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HomeMy WebLinkAboutOaklawn Ave & Wells AveSouthold Town Board -Letter ~~Nirat"ti,,, ®v '~%waf RESOLUTION 2008-695 ADOPTED Item DOC IU: 4081 THIS IS TO CERTIFY THAT THE FOLLOWING 12ESOLUTION NO. 2008-695 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON JULY 15, 2008: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs S_unervisor Scott A Russell to execute the Drainage Easements pertaining to the following tax parcels in connection with the dedication of the drainage area and recharge basin between Zoumas Contracting Corp and Gendot Homes Tnc. to the Town of Southold, subject to the approval of the Town Attorney. Suffolk County T'ax Map Nos. 1000-70-3-22.1; 1000-70-3-22.3; 1000-70-3-22.5; 1000-70-3-22.8; and 1000-70-3-22.9 ~~~Q~°' Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Vincent Orlando, Councilman SECONDER: Albert Krupski ]r., Councilman AYES: Ruland, Orlando, Krupski Jr., Wickham, Evans, Russell Y`I I Board Meeting of July 15, 2008 Generated July 17, 2008 Page 49 >i z Number of pages TORRENS Serial # Certificate # Prior Ctf. # Deed .Mortgage Instrument Deed /Mortgage Tax Stamp Recording /Filing Stamps 3 FEES Page /Filing Fee Mortgage Amt. _ 1. Basic Tax Handling 5. ~)Q _ _ 2. Additional Tax _ TP-584 Sub Total _ Spec. / Assit. Notation - or EA-5217 (County) Sub Total Spec. /Add. - TOT. MTG. TAX EA-5217 (State) Dual Town - Dual County - R.P.T.S.A. Held For Appointment - Transfer Tax _ Comm. of Ed. 5. 00 Mansion Tax Affidavit The property covered by this motgage is or will be improved by a one or two Certified Copy family dwelling only. YES or NO Reg. Copy Sub Total If NO, see appropriate tax clause on Other Grand Total page # of this instrument. 1000 070.00 03.00 022.001 4 District Section Block Lot 5 Community Preservation Fund Rea] Consideration Amount $ ~ Property Tax Service CPF Tax Due $ 0 Agency Improved X Verification Vacant Land 6 Satisfaction/Dischazges/Release List Property Owners Mailing Address TD RECORD & RETURN TO: PATRICIA A. FINNEGAN, ESO. TD TOWN OF SOUTHOLD, OFFICE OF TOWN ATTORNEY P.O. BOX 1179 TD SOUTHOLD, NY 11971-0959 7 Title Company Information Co. Name Sunrise Abstract LLC Ti[le# 622-5-2171-SS 8 ~ Suffolk County Recording & Endorsement Page This page forms part Of the attached DRAINAGE EASEMENT made by: (SPECIFY TYPE OF INSTRUMENT) The premisis herein is situated in CHARLES J. & LAURA ZEHIL SUFFOLK COUNTY, NEW YORK. TO In the Township of SOUTHOLD TOWN OF SOUTHOLD In the VILLAGE or HAMLET of soutbold BOXES 6 THROUGH 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING (nvrrl DRAINAGE EASEMENT d~ THIS AGREEMENT made this day of S~ , aoo~', between CHARLES J. ZEHIL and LAURA ZEHIL, residing at 444 East 82nd Street, Apt. 2R, New York, New York, party of the first part, hereinafter referred to as the "Property Owner", and the Town of Southold, a municipal corporation having principal offices located at 53095 Main Road, Southold, New York, party of the second part, hereinafter referred to as the "Town". WHEREAS, the Property Owner herein is the owner in fee and simple of certain real property designated as Lot #1 on a certain map entitled "Map of Peconic Development Corp." situate at Southold, Town of Southold, Suffolk County, New York, surveyed by Peconic Surveyors, PC and filed in the office of the Clerk of the county of Suffolk on December 27, 2001 as Map No. 10723. (see schedule A attached) NOW, THEREFORE, in consideration of Ten Dollars ($10.00) and other good and valuable consideration, the receipt and sufficiency of which the parties hereby acknowledge, the property owner hereby grants unto the Town, it's successor and assigns, a drainage easement over the southwesterly twenty (20) feet along Oaklawn Avenue, as shown on the filed map, and as more fully described in attached description, for the inspection, maintenance and repair and replacement of underground drainage structures and facilities within such easement area. Upon completion, the Town will restore the affected area with grading and seeding. The easement conveyed herein shall run with the land and shall be binding upon all purchasers and holders of said lot, their heirs, executors, legal representatives, distributees, successors and assigns, and that every purchaser by the acceptance of a deed thereto, covenants and agrees that the premises so purchased shall be held subject to the said easements. IN WITNESS WHEREOF, the parties hereto have caused these presents to be signed on the day and year first above written. Charles J. Zehil `) ,-. • it Laura C. Z G TOWN OF SOU HOLD BY: SCOTT A. RUSSELL SUPERVISOR State of New York ) ss: County of Suffolk ) On t if~-day o~fitJn vi~?before, the undersigned, personally appeared CHARLES J. ZEHIL AND LAURA C. ZEHIL, personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, execut~he instrument. Notary Pudic BE19VAPERKIII! Muby Pudic. Stnlc of Ner Vplh No. O1PE 6130Gf8 fkgllli0tl in $utldK Canly ~j C.OnrtM8910n EYprM July 1B / State of New York ) County of Suffolk ) ss: On this~2~~day ofS<-~~~ ,aabg, before, the undersigned, personally appeared SCOTT A. RUSSELL, personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. 0.>,~ra-~a U-~,.~=~~-- ~~ , Notary Public BARBARA ANN RUDDER Notary Public, Stata of New York No. 4855805 ~ualitied to Suitolk County Commlaefon Expirea Apr814, ~~ SCHEDULE A DESCRIPTION Title Number: AL-20601 AMENDED 9127/2004 ALL that certain plot, piece or parcel of land situate, lying and being at Southold, Town o Southold, County of Suffolk and State of New York, known a fi edenlghe Suffolk County Clerk'sn a certain map entitled, "Map of Peconic Development Corp. Office on December 27, 2001, as Map No. 10723, being further bounded and described as follows: BEGINNING at a point on the easterly side of Oaklawn Avenue distant 125.00 feet southerly from the corner formed by the intersection of Jernick Lane with the easterly side Of Oaklawn Avenue; IRneNbetween Lots 1Eand 135ont herabove reflerenced filed map;East 333.28 feet to the division THENCE along said division line south 24 degrees 11 minutes 10 seconds East 125.01 feet to the division line between Lots 1 and 2 on the above referenced file map; THENCE along said division line south 66 degrees 36 minutes 10 second West 335.00 feet to the easterly side of Oaklawn Avenue; THENCE along the easteomt'orpla eaof BEGINNING.orth 23 degrees 23 minutes 50 seconds West 125.00 feet to the p HAROLD F. TRANCHON JR. P.C. Surveyor P.O. BOX 616 1866 WADING RIVER-MANOR ROAD WADING RIVER, NEW YORK 11792 TELEPHONE: 631-929-4695 July 23, 2005 Drainage Easement Lot Number 1 Map of Peconic Development Corp. FAX: 631-929-1426 All that certain plot, piece or parcel of land, situated at Southold, Town of Southold, Suffolk County, New York, being a drainage easement on lot number 1, as shown on the Map of Peconic Development Corp., which map was filed in the Suffolk County Clerks office on 12-27-2001 as map number 10723, being further described as follows. Beginning at a point on the easterly side of Oaklawn Avenue, which point is 643.12 feet north of the intersection formed by the easterly side Oaklawn Avenue with the northerly side of Wells Road. Running thence northerly along the easterly side of Oaklawn Avenue N.23'23'S0'W. - 125.00 feet, thence N.66"36'10'E. - 20.00 feet, thence S.23'23'S0'E. - 125.00 feet, thence S.66'36'10"W. - 20.00 feet to a point on the easterly side of Oaklawn Avenue and the point or place of beginning. r-saa (lvoa) New VOrk State Department of Taxation antl Finance Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax Recording office time stamp or Schedule A -Information relating to conveyance Granfor/TranSferor Name (il individual; last, first, middle initial) Social security number ® Individual ZEHIL, CHARLES J. AND LAU RA C. ^ Corporation Mailing address 1905 OAKLAWN AVENUE S ci Ise dtyp umber _ ~~ ~ 2 ^ Partnership 02 ~ C..Po ^ Estate/rrust City State ZIP code Federal employer ident. number ^ Other SOUTHOLD NY 11971 Grantee/TranSferee Name (ilindividual: last, firs( middle initial) Social security number ^ Individual TOWN OF SOUTHOLD ^ Corporation Mailing address Social security number ^ Partnership 53095 MAIN ROAD ^ Estate/Trust City State ZIP code Fedeml employer ident. number ® other SOUTHOLD NY 11971 - Location and description of property conveyed Tax map designation Address City/village Town County Section Block Lot 70 3 22.1 Oaklawn Avenue Southold Southold Suffolk Type of property conveyed (check applicable box) 1 ^ One- to three-family house 5 ^ Commercial/Industrial Date of conveyance Percentage of real property 2 ^ Residential cooperative 6 ^ Apartment building conveyed which is residential 3 ^ Residential condominium 7 ^ Office building real property 4 ^ Vacant land a ^X Other drainage ease m°°'" eay y°a` (see instructions) Condition of conveyance (check all that apply) a. ^ Conveyance of fee interest b. ^ Acquisition of a controlling interest (state percentage acquired % ) c. ^ Transfer of a controlling interest (state percentage transferred %) f. ^ Conveyance which consists of a mere change of identify or form of ownership or organization (attach Form TP-584.7, Schedule F) g. ^ Conveyance for which credit for tax previously paid will be claimed (attach Form TP-584.1, Schedule G) h. ^ Conveyance of cooperative apartment(s) d. ^ Conveyance to cooperative housing corporation i. ^ Syndication e. ^ Conveyance pursuant to or in lieu of j. ^ Conveyance of air rights or foreclosure or enforcement of security development rights interest (attach Form TP-584.1, Schedule E) k rl Contract aacinnment I. ^ Option assignment or surrender m. ^ Leasehold assignment or surrender n. ^ Leasehold grant o. ^ Conveyance of an easement p. ^ Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part III) q. ^ Conveyance of property partly within and partly outside the state L Fl tither /descrihel For recording officer's use Amount received Schedule B., Part t $ Date received Transaction number ~~, Schedule B., Part II $ ~~ Page 2 of 4 TP-584 (11/04) Schedule B -Real estate transfer tax return (Tax Law, Article 31) Part I -Computation of tax due 1 Enter amount of consideration for the conveyance (il you are claiming a total exemption /rom tax, check the exemption claimed box, enter consideration and proceed to Part !!I) ............................ ^ Exemption claimed 1. 0.00 2 Continuing lien deduction (see instructions it property is taken subject fo mortgage or lien) ...................................... 2. 0.00 3 Taxable consideration (subtract line 2 from line t) ................................................................................................ 3. 0.00 4 Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ...................................................... 4. 0.00 5 Amount Of credit Claimed (see instructions and attach Form TP-584.1, Schedule G) ................................................ 5. 0.00 6 Total taX due` (subtract line 5 /rom line 4) ............................................................................................................. 6. 0.00 Part [I -Computation of additional tax due on the conveyance of residential real property for $1 million or more 1 Enter amount of consideration for conveyance (from Part t, line t) ..................................................................... 1. n/a 2 Taxable consideration (multiply line 1 by the percentage of fhe premises which is residential real property, as shown in Schedule A) .... 2. 3 Total additional transfer tax due` (multiply line 2 by 1 % (Ot)) .............................................................................. 3. Part III -Explanation of exemption claimed on Part [, line 1 (check any boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for the following reason: a. Conveyance is to the United Nations, the United States of America, the state of New York, or any of their instrumentalities, agencies, or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or ^ compact with another state or Canada) ............................................................................................................................................. a b. Conveyance is to secure a debt or other obligation ........................................................................................................................... b ^ c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................. c ^ d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts ...................................................................................................................................................................... d ^ e. Conveyance is given in connection with a tax sale ............................................................................................................................ e ^ f. Conveyance is a mere change of identity or form of ownership or organization where there is no change in beneficial ownership. (This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) Attach Form TP-584.1, Schedule F ................................................................... f ^ g. Conveyance consists of deed of partition .......................................................................................................................................... g ^ h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................ h ^ i. Conveyance consists of the execution of a contract to sell real property, without the use or occupancy of such property, or the granting of an option to purchase real property, without the use or occupancy of such property ............................................... i ^ j. Conveyance of an option or contract to purchase real property with the use or occupancy of such property where the consideration is less than $200,000 and such property was used solely by the grantor as the grantor's personal residence and consists of a one-, two-, orthree-family house, an individual residential condominium unit, or the sale of stock in a cooperative housing corporation in connection with the grant or transfer of a proprietary leasehold covering an individual residential cooperative apartment ....................................................................................................................................................................... j ^ k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401(e) (attach documents supporting such claim) .......................................................................................................................................................................... k ^ Other (attach explanation) .................................................................................................................................................................... I ^ `Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to fake place in New York City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department otTaxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (11/04) Schedule C -Credit Line Mortgage Certificate (Tax Law, Article 11) Complete the following only If the interest being transferred is a fee simple Interest. I (we) certify that: (check the appropriate box) 1. ^ The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. ^ The real property being sold or transferred is subject to an outstanding credit line mortgage. However, an exemption from the tax is claimed for the following reason: ^ The transfer of real property is a transfer of a fee simple interest to a person or persons who held a fee simple interest in the real property (whether as a joint tenant, a tenant in common or otherwise) immediately before the transfer. ^ The transfer of real property is (A) to a person or persons related by blood, marriage or adoption to the original obligor or to one or more of the original obligors or (B) to a person or entity where 50% or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). ^ The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. ^ The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and the real property being sold or transferred is not principally improved nor will it be improved by a one- to six-family owner-occupied residence or dwelling. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. ^ Other (attach detailed explanation). 3. ^ The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for [he following reason: ^ A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. ^ A check has been drawn payable for transmission to the credit line mortgagee or his agent for the balance due, and a satisfaction of such mortgage will be recorded as soon as ii is available. 4. ^ The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by the mortgage is . No exemption from tax is claimed and the tax of is being paid herewith. (Make check payable to county clerk where deed will be recorded or, if the recording is to take place in New York City, make check payable to the NYC Department o/Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersi ned certify that the above information contained in schedules A, B, and C, inc ng any retu n, ce~ntiGcation, schedule, or attachme the best of his/her knowledge, true and complete. ~®~ n S o (,~ ,r, C Grantor signature Title ~ ~ rGranleepign t~~~s~ ~~ Ttlle U(J~ Grant gnaWre Title - Grantee signature Title Reminder: Did yo~ mplete all of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you checked e, t, or g in Schedule A, did you complete Form TP-584.1? Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department o/Finance? If no recording is required, send your check(s), made payable to the Department o/Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 4 of 4 TP-584 (11/04) Schedule D -Certification of exemption from the payment of estimated personal Income tax (Tax Law, Article 22, section 663) Complete the following only If a fee simple Interest or a cooperative unit is being transferred by an indlvldual or estate or trust. Part I -New York State residents If you are a New York State resident transferor(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferors/sellers of the real property or cooperative unit is a resident of New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferors/sellers. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) as signed below was a resident of New York State, and therefore is not required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of this real property or cooperative unit. t ( Sign Print full name CHARLE ZEHIL Data S J. ~./ Print full name Date _ GLwr LAURA C. ZEHIL c7 9 6 Signature Print full name Date Signature Print full name Date Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), bui not as a condition of recording a deed. Part II -Nonresidents of New York State If you are a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but are not required to pay estimated personal incorne tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to [he transferor(s)/seller(s), that transferor(s)/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonresident transterors/sellers. If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated personal income tax, on page 1 of Form TP-584-t. Exemption for nonresident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) (grantor) of this real property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: ^ The real property or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from to (see instructions). Date Date ^ The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. ^ The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signature Print full name Date Signature Print full name Date Signature Print full name Date Signature Print full name Date econic Bay Region Community Preservation Fund Schedule A -Information Relatin to Conveyance GRANTOR Name (lndlvidual; lost, hrsq midd/e initial) O Individual ZEHIL, CHARLES J. AND LAURA C. ^ Corporation Mailing address O Partnership 1905 OAKLAWN AVENUE ^ Other city stare GRANTEE Name (individual; lasq first, middle initial) ^ Individual TOWN OF SOUTHOLD ^ COrpOratlOn Mailing address ^ Patmership 53095 MAIN ROAD, PO BOX 1179 tr0 Other Ciry sn SOUTHOLD NY Location and desc rintinn of nrnnartv rnnveved 11971 Social Security Number Social Security Number number Tax map designation Address Village Town Dist Section Block Lot 1000 70 3 22.1 OAKLAWN AVENUE SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box) ® Improved Date of Conveyance D Vacant Land MONTH DAV YEAR Dual Towns: a. - Conveyance of fee interest b. -Acquisition of a controlling interest (state percentage acquired %) c. - Transfer of a controlling interest (state percentage transferred __%) d. -Conveyance to cooperative housing corporation e. - Conveyance pursuant to or in Geu of foreclosure or enforcement of security interest f. - Conveyance which consists of a mere change of identity or form of ownership or organization g. -Conveyance for which credit for mx previously paid will be claimed h. -Conveyance of cooperative apartments(s) i. - Syndication j. - Conveyance of air tights or development fights k. -Contract assignment 1. - Option assignment or surrender m. -Leasehold assignment or surrender n. -Leasehold grant o. -Conveyance of an easement p. -Conveyance far which exemption from transfer tax is claimed (complete Schedule B. Part II) q. -Conveyance of property partly within and partly without the state. r. - Other (describe) Condition of conve ance check all that apply 3c e u e - ommunity Freservaho~un Part I -Computation of Tax Due 1 Enter amount of consideration for the conveyance (from line 1 TP-584 Schedule B) .......................... 1 0.00 2 Allowance (see below) ......................................................................... 2 0.00 3 Taxable consideration (subtract line 2 from line l) .................................................... 3 0.00 4 2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK ....... 4 0.00 5 Property no[ subject to CPF Tax (See Schedule CJ .................................................... For recording officer's use Amount Date received Transaction number received Allowance: East Hampton: $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) Shelter Island: $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) Southampton: $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) Riverhead: $150,000.00 Improved $75,000.00 Vacant Land (Unimproved) Southold: $150,000.00 Improved $75,000.00 Vacant Land (Unimproved) tz-0xi3..vsa Schedule B - (continued) Part II -Explanation of Exemption Claimed in Part I, line 1 (check any boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for the following reason: a. Conveyance is to [he United Nations, the United S[a[es of America, the state of New York or any of their instrumentalities, agencies or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or compact with another state or Canada) .................................................................. ^ b. Conveyance is to secure a debt or other obligation .......................................................... ^ c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance ............ ^ d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts ................................................................................... ^ e. Conveyance is given in connection with a [ax sale .......................................................... ^ f. Conveyance is a mere change of identity or form of ownership or organization where [here is no change in beneficial ownership. (This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) ..................................................................... ^ g. Conveyance consists of deed of partition ................................................................. ^ h. Conveyance is given pursuant to the federal bankruptcy act ................................................... ^ i. Conveyance consists of the execution of a contract to sell real property without the use or occupancy of such property or the granting of an option to purchase real property without the use or occupancy of such property ......................... ^ j. Conveyance or real property which is subject to resttictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) or (k) of Article 31-D of the Tax Law. (See required Town approval,below) .............................:...................................................... ^ k. Conveyance of real property for open space, pazks, or historic preservation purposes to any not-for-profit tax exempt corporation operated fpr conservation, environmental, or historic preservation purposes. 1. Other list explanations in space below (Grandfather/Canttact) ................................................. ^ m. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 31-D of the Tax law. (See j in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing to file a return or to pay any tax within the time required shall be subject to a penalty of 10% of the amount of tax due plus an interest penalty of 2% of such amount for each month of delay or fraction thereof after the expiration of the first month after such return was required to be filed or the tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Interest Daily compounded interest will be charged on [he amount of the [ax due not paid within the time required. ***** By signing the following, the buyer and seller further represent and attest to the fact that for property lying within Southold Town, a validly executed contract was in effect prior to March 1, 1999 and that for all other towns subject at the CPF tax, a validly executed contract was in effect prior to April 1, 1999. Seller Buyer Signature (both the grantor(s) and grantee(s) must sign). The i ned certify that the above return, including any certification, sche o .lec a an lets e. ~p~ /~ O'F \\ ,C ~ . i/ GRANTOR -GO ~ ~- attach~yent, i ~to the best of his/her ~nu~E-Ito C t3.- [ V IiRANTEE Number of 11121 TORRENS Setial # Certificate # Prior Ctf. # Deed .Mortgage Instrument Deed /Mortgage Tax Stamp Recording /Filing Stamps 3 FEES Page /Filing Fee Mortgage Amt. _ 1. Basic Tax Handling 5. 92 _ 2. Additional Tax _ TP-584 Sub Total _ Spec. / Assit. Notation - or EA-5217 (County) Sub Total Spec. /Add. TOT. MTG. TAX EA-5217 (State) _ Dual Town _ Dual County _ R.P.T.S.A. Held for Appointment Transfer Tax Comm. of Ed. 5. 00 _ Mansion Tax Affidavit The property covered by this motgage is or will be improved by a one or two Certified Copy family dwelling only. Reg. Copy Sub Total YES or NO If NO, see appropriate tax clause on Other Grand Total page # of this instrument. 4 1000 District 070.00 Section 03.00 Block 022.005 Lot 5 Community Preservation Fund Real Consideration Amount $ 0 Pro ert p y Tax Service CPF Tax Due $ Agency Improved x Verification Vacant Land 6 Satisfaction/Dischazges/Release List Property Owners Mailing Address RECORD & RETURN TO: TD PATRICIA A. FINNEGAN~ ESn. TOWN OF SOUTHOLD~ OFFICE OF TOWN ATTORNEY TD P.O. BOX 1179 SOUTHOLD, NY 11971-0959 TD 7 Title Company Informafion Co. Name Sunrise Abstract LLC Title # 8 ( Suffolk County Recording & Endorsement Pale This page forms part of the attached DRAINAGE EASEMENT made b Y~ (SPECIFY TYPE OF INSTRUMENT) The premisis herein is situated in NIGHAT s. CHAUDHARY SUFFOLK COUNTY, NEW YORK. TO In the Township of cnrrmxoLn TOWN OF SOUTHOLD In the VILLAGE or HAMLET of Southold BOXES 6 THROUGH 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING (crvP.rl i DRAINAGE EASEMENT THIS AGREEMENT made this~day of 7~-c-~, 200 between NIGHAT S. CHAUDHARY, residing at 81-15 252nd Street, Bellerose, New York 11425, party of the first part, hereinafter referred to as the "Property Owner", and the Town of Southold, a municipal corporation having principal offices located at 53095 Main Road, Southold, New York, party of the second part, hereinafter referred to as the "Town". WHEREAS, the Property Owner herein is the owner in fee and simple of certain real property designated as Lot #5 on a certain map entitled "Map of Peconic Development Corp." situate at Southold, Town of Southold, Suffolk County, New York, surveyed by Peconic Surveyors, PC and filed in the office of the Clerk of the county of Suffolk on December 27, 2001 as Map No. 10723. NOW, THEREFORE, in consideration of Ten Dollars ($10.00) and other good and valuable consideration, the receipt and sufficiency of which the parties hereby acknowledge, the property owner hereby grants unto the Town, it's successor and assigns, a drainage easement over the southwesterly twenty (20) feet along Oaklawn Avenue, as shown on the filed map, and as more fully described in attached description, for the inspection, maintenance and repair and replacement of underground drainage structures and facilities within such easement area. Upon completion, the Town will restore the affected area with grading and seeding. The easement conveyed herein shall run with the land and shall be binding upon all purchasers and holders of said lot, their heirs, executors, legal representatives, distributees, successors and assigns, and that every purchaser by the acceptance of a deed thereto, covenants and agrees that the premises so purchased shall be held subject to the said easements. IN WITNESS WHEREOF, the parties hereto have caused these presents to be signed on the day and year first above written. NIGHAT S. CHAUDHARY TOWN OF SOUTH LD BY: SCOTT A. SSELL, SUPERVISO State of New York ) County of S~,cPF4~) ss: On thiso~'day of ~`~ , 2006, before, the undersigned, personally appeared NIGHAT S. CHAUDHARY, personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. --~~---- Nbtary ublic PATRICIA C. MOORS t~lptary Public, State of New York Suffolk County - No. 4461 fi$8 FgRtmission Expires June 16,-97/Tv State of New York ) County of Suffolk ) ss: On this~d~day ofsw~ , 2008; before, the undersigned, personally appeared SCOTT A. RUSSELL, personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. Notary Public BARBARA ANN RUADER Notary p~ No.~ 48t55805 Naw'York OuaUifad I6 Sutlolk Cou~lty~,d,1~ Commlaalon Expina Apr1114, .... 6 SCHEDULE A "METES F.r BOUNDS DESCRIPTION FOR" Amended o0/00/0o TITLE # 0459810RPT District 1000 Sec#ion 070.00 Biock 03.00 Lot 022.005 ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being at Southold, Town of Southold, County of Suffolk and State of New York, known as Lot No. 5 on a certain subdivision map entitled "Map of Peconic Development Corp. at Southold" filed in the Office of the Clerk of the County of Suffolk as Map No. 10723 on December 27, 2001, and being more particularly bounded and described as follows: BEGINNING at a point on the easterly side of Oaklawn Avenue, distant 100 feet northerly from the corner formed by the intersection of the easterly side of Oaklawn Avenue with the northerly side of Wells Road; RUNNING THENCE north 23 degrees 23 minutes 50 seconds west, along the easterly side of Oaklawn Avenue, 168.12 feet; THENCE north 66 degrees 36 minutes 10 seconds east, 355.01 feet; THENCE south 24 degrees 34 minutes 30 seconds west, 277.38 feet; THENCE along lands now or formerly of Alice C. Leslie, south 73 degrees 20 minutes west, 150 feet back to the easterly side of Oaklawn Avenue at the point or place of BEGINNING. HAROLD F. TRANCHON JR. P.C. Surveyor P.O. BOX 616 1866 WADING RIVER-MANOR ROAD WADING RIVER, NEW YORK 11792 TELEPHONE: 631-929-4695 July 23, 2005 Drainage Easement Lot Number 5 Map of Peconic Development Corp. FAX: 631-929-1426 All that certain plot, piece or parcel of land, situated at Southold, Town of Southold, Suffolk County, New York, being a drainage easement on lot number 5, as shown on the Map of Peconic Development Corp., which map was filed in the Suffolk County Clerks office on 12-27-2001 as map number 10723, being further described as follows. Beginning at a point on the easterly side of Oaklawn Avenue, which point is 100.00 feet north of the intersection formed by the easterly side Oaklawn Avenue with the northerly side of Wells Road. Running thence northerly along the easterly side of Oaklawn Avenue N.23'23'S0'W. - 168.12 feet, thence N.66'36'10'E. - 20.00 feet, thence 5.23'23'S0'E. - 170.48 feet, thence S.73'20'00'W. - 20.14 feet to a point on the easterly side of Oaklawn Avenue and the point or place of beginning. P-584 (11/04) New VOrk State Department of Taxation antl Finance Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax ® Individual CHAUDHARY, NIGHATS. p'~ ~- ~ _ (oy a ^ Corporation Mailing address Social security number ^ Partnership 81-15 252ND STREET ^ Estate/Trust City State ZIP code Federal employer ident. number ^ other BELLEROSE NY 11425 Gfantee/Tfansfefee Name (it individual: last first middle inifiaQ Social security number ^ Individual TOWN OF SOUTHOLD ^ Corporation Mailing address Social security number ^ Padnership 53095 MAIN ROAD ^ Estate/Trusf Cify State ZIP code Federal employer ident. number ® Otner SOUTHOLD NY 11971 ~- Q(j Location and description of property conveyed Tax map designation Address City/village Town County Section Block Lot 70 3 22.5 Oaklawn Avenue Southold Southold Suffolk Type of property conveyed (check applicable box) 1 ^ One- to three-family house 5 ^ Commercial/Industrial Date of conveyance Percentage of real property 2 ^ Residential cooperative 6 ^ Apartment building conveyed which is residential 3 ^ Residential condominium 7 ^ Office building 20 real property °/, 4 ^ Vacant land 8 ^X Other dralna0e eaSp '"00tH tley Yedf (see instructions) to Recording oflice time stamp Condition of conveyance (check all that apply) a. ^ Conveyance of fee interest b. ^ Acquisition of a controlling interest (state percentage acquired % ) c. ^ Transfer of a controlling interest (state percentage transferred %) d. ^ Conveyance to cooperative housing corporation f. ^ Conveyance which consists of a mere change of identify or form of ownership or organization (attach Form TP-584.1, Schedule F) I. ^ Option assignment or surrender m. ^ Leasehold assignment or surrender n. ^ Leasehold grant o. ^ Conveyance of an easement p. ^ Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part!!!) g. ^ Conveyance for which credit for tax previously paid will be claimed (attach Form TP-584.1, Schedule G) h. ^ Conveyance of cooperative apartment(s) i. ^ Syndication e. ^ Conveyance pursuant to or in lieu of j. ^ Conveyance of air rights or foreclosure or enforcement of security development rights interest (attach Form TP-584.1, Schedule E) k. ^ Contract assignment q. ^ Conveyance of property partly within and partly outside the state r. t-I Other ldescribel For recording o//icer's use Amount received Schedule B., Part I $ Date received Transaction number Schedule B., Part II $ Page 2 of 4 TP-584 (11/04) Schedule B -Real estate transfer tax return (Tax Law, Article 31) Part I -Computation of tax due 1 Enter amount of ConsideratlOn for the Conveyance (if you are claiming a total exemption lrom tax, check the exemption c/a/med box, enter consideration and proceed fo Part 111) ............................ ^ Exemption claimed 1. 0.00 2 Continuing lien deduction (see instructions it property is taken subject to mortgage or lien) ...................................... 2. 0.00 3 Taxable consideration (subtract line 2 from line 1) ................................................................................................ 3. 0.00 4 Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ...................................................... 4. 0.00 5 Amount of credit claimed (see instructions and attach Form TP-584.1, Schedule G) ............:................................... 5. 0.00 6 Total tax due' (subtract line 5 Irom line 4) ............................................................................................................. 6. 0.00 Part II -Computation of additional tax due on the conveyance of residential real property for $1 million or more 1 Enter amount of consideration for conveyance (from Pan I, line 1) ..................................................................... 1. n/a 2 TaXable considerafion (multiply line 1 by the percentage o/the premises which is residential real property, as shown in Schedule A) ..... 2. 3 Total additional transfer tax due' (multiply line 2 by 1 % (.O1)) .............................................................................. 3. Part III -Explanation of exemption claimed on Part [, line 1 (check any boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for [he following reason: a. Conveyance is to the United Nations, the United States of America, the state of New York, or any of their instrumentalities, agencies, or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or ^ compact with another state or Canada) ............................................................................................................................................. a b. Conveyance is to secure a debt or other obligation ........................................................................................................................... b ^ c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................. c ^ d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts ...................................................................................................................................................................... d ^ e. Conveyance is given in connection with a tax sale ............................................................................................................................ e ^ f. Conveyance is a mere change of identity or form of ownership or organization where there is no change in beneficial ownership. (This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) Attach Form TP-584.1, Schedule F ................................................................... f ^ g. Conveyance consists of deed of partition .......................................................................................................................................... g ^ h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................ h ^ i. Conveyance consists of [he execution of a contract to sell real property, without the use or occupancy of such property, or ^ the granting of an option to purchase real property, without the use or occupancy of such property ............................................... i j. Conveyance of an option or contract to purchase real property with the use or occupancy of such property where the consideration is less than $200,000 and such property was used solely by the yrantor as the grantor's personal residence and consists of a one-, two-, or three-family house, an individual residential condominium unit, or the sale of stock in a cooperative housing corporation in connection with the grant or transfer of a proprietary leasehold covering an individual residential cooperative apartment ....................................................................................................................................................................... j ^ k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401(e) (attach documents rti h l i k ^ suppo ng suc c a m) .......................................................................................................................................................................... I. Other (attach explanation) .................................................................................................................................................................... I ^ 'Please make check(s) payable to the county clerk where the recording is to take place. It the recording is to take place in New York City, make check(s) payable to the NYC Department o/Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department otTaxaticn and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (11/04) Schedule C -Credit Line Mortgage Certificate (Tax Law, Article 11) Complete the following only if the interest being transferred is a fee simple Interest. I (we) certify that: (check the appropriate box) 1. ^ The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. ^ The real property being sold or transferred is subject to an outstanding credit line mortgage. However, an exemption from the tax is claimed for the following reason: ^ The transfer of real property is a transfer of a fee simple interest to a person or persons who held a fee simple interest in the real property (whether as a joint tenant, a tenant in common or otherwise) immediately before the transfer. ^ The transfer of real property is (A) to a person or persons related by blood, marriage or adoption to the original obligor or to one or more of the original obligors or (B) to a person or entity where 50%, or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). ^ The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. ^ The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and the real property being sold or transferred is not principally improved nor will it be improved by a one- to six-family owner-occupied residence or dwelling. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. ^ Other (attach detailed explanation). 3. ^ The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: ^ A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. ^ A check has been drawn payable for transmission to the credit line mortgagee or his agent for the balance due, and a satisfaction of such mortgage will be recorded as soon as it is available. 4. ^ The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by the mortgage is . No exemption from tax is claimed and the tax of is being paid herewith. (Make check payable to county clerk where deed will be recorded or, i/the recording is to take place in New York City, make check payable to the NYC Department of Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, inclu ' any return certifi/~ation, schedule, or attachment, is to the best of his/her knowledge, true and complete. ~~ u ,~ 1CI N ~~~~ T°r~~ o~ Grentorsignature Title ~ rants ignat i e U ~r~~ ~ ~uss~ll Grantor signature Title Grantee signature Reminder: Did you complete all of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you checked e, /, or g in Schedule A, did you complete Form TP-584.1? Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department o/Finance? If no recording is required, send your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 4 of 4 TP-584 (11/04) Schedule D - Certification of exemption from the payment of estimated personal Income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit is being transferred by an Individual or estate or trust. Part I -New York State residents If you are a New York State resident transferor(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferors/sellers of the real property or cooperative unit is a resident of New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferors/sellers. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) as signed below was a resident of New York State, and therefore is not required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of this real property or cooperative unit. Signature d/~ px,~e Print full name NIGHAT S. CHAUDHARY Data _a Signature Print full name Dale Signature Print full name Date Signaure PrinUull name Date Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed. Part II -Nonresidents of New York State If you are a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but are not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferor(s)/seller(s), that transferor(s)/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonresident transferors/sellers. It none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated personal income tax, on page 1 of Form TP-584-I. This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) (grantor) of this real property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: ^ The real property or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from Date to Dale (see instructions). ^ The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. ^ The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private rc~ortgage insurance company. Signature Print full name Date Signature Print full name Dale Signature Print full name Date Signature Print full name Date econic Bay Region Community Preservation Fund ~cneaute a - lntoflnation Kelatin to Conve ance GeANTOe Namt (individual; lost, first, middle initial) Social Security Number t~l Individual CHAUDHARY, NIGHAT S. b78 Glo 6 9a~ ^ Corporation Mailing address Socia] Security Number ^ Partnership 81-15 252ND STREET ^ Other Ciry srarr. oro ,...ae ~_~`-' ---'--.-'_-. , GRANTeE Name (individual; lasq first, middle initio/J Social Security Number ^ Individual TOWN OF SOUTHOLD ^ Corporation Mailing address Social Security Number ^ Partnership 53095 MAIN ROAD, PO BOX 1179 r^ Other Ciry State ZIP code Federal employer ident. number SOUTHOLD NY 11971 00 ~ Location and descrintinn of nrrv.Pxv ~ ,od Tax map designation Address Village Town Dist Section Block Lot 1000 70 3 22.5 OAKLAWN AVENUE SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box) © Improved Date of Conveyance ^ Vacant Land 2005 MONTa DAY YEAR a. -Conveyance of fee interest b. -Acquisition of a controlling interest (state percentage acquired c. -Transfer of a convolling interest (state percentage transferred d. -Conveyance to coopemdve housing corpomdon e. - Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest f. - Conveyance which consists of a mere change of identity or form of ownership or organization g. -Conveyance for which credit for tax previously paid will be claimed h. -Conveyance of cooperative apanments(s) i. - Syndication j. - Conveyance of air tights or development rights k. -Contract assignment 1. - Option assignment or surrender Dual Towns: m. -Leasehold assignment or surrender n. -Leasehold grant o. - Conveyance of an easement p. -Conveyance for which exemption from transfer tax is claimed (complete Schedule B. Part 11) q. -Conveyance of property partly within and partly without the state. r. - Other (describe) Condition of Conve ance check all that a l ~.~ueuu.c „ - a,CnTuTriiir3ty rl"eJ'OlVallOn Un Part I -Computation of Tax Due 1 Enter amount of consideration for the conveyance (from line I TP-584 Schedule B) ......................... . 2 Allowance (see be[ow) ......................................................................... 3 Taxable consideration (subtract line 2 from line I) ................................................... . 4 2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK ...... . t 0.00 z 0.00 s 0.00 a 0.00 5 Property no[subject to CPF Tax (See Schedule C) .................................................... nuowance: East Hampton: $250,000.00 Improved Shelter Islaud: $250,000.00 Improved Southampton: $250,000.OOImproved Riverhead: $150,000.00 Improved Southold: $150,000.00 Lnproved $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) $75,000.00 Vacant Land (Unimproved) $75,000.00 Vacant Land (Unimproved) I2-0213..Y99 Schedule B - (continued) Part II -Explanation of Exemption Claimed in Part I, line 1 (check any boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for the following reason: a. Conveyance is to the United Nations, the United States of America, [he state of New York or any of [heir instrumentalities, agencies or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or compact with another .state or Canada) .................................................................. ^ b. Conveyance is to secure a debt or other obligation .......................................................... ^ c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance ............ ^ d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts ................................................................................... ^ e. Conveyance is given in connection with a tax sale .......................................................... ^ f. Conveyance is a mere change of identity or form of ownership or organization where there is no change in beneficial ownership. (This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) ..................................................................... ^ g. Conveyance consists of deed of partition ................................................................. ^ h. Conveyance is given pursuant to the federal bankruptcy act ................................................... ^ i. Conveyance consists of the execution of a contract [o sell real property without the use or occupancy of such property or the granting of an option to purchase real property without the use or occupancy of such property ......................... ^ j. Conveyance or real property which is subject to restrictions which prohibit the use of [he entire property fot any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) or (k) of Article 31-D of the Tax Law. (See required Town approval,below) .................................................................................... ^ k. Conveyance of real property for open space, pazks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, environmental, or historic preservation purposes. 1. Other list explanations in space below (Grandfather/Contract) ................................................. ^ m. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 31-D of the Tax law. (See j in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing [o file a return or to pay any tax within the time required shall be subject m a penalty of 10% of the amount of tax due plus an interest penalty of 2% of such amount for each month of delay or fraction [hereof after the expiration of [he firs[ month after such return was required to be filed or the tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Interest Daily compounded interest will be chazged on the amount of the tax due not paid within the time required. ***** By signing the following, the buyer and seller further represent and attest to the fact that for property lying within Southold Town, a validly executed contract was in effect prior to March 1, 1999 and that for all other [owns subject a[ [he CPF tax, a validly executed contract was in effect prior to April 1, 1999. Seller Buyer Signature (both the grantor(s) and grantee(s) must sign). The undersigned certify that the above return, including any certification, sched r attachment, is to the best of his/her knowledge, true and complete. ,~ -~'o~..~.t of u CHAUDHARY ~uSS e l 1, ~ ~LP~ tJ~r ~I GRANTEE 11121 Number of Wages TORRENS Serial # Certificate # Prior Cff. # Deed .Mortgage Instrument Deed /Mortgage Tax Stamp Recording /Filing Stamps 3 FEES Page /Filing Fee Mortgage Amt. _ Handling 5 00 1. Basic Tax _ 2. Additional Tax _ TP-584 Sub Total _ Spec. / Assit. Notation or EA-5217 (County) Sub Total Spec. /Add. TOT. MTG. TAX EA-5217 (State) _ Dual Town _ Dual County _ R.P.T.S.A. Held for Appointment Transfer Tax Comm. of Ed. 5. 00 _ Mansion Tax Affidavit The property covered by this motgage is or will be improved by a one or two Certified Copy family dwelling only. Reg. Copy Sub Total YES or NO If NO, see appropriate tax clause on Other Grand Total page # of this instrument. 4 1000 070.00 03.00 022.008 District Section Block Lot 5 Community Preservation Fund Real Consideration Amount $ 0 Property Tax Service CPF Tax Due $ 0 Agency Improved X Verification Vacant Land 6 Satisfaction/Dischazges/Release List Property Owners Mailing Address RECORD & RETURN TO: TD PATRICIA A. FINNEGAN, ESQ. TD TOTdN OF SOUTHOLD, OFFICE OF TOWN ATTORNEY P.O. BOX .1179 ~ SOUTHOLD, NY 11971-0959 ' 7 ~ Title Company Information ~Co.Name Sunrise Abstract LLC Ti[le# 622-5-2171-SS 8 Suffolk County Recording & Endorsement Page This page forms part of the attached DRAINAGE EASEMENT made by: (SPECIFY TYPE OF INSTRUMENT) The premisis herein is situated in MICHAEL & JENNIFER KOKE SUFFOLK COUNTY, NEW YORK. TO In the Township of SOUTHOLD TOWN OF SOUTHOLD In the VILLAGE or HAMLET of Southold BOXES 6 THROUGH 8 MUST BE TYPED OR PRINTED IN BLACK 11VK ONT Y PRmR Tn RFrnRnrnrr. nn err rntr_ DRAINAGE EASEMENT THIS AGREEMENT made this~day of 7~~ 200$, between MICHAEL KOKE and JENNIFER KOKE, both residing at 3400 Wells Road, Southold, New York, party of the first part, hereinafter referred to as the "Property Owner", and the Town of Southold, a municipal corporation having principal offices located at 53095 Main Road, Southold, New York, party of the second part, hereinafter referred to as the "Town". WHEREAS, the Property Owner herein is the owner in fee and simple of certain real property designated as Lot #8 on a certain map entitled "Map of Peconic Development Corp." situate at Southold, Town of Southold, Suffolk County, New York, surveyed by Peconic Surveyors, PC and filed in the office of the Clerk of the county of Suffolk on December 27, 2001 as Map No. 10723. NOW, THEREFORE, in consideration of Ten Dollars ($10.00) and other good and valuable consideration, the receipt and sufficiency of which the parties hereby acknowledge, the property owner hereby grants unto the Town, it's successor and assigns, a drainage easement over the southerly twenty feet (20') along Wells Road, as shown on the filed map and as described in the attached description, for the inspection, maintenance and repair and replacement of` underground drainage structures and facilities within such easement area. Upon completion, the Town will restore the affected area with grading and seeding. The easement conveyed herein shall run with the land and shall be binding upon all purchasers and holders of said lot, their heirs, executors, legal representatives, distributees, successors and assigns, and that every purchaser by the acceptance of a deed thereto, covenants and agrees that the premises so purchased shall be held subject to the said easements. IN WITNESS WHEREOF, the parties hereto have caused these presents to be signed on the day and year first above written. ~~~~ Michael Koke nnn,.~~t , I\o~-~ Je Ifer K ke TOWN OF SOUT LD ~ ~ ~ ~ J/ SCOTT A. RUSSELL, SUPERVISOR State of New York ) County of Suffolk ) ss: On this~day of Hp~--e , 2006, before, the undersigned, personally appeared MICHAEL KOKE AND JENNIFER KOKE, personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. ~~~--_ ublic PATRICIA C. MOORE Notary Public, State of New York Suffolk Coumy - No. 4661668 Commission ExPiresJune 16,.7 ~~ State of New York ) ss: County of Suffolk ) b On this ~ day of ~w~sf , 2008, before, the undersigned, personally appeared SCOTT A. RUSSELL, personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. Notary Public BARBARA ANN RUDDER Notary Public, Stata of New York No. 4855805 CuaRfied fn Sullolk County~l U Commlulon Efrpiraa Aprt114, ,_... SCHEDULE A -DESCRIPTION AMENDE411/18/04 ALL that certain plot, piece or parcel of land, situate, lying and being at Southold, Town of Southold, County of Suffolk and State of New York, known and designated as Lot No. 8 on a certain map entitled, "Map of Peconic Development Corp.", filed in the Suffolk County Clerk's Office on December 27, 2001, as Map No. 10723; said lot being bounded and described as follows: BEGINNING at a point on the northerly side of Wells Road distant easterly 474.11 feet from the corner formed by the intersection of the easterly side of Oaklawn Avenue and the northerly side of Wells Road; RUNNING THENCE North 16 degrees 33 minutes 00 seconds West, 315.06 feet; THENCE South 69 degrees 55 minutes 10 seconds East, 161.50 feet; THENCE South 46 degrees 00 minutes 00 seconds East, 175.00 feet; THENCE South 22 degrees 32 minutes 00 seconds West, 97.10 feet; THENCE South 70 degrees 44 minutes 19 seconds West, 69.19 feet to the northerly side of Wells Road; THENCE South 81 degrees 40 minutes 00 seconds West along the northerly side of Wells Road, 86.20 feet to the point or place of BEGINNING. P-584 (11/04) New York State Depanment of Tazalion and Finance Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax See Form TP-584-1, Instructions for Form TP-584, be/ore completing this form. P/e~ Schedule A -Information relating to conveyance Grantorlfransferor Name (ulndroidual; last rrst middiemmap ®Individual KOKE, MICHAEL AND JENNIFER ^ Corporation Mailing address 2 9X I O~ R AD P• O ^ Partnership 3400 WELLS O IJ~ ^ Estate/Trust City Stale ^ Other SOUTHOLD NY Granteefiransferee Name(ilindividuaC last rust middle initial) ^ Individual TOWN OF SOUTHOLD ^ Corporation Mailing address ^ Partnership 53095 MAIN ROAD ^ EstatelTrust City Stale ®Other SOUTHOLD NY Location and description of property conveyed / ~o Tax map designation Address City/village Town County Section Block Lot WELLS ROAD Southold Southold Suffolk 70 3 22.8 Type of property conveyed (check applicable box) 1 ^ One- to three-family house 5 ^ Commercial/Industrial Date of conveyance Percentage of real property 2 ^ Residential cooperative 6 ^ Apartment building conveyed which is residential 3 ^ Residential condominium 7 ^ Office building ~ real property 4 ^ Vacant land 8 ^X Other drainage easo month aav rear (see instructions) Recording office time stamp ZIP code 11971 11971 / /- .,, . Social security number Condition of conveyance (check all that apply) a. ^ Conveyance of tee interest b. ^ Acquisition of a controlling interest (state percentage acquired % ) c. ^ Transfer of a controlling interest (state percentage transferred % ) d. ^ Conveyance to cooperative housing corporation e. ^ Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest (attach Form TP-584.1, Schedule E) t. ^ Conveyance which consists of a mere change of identify or form of ownership or organization (attach Form TP-584.1, Schedule FJ g. ^ Conveyance for which credit for tax previously paid will be claimed (attach Form TP-584.1, Schedule G) h. ^ Conveyance of coopemtive apartment(s) i. ^ Syndication j. ^ Conveyance of air rights or development rights k n Contract assienment I. ^ Option assignment or surrender m. ^ Leasehold assignment or surrender n. ^ Leasehold grant o. ^ Conveyance of an easement p. ^ Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part 17!) q. ^ Conveyance of property partly within and partly outside the state r. 11 Other (describe) For recording oNicer's use Amount received Schedule B., Part I $ Date received Transaction number Schedule B., Part i1 $ Page 2 of 4 TP-564 (11/04) Schedule B -Real estate transfer tax return (Tax Law, Article 31) Part I -Computation of tax due 1 Enter amount of consideration for the conveyance (if you are claiming a total exemption Irom tax, check the exemption claimed box, enter consideration and proceed to Part ln) ............................ ^ Exemption claimed 2 Continuing Iles deduction (see instructions it property is taken subject to mortgage or lien) ...................................... 3 Taxable consideration (subtract line 2 from line 1) ................................................................................................ 4 Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ...................................................... 5 Amount of credit claimed (see instructions and attach Form TP-584.1, Schedule G) ................................................ 6 Total tax due' (subtract line 5 /rom line 4) ............................................................................................................. Part II -Computation of additional lax due on the conveyance of residential real property for $1 million or more 1 Enter amount of consideration for conveyance (/rom Pan 1, line 1) ..................................................................... 1. n/a 2 Taxable consideration (multiply line 1 by the percentage o/the premises which is residential real property, as shown in Schedule A) ..... 2. v Total additional transfer tax due' (multiply line 2 by 1 % (O1)) .............................................................................. 3. Part III -Explanation of exemption claimed on Part I, line 1 (check any boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for the following reason: a. Conveyance is to the United Nations, the United States of America, the state of New York, or any of their instrumentalities, agencies, or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or d ^ a) ............................................................................................................................................ compact with another state or Cana . a b. Conveyance is to secure a debt or other obligation .......................................................................................................................... . b ^ c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................ . c ^ d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying ^ realty as bona fide gifts ..................................................................................................................................................................... . d e. Conveyance is given in connection with a tax sale ............................................................................................................................ e ^ f. Conveyance is a mere change of identity or form of ownership or organization where there is no change in beneficial ownership. (This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) Attach Form TP-584.1, Schedule F ................................................................... f ^ g. Conveyance consists of deed of partition .......................................................................................................................................... g ^ h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................ h ^ i. Conveyance consists of the execution of a contract to sell real property, without the use or occupancy of such property, or ^ the granting of an option to purchase real property, without the use or occupancy of such property ............................................... i j. Conveyance of an option or contract to purchase real property with the use or occupancy of such property where the consideration is less than $200,000 and such property was used solely by the grantor as the grantors personal residence and consists of a one-, two-, or three-family house, an individual residential condominium unit, or the sale oT stock in a cooperative housing corporation in connection with the grant or transfer of a proprietary leasehold covering an individual residential cooperative apartment ....................................................................................................................................................................... j ^ k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401(e) (attach documents supporting such claim) .......................................................................................................................................................................... k ^ I. Other (attach explanation) .................................................................................................................................................................... I ^ 'Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in New York City, make check(s) payable to the NYC Department o/ Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department o/Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (11/04) Schedule C-Credit Line Mortgage Certificate (Tax Law, Article 11) Complete the following only if the interest being transferred is a fee simple Interest. I (we) certify that: (check the appropriate box) 1. ^ The real property being sold or transferred is not subject [o an outstanding credit line mortgage. 2. ^ The real property being sold or transferred is subject to an outstanding credit line mortgage. However, an exemption from the tax is claimed for the following reason: ^ The transfer of real property is a transfer of a fee simple interest to a person or persons who held a fee simple interest in the real property (whether as a joint tenant, a tenant in common or otherwise) immediately before the transfer. ^ The transfer of real property is (A) to a person or persons related by blood, marriage or adoption to the original obligor or to one or more of the odginal obligors or (B) to a person or entity where 50%, or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). ^ The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. ^ The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and the real property being sold or transferred is not principally improved nor will it be improved by a one- to six-family owner-occupied residence or dwelling. Please note: Tor purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. ^ Other (attach detailed explanation). 3. ^ The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: ^ A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. ^ A check has been drawn payable for transmission to the credit line mortgagee or his agent for the balance due, and a satisfaction of such mortgage will be recorded as soon as it is available. 4. ^ The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by the mortgage is . No exemption from tax is claimed and the tax of is being paid herewith. (Make check payable to county clerk where deed w!ll be recorded or, i/the recording is to take place in New York City, make check payable to the NYC Department o/ Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, incl ng any return, certification, schedule, or attachment, is to the best of his/her knowledge, true and complete. I p W n a S"~~-~- (.~ I~~/v/ _ ~f ~ - ~ ' t'I ~~G/anlOr signature Title <' antes signature ~f ~ ~ Title J f} (~ sS~ C Q0, ~;/° Granlo si nature Title Grantee signature Title Reminder: Did you complete all of the required information in Schedules A, 8, and C? Are you required to complete Schedule D? If you checked e, 1, or g in Schedule A, did you complete Form TP-584.1? Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department o/Finance? If no recording is required, send your check(s), made payable [o the Department otTaxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 4 of 4 TP-584 (11/04) Schedule D -Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit is being transferred by an individual or estate or trust. Part I • New York State residents If you are a New York State resident transferor(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferors/sellers of the real property or cooperative unit is a resident of New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferors/sellers. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) as signed below was a resident of New York State, and therefore is not required to pay estimated personal income tax under Tax law, section 663(a) upon the sale or transfer of this real property or cooperative unit. Signature Print full name MICHAEL KOKE Date - -~~ Signatur Print full name JENNIFER KOKE Date .- Q Signal Print full name Date Signature Print full name Dale Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed. Part II -Nonresidents of New York State If you are a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but are not required to pay estimated personal income tax because one of [he exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferor(s)/seller(s), that transferor(s)/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space provided. If more space is needed, please photocopy this Schedule C and submit as many schedules as necessary to accommodate all nonresident transferors/sellers. If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated personal income tax, on page 1 of Form TP-584-[. Exemption for nonresident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) (grantor) of this real property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: ^ The real property or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from to (see instructions). Date Date ^ The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. ^ The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signature Print full name Date Signature Print full name Date Signature Print full name Date Signature Print full name Date i HAROLD F. TRANCHON JR. P.C. Surveyor P.O. BOX 616 1866 WADING RIVER-MANOR ROAD WADING RIVER, NEW YORK 11792 TELEPHONE: 631-929-4695 July 23, 2005 Drainage Easement Lot Number 8 Map of Peconic Development Corp. FAX: 631-929-1426 All that certain plot, piece or parcel of land, situated at Southold, Town of Southold, Suffolk County, New York, being a drainage easement on lot number 8, as shown on the Map of Peconic Development Corp., which map was filed in the Suffolk County Clerks office on 12-27-2001 as map number 10723, being further described as follows. Beginning at a point on the northerly side of Wells Road, which point is 540.31 feet east of the intersection formed by the northerly side of Wells Road with the easterly side of Oaklawn Avenue. Running thence N.22'ST23"E. - 21.89 feet, thence N.70'44'19"E. - 92.00 feet, thence S.22'32'00'W. - 26.83 feet to a point on the northerly side of Wells Road, thence westerly along the northerly side of Wells Road S.70'44'19'W. 69.19 feet and 5.81'40'00'W. - 20.00 feet to a the point or place of beginning. Peconic Bay Region Community Preservation Fund Schedule A -Information Relatin to Conve auce GRANTOR Name (individua/; /asq first, middle initial) O Individual KOKE, MICHAEL AND JENNIFER ^ COrpoia[iOn Mailing address P ~ - ^ Partnership - D v 3400 WELLS ROAD ^ Other City S[a[e SOUTHOLD NY GRANTEE Name (individual; lart, first, middle initial) ^ Individual TOWN OF SOUTHOLD ^ Corporation Mailing address ^ Partnership 53095 MAIN ROAD PO BOX 1179 r^ Other City State SOUTHOLD NY Location and descdo[ion of orooerty conveved ~ o3s'" 11971 7~a per iden[. number Social Security Number 11971 Number Tax map designation Address Village Town Dist Section Block Loi 1000 70 3 22.8 WELLS AVENUE SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box) r<^ Improved Date of Conveyance ^ Vacant Land MOMH OwY YEAR a. - Conveyance of fee interest b. - Acquisition of a controlling interest (state percentage acquired %) c. -Transfer of a controlling interest (state percentage transferred _ %) d. -Conveyance [o cooperative housing corporation e. -Conveyance pursuant to or in Geu of foreclosure or enforcement of security interest f. - Conveyance which consists of a mere change of identity or form of ownership or organization g. -Conveyance for which credit for tax previously paid will be claimed h. -Conveyance of cooperative apattments(s) i. - Syndication j. - Conveyance of air rights or development fights k. -Contract assignment 1. - Option assignmem or surrender Dual Towns: m. -Leasehold assignment or surrender n. -Leasehold gran[ o. -Conveyance of an easement p. -Conveyance for which exemption from transfer tax is claimed (complete Schedufe B. Pan II) q. -Conveyance of property partly within and partly without the state. r. - Other (describe) Condition of conveyance check al[ that a ! 3 e u e - ommum y r~ -F eservatio~un Part I -Computation of Tax Due 1 Enter amount of consideration for the conveyance (from line I TP-584 Schedule B) .......................... 1 0.00 2 Allowance(see below) ......................................................................... 2 ~.QO 3 Taxable consideration (subtract line 2 from line I) .................................................... 3 0.00 4 2%a Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK ....... 4 ~ 0.00 5 Property not subject to CPF Tax (See Schedule C) .................................................... For recording officer's use Amount Date received Transaction number received i Allowance: East Hampton: $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) Shelter Island: $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) Southampton: $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) Riverhead: $150,000.00 Improved $75,000.00 Vacant Land (Unimproved) Southold: $150,000.00 Improved $75,000.00 Vacant Land (Unimproved) iaozt3..vs9 ' ' Sch6dule B - Part II -Explanation of Exemption Claimed in Part I, line 1 (check any boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for the following reason: a. Conveyance is to the United Nations, the United States of America, the state of New York or any of their instrumentalities, agencies or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or compact with another state or Canada) ................................................................. . b. Conveyance is to secure a debt or other obligation ......................................................... . c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance ........... . d. Conveyance of real property is without consideration and no[ in connection with a sale, including conveyances conveying realty as bona fide gifts ................................................................................... . e. Conveyance is given in connection with a tax sale ......................................................... . f. Conveyance is a mere change of identity or form of ownership or organization where there is no change in beneficial ownership. (This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) .................................................................... . g. Conveyance consists of deed of partition ................................................................ . h. Conveyance is given pursuant [o the federal bankruptcy act ................................................... i. Conveyance consists of the execution of a contract to sell real property without the use or occupancy of such property or the granting of an option to purchase real property without the use or occupancy of such proper[y ........................ . j. Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) or (k) of Article 31-D of the Tax Law. (See required Town npproval,below) .................................................................................... k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, environmental, or historic preservation purposes. 1. Other list~explanations in space below (Grandfather/Contract) ................................................ . m. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 31-D of the Tax law. (See j in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing to file a return or to pay any tax within the time required shall be subject to a penalty of 10% of the amount of tax due plus an interest penalty of 2% of such amount for each month of delay or fraction thereof after the expirafion of the fast month after such return was required [o be filed or the tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Interest Daily compounded interest will be chazged on the amount of the tax due not paid within the time required. ***** By signing the following, the buyer and seller further represent and attest to the fact that for property lying within Southold Town, a validly executed contract was in effect prior to March 1, 1999 and that for all other towns subject at the CPF tax, a validly executed contract was in effect prior to April 1, 1999. Seller Signature (both the grantor(s) and grantee(s) must sign). The undersigned certify that [he above return, including any certification, schedule or [ac knowledge, true and complete. ~p~2 O ~ ~ •- ;/a Buyer GRANTOR ~s~~e best of his/her 2 ~ uQPi( t/rS GRANTOR 11121 Number of pages TORRENS~ Serial # Certificate # Prior Ctf. # Deed .Mortgage Instrument Deed /Mortgage Tax Stamp I Recording /Filing Stamps 3 FEES Page /Filing Fee Mortgage Amt. _ Handling 5 Q~ 1. Basic Tax 2. Additional Tax _ TP-584 Sub Total _ Spec. / Assit. Notation or EA-5217 (County) Sub Total Spec. /Add. TOT. MTG. TAX EA-5217 (State) _ Dual Town _ Dual County R.P.T.S.A. Held for Appointment Transfer Tax Comm. of Ed. 5. 00 _ Mansion Tax Affidavit The property covered by this motage is or will be improved by a one or two Certified Copy family dwelling only. Reg. Copy Sub Total YES or NO If NO, see appropriate tax clause on Other Grand Total page # of this instrument. 1000 070.00 4 District Section Block Lot 5 Community Preservation Fund Real Consideration Amount $ 0 Pro ert p y Tax Service CPF Tax Due $ ~ Agency Improved R Verification Vacant Land 6 Safisfaction/Discharges/Release List Property Owners Mailing Address RECORD & RETURN TO: TD PATRICIA A. FINNEGAN, ESO_. TD TOWN OF SOUTHOLD, OFFICE OF TOWN ATTORNEY P.O. BOX 1179 TD SOUTHOLD, NY 11971-0959 7 ~ Title Company Information Title # Sunrise Abstract LLC 622-5-2171-SS 8 ~ Suffolk County. Recording & Endorsement Pale This page forms part of the attached DRAINAGE EASEMENT made by: (SPECIFY TYPE OF INSTRUMENT) The premisis herein is situated in PHILIP S. & ANN MARIE PENNISI SUFFOLK COUNTY, NEW YORK. TO In the Township of SOUTHOLD TOWN OF SOUTHOLD In the VILLAGE or HAMLET of Southold BOXES 6 THROUGH 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FIL,INCz DRAINAGE EASEMENT ~d' THIS AGREEMENT made thisaaday of1~.~; 200 between PHILIP S. PENNISI and ANN MARIE PENNISI, party of the first part, both residing at 2570 Wells Avenue, Southold, New York, 11971, hereinafter referred to as the "Property Owner", and the Town of Southold, a municipal corporation having principal offices located at 53095 Main Road, Southold, New York, party of the second part, hereinafter referred to as the "Town". WHEREAS, the Property Owner herein is the owner in fee and simple of certain real property designated as Lot # 9 on a certain map entitled "Map of Peconic Development Corp." situate at Southold, Town of Southold, Suffolk County, New York, surveyed by Peconic Surveyors, PC and filed in the office of the Clerk of the county of Suffolk on December 27, 2001 as Map No. 10723. NOW, THEREFORE, in consideration of Ten Dollars ($10.00) and other good and valuable consideration, the receipt and sufficiency of which the parties hereby acknowledge, the property owner hereby grants unto the Town, it's successor and assigns, a drainage easement over the northeasterly twenty (20) feet along Wells Road and the division line of the recharge basin (as Oje fully described in attached description), as shown on the filed map, for the inspection, maintenance and repair and replacement of underground drainage structures and facilities within such easement area. Upon completion, the Town will restore the affected area with grading and seeding. The easement conveyed herein shall run with the land and shall be binding upon all purchasers and holders of said lot, their heirs, executors, legal representatives, distributees, successors and assigns, and that every purchaser by the acceptance of a deed thereto, covenants and agrees that the premises so purchased shall be held subject to the said easements. IN WITNESS WHEREOF, the parties hereto have caused these presents to be signed on the day and year first above written. t--- Phil`ip~S./P~~e/n i Ann Marie Pennisi TOWN OF SOUTHO -,,~j' BY: ~J~( SCO A. RUSSELL, SUPERVISOR State of New York ) County of Suffolk ss: `• ~p~ On th's~ay ofi-~~2~288~ before, the undersigned, personally appeared Philip S. Pennisi personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. State of New York ) ss: County of Suffolk ) ad; ~~~ On thi~day of~e--, 29@8', before, the undersigned, personally appeared Ann Marie Pennisi personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. 9EfSV A. PERKIN9 i µ~,y Pudlc, SIBAe of New VoR "° °,PE6"°6's otary Pu i ,°°,,,,'", ~'~ ~,I° v" State of New York ) County of Suffolk ) ss: On thisaa"day of ~~~ , 2008, before, the undersigned, personally appeared SCOTT A. RUSSELL, personally known to me or proved to me on the basis of satisfactory evidence to the be individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. Notary Public BARBARA ANN RUDDER Notary Public, State of New York No. 4855805 Qualified in Suffolk Ceu~ty Commiaebn Ezpiroe Apr814,~b HAROLD F. TRANCHON JR. P.C. Surveyor P.O. BOX 616 1866 WADING RIVER-MANOR ROAD WADING RIVER, NEW YORK 11792 TELEPHONE: 631-929-4695 July 23, 2005 Access Easement to Rechazge Basin Lot Number 9 Map of Peconic Development Corp. FAX: 631-929-1426 All that certain plot, piece or pazcel of land, situated at Southold, Town of Southold, Suffolk County, New York, being a access easement to the recharge basin on lot number 9 as shown on the Map of Peconic Development Corp., which map was filed in the Suffolk County Clerks office on 12-27-2001 as map number 10723, being further described as follows. Beginning at a point on the southerly side of Wells Road, where the division line between lot number 9 and the rechazge basin intersects the southerly side of Wells Road.. Running thence along said division line 5.22'32'00'W. - 30.00 feet, thence N.19' 40'29'W. - 29.26 feet, thence N.22'32'00"E. - 12.00 feet to a point on the southerly side of Wells Road, thence southeasterly along the southerly side of Wells Road 5.56'S2'40'E. - 20.00 feet to the point or place of beginning. P-584 (11/04) New York State Department of Taxation and Finance Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax Form A- ® Individual ^ Corporation ^ Partnership ^ Estate/Trust uc[ions for Form TP-584, before comp/etin this lorm. ation relating to conveyance Name (ilindividual; last, lust, middle initial/ PENNISI, PHILIP S. AND ANN MARIE Mailing address 2570 WELLS AVE SOUTHOLD Grantee/ Iransteree Name (it individual: last, first, middle initial) ^ Individual TOWN OF SOUTHOLD ^ Corporation Mailing address ^ Partnership 53095 MAIN ROAD ^ Esfate/Trust City ® other SOUTHOLD Location and description of property conveyed Type of property conveyed (check applicable box) t ^ One- to three-family house 5 ^ Commercial/Industrial 2 ^ Residential cooperative 6 ^ Apartment building 3 ^ Residential condominium 7 ^ Office building 4 ^ Vacant land 8 ^X Other drainage eas Condition of conveyance (check au that apply) a. ^ Conveyance of fee interest b. ^ Acquisition of a controlling interest (state percentage acquired %) c. ^ Transfer of a controlling interest (state percentage transferred %) Recording office time stamp or type. ZIP cod 11971 Social Date of conveyance month tlay year f. ^ Conveyance which consists of a mere change of identify or form of ownership or organization (attach Form TP-584.7, Schedule F) g. ^ Conveyance for which credit for tax previously paid will be claimed (attach Form TP-584.1, Schedule G) h. ^ Conveyance of cooperative apartment(s) d. ^ Conveyance to cooperative housing corporation i. ^ Syndication e. ^ Conveyance pursuant to or in lieu of j. ^ Conveyance of air rights or foreclosure or enforcement of security development rights interest (attach Form TP-584.1, Schedule E) k f"1 (:nntrart accinnme.,t Percentage of real property conveyed which is residential real property 100.00 % (see instructions) I. ^ Option assignment or surrender m. ^ Leasehold assignment or surrender n. ^ Leasehold grant o. ^ Conveyance of an easement p. ^ Conveyance for which exemption from transfer tax claimed (complete Schedule B, Part /!/) q. ^ Conveyance of property partly within and partly outside the state . r-1 ntr.~, r .........:..... For recording of/icer's use Amount received Schedule B., Part I $ Date received Transaction number Schedule B., Part tf $ NY NY 11971 ~ 3( I security number 3 Tax map designation Address City/village Town County Section Block Lot WELLS ROAD SOUTHOLD SOUTHOLD SUFFOLK 70 3 22. ' Page 2 of 4 TP-584 (11/04) Schedule B -Real estate transfer tax return (Tax Law, Article 31) Part I -Computation of tax due 1 Enter amount of consideration for the conveyance (if you are claiming a total exemption /tom tax, check the exemption claimed box, enter consideration and proceed to Part 717) ............................ ~ Exemption claimed 2 Continuing lien deduction (see instructions if property is taken subject to mortgage or lien) ...................................... 3 Taxable consideration (subtract line 2 from line f) ................................................................................................ 4 Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ...................................................... 5 Amount of Credit Claimed (see instructions and attach Form TP-584. t, Schedule G) ................................................ 6 Total tax due` (subtract line 5 /tom line 4) ............................................................................................................. Part II -Computation of additional tax due on the conveyance of residential real property for $1 million or more 1 Enter amount of consideration for conveyance (from Part t, line f) ..................................................................... 1. 0 2 Taxable Consideration (multiply line 1 by the percentage of the premises which is residential real property, as shown in Schedule A) ..... 2. 0 3 Total additional transfer tax due" (multiply line 2 by 1 % (.Ot)) .............................................................................. 3. 0 Part III -Explanation of exemption claimed on Part 1, line 1 (check any boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for the following reason: a. Conveyance is to the United Nations, the United States of America, the state of New York, or any of their instrumentalities, agencies, or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or compact with another state or Canada) ............................................................................................................................................. a ^ b. Conveyance is to secure a debt or other obligation ........................................................................................................................... b ^ c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................. c ^ d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts ...................................................................................................................................................................... d ^ e. Conveyance is given in connection with a tax sale ............................................................................................................................ e ^ f. Conveyance is a mere change of identity or form of ownership or organization where there is no change in beneficial ownership. (This exemption cannot be claimed far a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) Attach Form TP-584.1, Schedule F ................................................................... f ^ g. Conveyance consists of deed of partition .......................................................................................................................................... g ^ h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................ h ^ i. Conveyance consists of the execution of a contract to sell real property, without the use or occupancy of such property, or the granting of an option to purchase real property, without the use or occupancy of such property ............................................... i ^ j. Conveyance of an option or contract to purchase real property with the use or occupancy of such property where the consideration is less than $200,000 and such property was used solely by the grantor as the grantor's personal residence and consists of a one-, two-, or three-family house, an individual residential condominium unit, or the sale of stock in a cooperative housing corporation in connection with the grant or transfer of a proprietary leasehold covering an individual residential cooperative apartment ....................................................................................................................................................................... j ^ k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401(e) (attach documents supporting such claim) .......................................................................................................................................................................... k ^ I. Other (attach explanation) .................................................................................................................................................................... I ^ "Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in New York City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (11/04) Schedule C -Credit Line Mortgage Certificate (Tax Law Article 11) Complete the following only if the interest being transferred is a fee simple interest. I (we) certify that: (check the appropriate box) 1. ^ The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. ^ The real property being sold or transferred is subject to an outstanding credit line mortgage. However, an exemption from the tax is claimed for the following reason: ^ The transfer of real property is a transfer of a fee simple interest to a person or persons who held a fee simple interest in the real property (whether as a joint tenant, a tenant in common or otherwise) immediately before the transfer. ^ The transfer of real property is (A) to a person or persons related by blood, marriage or adoption to the original obligor or to one or more of the original obligors or (B) to a person or entity where 50% or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). ^ The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. ^ The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and the real property being sold or transferred is not principally improved nor will it be improved by a one- to six-family owner-occupied residence or dwelling. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. ^ Other (attach detailed explanation). 3. ^ The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: ^ A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. ^ A check has been drawn payable for transmission to the credit line mortgagee or his agent for the balance due, and a satisfaction of such mortgage will be recorded as soon as it is available. 4. ^ The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by the mortgage is . No exemption from tax is claimed and the tax of is being paid herewith. (Make check payable to county clerk where deed will be recorded or, i/the recording is to take place in New York City, make check payable to the NYC Department of Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, i^ncludin any return, certification, schedule, or attachment, is to the best of his/her knowledge, true and complete. ~Q do oT~ ~~~ ~ I//1a_ ~ Granto signs ure N~ Title (~ ran e~signa)u~e ~ Title ~r /r ~~usse l ~~~_~~ Grantor signature Title Grantee signature Title Reminder: Did you complete all of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you checked e, t, or g in Schedule A, did you complete Form TP-584.1? Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department of Finance? If no recording is required, send your check(s), made payable to the Department oiTaxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 4 of 4 TP-584 (11/04) Schedule D -Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit is being transferred by an individual or estate or trust. Part I -New York State residents If you are a New York State resident transferor(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferors/sellers of the real property or cooperative unit is a resident of New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferors/sellers. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) as signed below was a +asident of New York State, and thereTore is not required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of this real property or cooperative unit. ure ~ ~ Prins full name Date - ~-v~ PHILIP S. PENNISI _~ S" a Print full name Date ANN MARIE PENNISI _ a_ O Signature Print full name Date Signature Print full name Date Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed. Part II -Nonresidents of New York State If you are a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-584 (or an attachment [o Form TP-584) but are not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below. If any one of the exemptions below applies to the transferor(s)/seller(s), that transferor(s)/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who qualifies under one of the exemptions below must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all nonresident transferors/sellers. If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated Income Tax Payment Form. For more information, see Payment of estimated personal income tax, on page 1 of Form TP-584-I. This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) (grantor) of this real property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: ^ The real property or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from to (see instructions). Date Date ^ The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration. ^ The transferor cr transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signature Print full name Date Signature Print full name Date Signature Print Lull name Date Signature Print full name Date Peconic Bay Region Community Preservation Fund Schedule A - lnl'otmtation Relating to Conveyance GRANTOR Name (individual; fart, frrsq middle iniria/) © Individual PENNISI PHILIP S. AND ANN MARIE ^ COrpOfatlOn Mailing address ^ Partnership 2570 WELLS AVE ^ GtheC City State Social Security Number c~ G I o0~7 SUU'1'HULll NY 11971 GRANTEE Name (individual; lasq first, middle iniriaq Social Security Number ^ Individual TOWN OF SOUTHOLD ^ COrpOraLlOri Mailing address Social Security Number O Partnership 53095 MAIN ROAD © Other City Sm[e ZIP code Federal employer iden[. number SOUTHOLD NY 11971 Location and description of nrnnerty cnnveved Tax map designation Address Village Town Dist Section Block Lot 1000 70 3 22.$ 9 WELLS ROAD SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box) ^ Improved Date of Conveyance ^ Vacant Land MONTH aAY YEAR a. - Conveyance of fee interest b. -Acquisition of a controlling interest (state percentage acquired %) c. - Transfer of a controlling interest (state percentage transferred %) d. -Conveyance to cooperative housing corporation e. -Conveyance pursuant [o or in lieu of foreclosure or enforcement of security interest f. - Conveyance which consists of a mere change of identity or form of ownership or organization g. -Conveyance for which credit for [ax previously paid wil] be claimed h. -Conveyance of coopemtive aparhnents(s) i. - Syndication j. - Conveyance of air rights or development fights k. -Contract assignment 1. - Option assignment or surrender Dual Towns: m. -Leasehold assignment or surrender n. -Leasehold grant , o. -Conveyance of an easement p. -Conveyance for which exemption from transfer tax is claimed (complete Schedule B. Part I/) q. -Conveyance of property partly within and partly without the state. r.- Other (describe) Condition of conveyance check all that a l acne u e - ommum y reserva town Part I -Computation of Tax Due 1 Enter amount of consideration for the conveyance (from Line 1 TP-584 Schedule B) .......................... 1 0 2 Allowance(see 6elow) ......................................................................... 2 0 3 Taxable consideration (subtract line 2 from line I) .................................................... 3 0 4 2% Community Preservation Fund (of line 3) make certified check payable [o SUFFOLK COUNTY CLERK ....... 4 0 5 Property not subject to CPF Tax (See Schedule C) .................................................... For recording officer's use Amount Date received Transaction number received Allowance: East Hampton: $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) Shelter Island: $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) Southampton: $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) Riverhead: $150,000.00 Improved $75,000.00 Vacant Land (Unimproved) Southold: $150,000.00 Improved $75,000.00 Vacant Land (Unimproved) 12-02 B..2199 Schedule B - (continued) Part II -Explanation of Exemption Claimed in Part I, line 1 (check any boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for the following reason: a. Conveyance is to the United Nations, the United States of America, the state of New York or any of their instrumentalities, agencies or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or compact with another state or Canada) .................................................................. ^ b. Conveyance is to secure a debt or other obligation .......................................................... ^ c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance ............ ^ d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts .......................................................................:........... ^ e. Conveyance is given in connection with a tax sale .......................................................... ^ f. Conveyance is a mere change of identity or form of ownership or organization where there is no change in beneficial ownership. (This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprisirzg the cooperative dwelling or dwellings.) ..................................................................... ^ g. Conveyance consists of deed of par[ition ................................................................. ^ h. Conveyance is given pursuant to [he federal bankruptcy ac[ ................................................... ^ i. Conveyance consists of the execution of a contract to sell real property without the use or occupancy of such property or the granting of an option to purchase real property without the use or occupancy of such property ......................... ^ j. Conveyance or real property which is subject to restricfions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) or (k) of Article 31-D of the Tax Law. (See required Town approval.below) .................................................................................... ^ k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operatgd for conservation, environmental, or historic preservation purposes. I. Other list explanations in space below (Grandfather/Contract) ................................................. ^ m. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 31-D of the Tax law. (See j in Schedule C) Town Attorney or other designated official Penalties and Interest Penalties Any grantor or grantee failing to file a remm or to pay any tax within the time required shall be subject to a penalty of 10%o of the amount of tax due plus an interest penalty of 2% of such amount for each month of delay or fraction [hereof after [he expiration of [he firs[ month after such retum was required to be filed or the tax became due. However, the interest penalty shall not exceed 2% in the aggregate. Interest Daily compounded interest will be charged on the amount of the tax due not paid within the time required. ***** By signing the following, the buyer and seller further represent and attest to the fact that for property lying within Southold Town, a validly executed contract was in effect prior to Mazch 1, 1999 and that for all other towns subject at the CPF tax, a validly executed contract was in effect prior to April 1, 1999. Seller Signature (both the grantor(s) anti grantee(s) must sign). The undersigned certify that the above return, including any certification, sche k{n~o~w~le~dge~,~tr~ue and comple ~...~.~ .. ,. O e e GRANTOR Buyer e attachment, is tot a best of his/her O ~C ~- ~us~e, ~, Sie~Le.( vise'( GRANTOR