaa AmL
I. Basic Tax
Handling
TP-SI4
2. AckIidonaI Tax
Sub TOlal
NoJation
EA-S2 17 (Cc.unty)
Sub TOIaI
GRAND TOTAL
{J
SpecJAall.
Or
Spec./AJJd.
TOT. M:f(3. TAX
Dual Town Dual County_
HoleI for Apportlonmenl
'lnnafor Tax <<
Man.lon Tax . _
The property oovered by Ibis mOr1gega is or
will be Improvad by . one or two family
dwellina only.
YES or NO
If NO, ..a Ipproprlale tax clau.a on paga #
oftbll L
s
EA-S217 (Sb.te)
..11=
. R.P. T.S.A.
Comm. of Ed.
S~
Affidavit
Certified Col'Y
Rail. Copy
Other
Sub 1'DCa1
JJ
SlamI'
Dele
R.eaI Property TIIX Service.Aprr:y Varification
1"0:... CZN"!t'lnn B lock Lot
1000 14000 0200 02D001
6! COlDIDuni
Con.alderatl!>n Amount S
Initiala ..... - ---
3 Satisfac1tions/Discharg~'='':t.L~~~ Mailing Addrea
J1
CPF Tax Due
Improved
Vacant Land
TD
TO
TO
... ...-.......
--...---
"'u_U_
~
B Title Company Information
Co. Nallla
TItIo 1# ':
Suffolk County Recording & Endorsenient Page
'IlW, psge forms pert of the Il1laCbed
Baraitili,.& Sale Deed
(SPECIFY lYPE OF 1NS1RIJMENI')
. The premises herein is situated in
SUFFQLKOOUNfY, NEW YORK.
mldo by:
Carol "urgi.elewicz
TO
In the Township of
In the VIlLAOE
or HAMLET of.
Southold
Debra Granberg
Mattltuck
. BOXES~; 1HRU 9 MUST BE TYPED OR. PRINJE) IN BLACK INK ONLY PRIOR TO RECORDING ORFIUNO.
11111111111111111111111111111111 11111111111111111111111
1111111111111111111111111
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGB
Type of Instrument I DEEDS/DDD'
Number Ol~ Pages: 3
Receipt Jfumber : 04-0096701
TRANSPER TAX NUMBER: 04-05211
Recorded:
At:
08/31/2004
04:15:23 PM
LIBER:
PAGE:
D00012341
006
District I
1000
Section: Block:
140.00 02.00
EXAMINED AND CHARGED AS FOLLOWS
$0.00
Lot:
029.001
Deed 1IIIIount:
Received the Following Fees For Above Instrument
Exempt Exempt
Page/FiJ.ing $9.00 NO Handling $5.00 NO
COE $5.00 NO NYS SRCHG $15.00 NO
EA- en $5.00 NO lA-STATE $50.00 NO
TP-5B4 $5.00 NO Cert.Copies $0.00 NO
RPT $30.00 NO SCTM $0.00 NO
Transfer tax $0.00 NO Camm.Pres $0.00 NO
Fees Paid $124.00
TRANSFER TAX NUMBER: 04-05211
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
Edward P.Romaine
County Clerk, Suffolk County
FOR COUNTY USE ONLY
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: httpJI www.orps.state.ny.us or PHONE 15181 473-7222
(/y, 7', 3 ,[3 ..f2.2..J
108/ g( ,({a;<,(.
Month Day Year
C3 Book 1/ ;;z, 3 /'1.1 I C4. Page uQ O,~,
PROP::RTY INFORMATION I
C1. SWIS Code
..,
. "
'; ", "
~ o!f'
CZ. Date Deed Accorded
',Prope.rty~5
Location STRfFl'><lJM8(R
Wickham Avenue
STREET~ NAME
Southold
Mattituck
VillAGE
CIN OR TOWN
2, Buyur
Narl'e
Granberg
lAST NAME iCOMPANY
Debra
FIRST NAME
l
LAST NAME/COMPANY
nASTNAME
3. Tax
BIlling
Addl'ess
Indicalp.-wherefuture Tax Bills are 10 be sent
it other lhall buye' address (at bonom of form) L
LAST."AMEiCO~PA><Y
1____
STREET "UMIER AND STREET NAME
CITY OR TOWN
4. Indiute the number of Assessment
Roll parcels transferred onths deed l_
1J # of Parcels OR D Pan: of a Parcel
5. Deecl
PrOflerty
Size
L-
FRONTFEH
I X L....._
CEPT!-<
_-.J OR I
.4 3 I
ACRES
6. S.1I1,r
Narre
~ielewicz
~/lST NAME/COMPANY
Carol
FI"STNAME
lA5T'NAME,CCMPAW
FIRST NAME
7 Ched the box below which most accurately describes the use of the propel1y at the time of s..le'
A~~one Family Residential
H 2 or3 -ami I, Res'denti.'
C Residential Vacant Land
D Non.Residential Vacant land
~B
HB
Agricultur~1
Commerci"J
Apartment
Entertainment/Amuser:cent
[~ Commun,tyservlce
J Industrial
K Public Service
L Forest
I SAtE NfOAMATION I
11. SldeContraet Date
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RI'.5217 Re,.Jf97
11952
z,p coo~
___ _--.J
;'RST N"M~
-.-J
I
STATE
ZIP CODE
(Only it Part of a Parcell Check as they apply:
4A. Plann'ng Boarrl with SUbdivision Authority Exists
48. Subdivision Approval was Required for Transfer
4C. Parcel Approved 10rSubclivision wi~h Map Provided
o
o
o
Check the boxes below as they applv:
8. Ownership Type is Conaominiurn
9. New Construction on Vacant land
o
o
o
o
lOA. Property localldwithin an Agricultural District
lOB. Buyer received a d'sciosure notice indicating
lhatthe property is in an AgricultUTa: District
15. Check one or more of these conditions as applicable to transfer:
Monlh n /('-1 Yea,
0,
7 / 10 (;If-I
Month 0., Y"ar
A
B
C
D
E
F
G
H
[
J
12, Dale of Sale I Transfer
13. Ful Sale Price
,C
o , 0 (
,
, ~I .
{Full Sale Price is the total amount paid for the propertyin,;ludi ng personal property
This payme'lt may be in the form of cash. other property cr goods. Of the ~ss\Jmpl;on of
mort~ages or othe.. obliga~;ons,: Please round (0 the nearest whole dol!ar amount
14, Indicate the value of personal ,C' H , (I I
property included in the sale, ~I .
I ASSESSMENT INFORMATION - Data should reflect tl1e latest Final Assessment Roll ilnd Tax Bill
16. Year of Asses5ment Roll from 103 .04 J 17. Tot..l Assessed Value lof all parcels in transfer) I
whtch infonnation taken
18. Property Class
IXg{WJ0( I-U 19. School District Name: Mattituck-Cutchogue
210
20. TalC Map Identifierlsll Rollldentifierls) (tf mora than "our, anach sheet with additional identffil;'r(sll
L
1000-140-2-29.1
Sale Between Relat,ves or Former Relatives
Sale B!!tween Related Companies or Partners io Business
One of the Buyers is also a Sellee
Buyer or Seller is Governrnent Agency 0.. I f!nd;ng Institution
Deed Type not Warranty or Bargain and Sale (Specify Below)
Salft 0' Ffactlonal or less ~han Fee Interest (Specify Below)
Significant Change in Property Between Taxable Status and Sale Dates
Sale Of Busilless is I"cluded in Sllle Price
Other Unusual Factors Affecting Sale Price (Specify Belowl
None
3 8 0 0 I
-------1
L
I CERTI;ICATION
I ctrtiJ) that all of the items of infurm<ltiun elller('(l on lhh form are true and correct (to the ht>,~t uf m~ kllowledli:e and belief) and I understand that th~ makinl.:
of 11m Ilillful faL'W' ST<llemenl of materiaf fact h~rcin will subjrtl me to the prm'ision.s of the oenall;!" relalin- 10 the making Hml1ilinj.: of fal", instnmlents,
BUYER
~.Q ~\~ b\Clrfl~-'-6 Ilb<i~D'-t
B'.lYD~' I't'&" ranberg Oft.TE
BUYER'S ATTORNE__~
~~,~yt Jt{UY~ tl L?,i,~{( I fi
ft;l;/ Jc;CZ 9353
"'~E'" com' ~i'''PI<:)~E ~\)t.~e,"
____ 73?___~ickham Avenue
,1Rc(] NUMeER Sl~c'" ~~MF '-'FT(R SAl[
Mattituck
..L NY .1...11952
~'lIPCOOJ;
CITrORTOWN
/~ ~E:,,~ '~1 i ~
~('-.:::_. ______ "-. - {G 1(;1
SEltER S'GNAlU~E., -- T
NeW Y~:,','''IT ~
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