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t 693-s'an~rd N.Y.B.T.U. Form 8004. Quitdaimdeed,
Individual orCorponuion(linale sheell. 11-98
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CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY.
THIS INDENTURE, made the l.p day of l\l\l\J"'-1Y\ ~r ;20(:::> \
BE1WEEN
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party of the first part, and
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party of the second part,
WITNESSETH, that the party of the first part, in consideration of ten dollars paid by the party of the second
part, does hereby remise, release and quitclaim unto the party of the second part, the heirs or successors and
assigns of the party of the second part forever,
ALL that certain plot, piece or' parcel of land, with the buildings and improvements thereon erected, situate,
lying and being in the
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TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and
roads abutting the above described premises to the center lines thereof; TOGETHER with the appurtenances
and all tl>'tlf\ll;....{li"'oily of the first part in and to said premises; TO HAVE AND TO
HOLD the ,0811I__ unto the party of the second part, the heirs or successors and assigns of
the party M, .<:r~
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AND the party of the first part, in compliance with Section 13 of the Lien Law, hereby covenants that the party
of the first part will receive the consideration for this conveyance and will hold the right to receive such consid-
eration as a trust fund to be applied first for the purpose of paying the cost of the improvement an, I will apply
the same first to the payment of the cost of the improvement beiore using any part of the total of the same for
any other purpose.
The word "party" shall ~ construr:d as if it read "parties" whenever the sense of thi! indenture so requires.
IN WITNESS WHEREOF,the party of the first part has duly executed this deed the day and year first above
written. ...
IN PaESJtNCE OF:
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TITLE NO, RH961739
SCHEDULE A
THE PREMISES IN WHICH THE INSURED HAS THE ESTATE OR INTEREST COVERED BY THIS POLICY
ALL that
Suffolk,
certain plot, piece or parcel of land, situate, lying and being at New
in the Town of Southold, County of Suffolk and State of New York:
BEGINNING at the corner formed by the intersection of the southerly side of Main Street
with the westerly side of Second Street;
RUNNING THENCE along the westerly side of Second Street, South 5 degrees 58 minutes 10
seconds West, 101.09 feet;
THENCE North 83 degrees 43 minutes 40 seconds West, 70.00 feet to land now or formerly
of Benjamin Smolenski;
THENCE along said lands North 5 degrees 58 minutes 10 seconds East, 100.00 feet to the
southerly side of Main Street;
THENCE along the southerly side of Main Street, South 84 degrees 37 minutes 30 seconds
East, 70.00 feet to the westerly side of Second Street at the point or place of
BEGINNING,
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Number of pages
RECORDED
2001 t.jOI.} 07 03:41: 1.7 PH
Eduard P.Rofl!aine
CLEPf< OF
SUFFOU< COUtH'y'
L D00012151
F' 796
DT# 01-13822
TORRENS
Serial #
Certificate #
Prior Clf. #
Deed / Mortgage Instrument
Deed / Mortgage Tax Stamp
FEES
Recording / Filing Stamps
4
Page / Filing Fee (~ -
Handling r; -
TP-584 S
Notation
EA-52 17 (County) 5 Sub Total
EA-5217 (State) dS
.- -
RP. T.S.A. >-
Comm. of Ed. 50~
Mortgage AmI.
1. Basic Tax
2. Additional Tax
Sub Total
d-7~
Spec.! Assit.
Or
Spec. / Add.
TOT. MTG. TAX
Dual Town Dual County
Held for APportionm;.v-----
Transfer Tax ;-_
Mansion Tax _
The property covered by this mortgage is or
will be improved by a one or two family
dwelling only.
YES or NO
If NO. see appropriate tax clause on page #
of this instrument.
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7(.,
Sub Total
Other
-
GRAND TOTAL
f~'
Real Property Tax Service Agef!e'y Verification
Dist. Section Block
6 Community Preservation Fund
Consideration Amount $
/17-.W Oq. W U;)3.
[XX)
$
CPF Tax Due
Improved
Vacant Land
Satisfactions/Discharges/Releases List Property Owners Mailing Addres
f RECORD & RETURN TO:
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TD
TD
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Title Company Information
8
Co. Name
Title #
Suffolk Count
& Endorsement Pa e
9
lbis page fonTIS part ofthe attached
made by:
(SPEOFY TYPE OF INSTRUMENf)
The premises herein is si luated in
SUFFOLK COUN1Y, NEW YORK.
In the Township of SOl ;)J-y) I d
In the VILLAGE
orHAMLETof ~~w "S IIfVoLIfC.-
TO
'J-D('QJrl J B<A-le~
_t)1dvl2- M. E~9-lt'---f'
BOXES 5 TIIRU 9 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
(OVER)
,
. .
1111111111111111111111111111111111111111111111111111111
1111111111111111111111111
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEEDS/DDD
Number of Pages: 4
TRANSFER TAX NUMBER: 01-13822
Recorded:
At:
LIBER:
PAGE:
11/07/2001
03:41:17 PM
D00012151
796
District:
1000
Section:
117.00
EXAMINED AND
$0.00
Block:
09.00
CHARGED AS
Lot:
023.000
FOLLOWS
Deed Amount:
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $12.00 NO Handling $5.00 NO
COE $5.00 NO EA-CTY $5.00 NO
EA-STATE $25.00 NO TP-584 $5.00 NO
Cert.Copies $4.00 NO RPT $15.00 NO
SCTM $0.00 NO Transfer tax $0.00 NO
Comm.Pres $0.00 NO
Fees Paid $76.00
TRANSFER TAX NUMBER: 01-13822
THIS PAGE IS A PART OF THE INSTRUMENT
Edward P.Romaine
County Clerk, Suffolk County
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PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http:// www.orps.state.ny.us or PHONE (518) 473-7222
4A. Planning Board with Subdivision Authority Exists 0
4B.Subdivision Approval wa~ Requ!rl}d for Tra~~.er ,,0.. *"
Ii \S4 1\ ,4(;. "1'w,' rlWlt'e~ ~1!!>_d;vil.iDrft;,\, ~p "''''Vid'l~ :). );.
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FIRST NAME
J 41'1 j.-f
ICj ,
Check the boxes below as they apply:
8. Ownership Type is Condominium
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/ K:EET NAME
2. Buyer
Name
f- j
LAST NAME! COMPANY
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FIR~NAME
LAST NAME! COMPANY
3. Tax Indicate where future Tax Bills are to be sent
Billing jf other than buyer address (at bottom of form)
Address
LAST NAME I COMPANY
STREET NUMBER ANO STREET NAME
CITY OR TOWN
/
# of Parcels OR D Part of a Parcel
4. Indicate the number of Assessment
Rolf parcels transferred on the deed
5," Deed
Property
Size
lOR I
I xl
'ACRES' 'f,7
DEPTH
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP . 5217
RP.S217 Rev 3I'J7
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ZIP CODE
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;i
FIRST NAME
j
ST~TE
ZIP CODE
(Only if Part of a Parcel) Check as they apply:
6. Seller
Name
C'r-
f.' 1:
7. Check the box ,below hich most accurately describes the use of the property at the time of sale:
A~ One Family Residential
B 2 or 3 Family Residential
C Residential Vacant Land
D No~-Residentia\ Vacant Land
E ~ Agricultural
F Commercial
G Apartment
H Entertainment / Amusement
I ~ Community Service
J Industrial
K Public Service
L Forest
9. New Construction on Vacant Land
10A. Property Located within an Agricultural District
10B. Buyer received a disclosure notice indicating
that the property is in an Agricultural District
o
o
o
o
15. Check one or mar. 'Of these conditions as applicable to transfer:
A +-,
B
C
D
E
F
G
H
I
J
11. Sale Contract Date
....... Month D.y Year
12. Date of Sale I Transfer \ \ 1 ~ 10 \
Month Day Year
13. Full Sale Price I I I 0 , 0 I
, , .
(Full Sale Price is the total amount paid for the property including personal property.
This payment may be in the form of cash, other property or goods, or the assumption of
mortgages or other obligations.} Please round to the nearest whole dollar amount.
14. Indicate t~e value ~ personal I j I I [ I I I 0 I 0 I
property Included In the.sale .. '. ".' .. '.. . ".
1;~~~Ilioif~~_.~~1
16. Year of Assessment Roll from I (j I I I
which information taken . I . 17. Total Assessed Value (of all parcels in transfer)
Sale Betwe,p Relatives or Forrver Relativ~s
Sale Betwe~n Related Companies or Partners in Business
One of the Buyers is also a Seller
Buyer or Seller is Government Agency or Lending Institution
Deed Type not Warranty or Bargain and Sale (Specify Below)
Sale of Fractional or Less than Fee Interest (Specify Below)
Significant Change in Property Between Taxable Status and Sale Dates
Sale of Business is Included in Sale Price
Other Unusual Factors Affecting Sale Price (Specify Below)
None
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18. Property Class
~, I ,0 I-LJ 19. School Di"";" Nama leU -1(1 he:) u e ,
20. Tax Map Identifierls} I Rollldentitierls) (If more than four, attach sheet with additional identifierls))
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I certify that aU of the items of infonnation entered on this form are true and correct (to the best of my knowledge and belief) and I understand that the making
If ;:::;;lJaIse 7~:~:: f:tJ pu sutiJ, .' ect mero) th~JPro~ons of the oenaIlaw relative ::~~:;~= of false instruments.
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BUY~R SIGNATURE DATE
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STREET NUMBER
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STREET NAME (AFTE~ S~LEf
AREACOOE
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~ELLER
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ZlPCOOE
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DATE
SELLER SIGNATURE
FIRST NAME
TELEPHONE NUMBER