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_ Rarpil'lllnd SlIle n-d. ....ith Covel'Ullll,pin. Gn.n&nr's Arts _IPliividwd orC~i.c>n (SIDJIe S~I)
I! CONSULT YOUR LAWYER B~FORE SIGNING THIS INSTFIUMENT -THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY.
II
,
THIS INDENTURE, made the
1~15
day of
Hay
. in the year
two thousand three
~~EEN FISRERS ISLAND COMMUNITY HF~LTH FUND, INC., with
NDo~ Ml\-iN ~tl Fishers Island, New York 06390
an address of
II
1000 I
o::A. Q.)
oa.oo
(XfO.
pany of the first pan. and ISLAND HEAl.TH PROJECT.. INC., 8. New York not-for-profit
corporation w~th an address o~Maln Street. P.O. Box 344, Fishers Island, NY 06390
Nbif
party of me second part.
WITNESSETH, that the patty of the first part. in consideration or TEN ($ lO. 00) and No/lOO------------
_____________________________________________________________________________ dollars
paid by the pany of the second port. does hereby grant and release unto Ibe party of the second part. the heirs or successors ami
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
,.
:1 in the Town of Southbld. at Fis~er8 Island, County of Suff01k and St~te of New York.
being bounded nnd(:described as follows:
BEGINNING at a stone monument on. the northwesEr:ty line of Crescent Avenue, said
monument being 2543.98 feet north of a point which is 1852.41 feet west of another
monument marking the U~ Coast and Geodetic Survey Tr1angul~tion Station "PROS" and
THENCE running along said Avenue line south 50 degrees 06 minutes 20 seconds west.
121.97 feet; THENCE north 37 degrees 43 minutes 20 seconds west, 142.16 feet;
THENCE north 77 degrees 45 minutes 30 seconds e~st, 100.89 feet; THENCE south 66
degrees 29 minutes 40 seconds east, 30.95 feet; THE~CE south 51 degrees 04 minutes
seconds west. 68.85 feet to' the point of BEGIN~ING.
SUBJECT however, to.,the easement or right of w~y reserved in favor
10'1 Electric COTp.. for the construction URe and maintenance of a pole
with the appurtenances and to said right of way being described in
I:
I
II
40
of Fishers Island
1.1ne toget.her
libe 4597 cp 542.
BEING AND INTENDED TO BE the same premiRes known 85 No # Crescent; Fishers Island~
New York as conveyed to the grantor herein by deed dated 3/3/59 and recorded 3/11/59
in liber 4597 page 542 in the office of the Suffolk County Clerk.
TOGETHER with all right. title and interest, if any. of the pany of the filSt pan in and to any streets ami roads abutting the above
described premises to the center lines thereof; TOGETHER with the appurtenances and all the estate and rights of the party of
the rust part in and to said premises; TO HAVE AND TO HOLD the premises herein granted unto the party of the second part.
the heirs or successors and assigns of the party of the second part forever.
~! AND the party of the first pact covenants thar. the party of the first part ha..'i; not done 0[" suffered anything wherehy Ihe sllid
I premises have been encumbered: n any way whalcver. except as aforesaid.
AND the patty of the first p:.ut. in compliance wilh Section 13 of the Lien La\\'. covenants that the pact)" of the first pan will
receive the consideration for this conveyance and will hold the right to receive such consideration as a lrust fund 10 bc applied
I' first for the purpose of paying the cost of Ihe improvement and will apply Ihe same first to the payment of Ihe cost of the
"0 improvement before using any part of the total of the same for any other purpose. The word .'party" shall be con~trucd U~ ifil
read "parties" whenever the sense of this indenture 50 requires.
II
IN WITNESS WHEREOF, Ihe party of the first pan has duly cx.ecuted this deed the day and ye.ar first above written.
FISHERS ISLAND COMMUNITY HEALTH F~~. INC.
~i IN PRESENCE OF:
II '7~"-<f 8. a. ~lIv/l- 0-
'II
STATE OF NEW YORK, COUNTY OF
On the day of in Ihc year
bcfon: me-lbc undersigned. personally appeared
. personally known to me or proved 10 me on
che basis of sa1iaractory evidence to be the individua1(I) whose
name(s) l5 Care) subscribed to tbe within instrument and M:"knowl-
edged to me mal hclfihcllbcy cxceuccd the same in hislhcrlthc.ir
capaeity(ics), and that by hislheritheir aignature(s) on the
inslnnnenl. the indivldual(s). or the person on behalf of whicb the
individualCs) acted. executed the instrUment.
STATE OF
. COUNTY OF
On the day of in the year
bcfOR: me. the undersigned. a Norary Public in and for said Slate,
personallyappc.an:d
.Ihe
subseribin, wiuu:s.s 10 the foregoing instrument. with whom I am
pononallyacquainted. who. baiDS by me duly .wom. did depose
and say thar. hcl5hellhcy raidc(s) in
(if me place of residence is ill . city. indudc: lhc. stteel lAd Sutd number if any. tbtrcof);
that hclshclthey know(s)
to be the individual d~ribcd in and who executed the foregoing
instrument; 1I1a1 5aid subscribing witness wu present and saw said
ex.ecuLC the Sollmc; and IMI said witness a. the same lime subscribed
hislhcrhheir IULI11C'(S) as a wilness thereto
(add the followma if lbe Kknowledamenl i.taRn ouu.ide NY S\iile)
and thai said subscribing wilne5S made such appearance before
lhc undcnr.igned in the (insert me city 01 other political subdivision and
1M S~te or C'OlIDtry oc OIher place the pnKJl' WIlS blken).
llInrgnin nnb ~nlr nrrb
WrrH COVENANT AGAINST GRANTOR'S ACTS
TrTu! No.
632-S-7343
Fishers Island Communicy Health Fund, Inc.
TO
Island Health Project, Inc.
~
s,,1IC'iI:I"'c-r~.
Dlstrlnlnl by
STEWART TITLE-
INSURANCE COMPANY
250 PARK AVEl'iUE
NEW YORK. NEW ,"ORK 10171
1:112) !l.Z2.-Q050 Fa (212J9Il-II.lJ
. ""'--.
STATE OF
On the day of in the year
before me. the undenigned, personally appeared
. personally known to me or pro~ to me on
the bub; of satisfactory evidence to be 1hc individual(l) wboae
Damc(S) is (ue) subM:ribcd to the wirhiA instrumeat and ac:lmowl-
edged to me that helahellbey cx.ecutcd the same In hlslhcrl1he.ir
c:apacity(ies);1lIld dud: by hi.slhcrJtbeir signature(l) on lite
instrument. the individual(s). or the person on bcbaJf of which the
iDdividual(l) 1lC~. executed the illlllmment
(add the foIlowillllrthe Kknowleclaml:nt w lab:n ou&sidc NY Slate)
and that said individualmadc such appcaranc:c before the
undersigned In the (imatllEc:irya:allcrpullliallUWiri_IIIlI&t&s.:a:CXIUIIfIJ
ClI.... plIlz IbI: 1ICbIuw1alpat....1ItaI)..
STATE OF . COUNTY OF
On the day of in d1e year
bcf~ me personally came
10 me known, who. being by me duly sworn, did depose and say
that he resides 8t
thll: be is the
of
the corpoI'Blion dcs.c:ribed in and which executed rhc fOR:aoina
insttumcnti mil he knows the seal of said corporar.ion; that the
seal affixed to said instrument is such corporate seal; that it was
so affixed by order of the boan:I of di~clOJ'S or said c:orponu:ion,
and thac he signed h name thereto by like o.rder.
Diet. 1000
SEC'IlON 9 . 00
BLOCK 2 . 00
LOT 8.00
COUNTY-.x SUFFOLK
STREET ADDRESS
Recorded at Request of STEWART TITLe-
RETURN BY MAIL TO:
L~nda U. Margo1in, Esq.
Bracken, Margolin & Gouvis, LLP
One Suffolk Square, Su~te 300
Islandia. New York 11749
.
~. \.
Uniform Acknowledgement
Stale of New York )
)
County of SI(~1 k ) 55.:
'l'<-
On the~" day of May, of year 2003 before me, the undersigned, a Notary Public in
and for said State, personally appean:d Suzalllle Parsomi, personally known to me or proved to me
on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the
within instrument and acknowledged to me that she executed the same in her eapacity(ies), and
that by her signature(s) on the instrument, the individual(s) or the person upon behalf of which the
individual(s) acted, executed the instrument.
County or ~(lc
)
)
) SS.:
~B. (L ClIMb!;
Not' ublic
lAIn' B PANXIE~
bIv Public S1aIlI II,.. YOlk
1tl52"-ll26795O .
Co.,......, ExIiM "/1./0(,
State of New York
~
On the.;u. day of May, of year 2003 before me, the undersigned, a Notary Public in
and for said State, personally appeared Margaret Killg, personally known to me or proved to me
on the basis of satisfactory ev:dence 10 be the individual(sl whose name(s) is (arc) subscribed to the
wilhin instrument and acknowledged to me that she executed the same in her capacity(ie5), and
that by her signature(s) on the instrumenl, the individual(s) or the person upon behalf of which the
individual(s) acted, executed the instrument.
~ g e.1-"""'J
Not. ublic
MAllY B PANXEWICZ
buy PtdJli: SllIIB 01 ,.. York
1tl52-ll2671l5O
CAAIII....I~ l{(g.let..
~.._. . ..
Uniform Acknowledgement
State of New York )
)
County of ~k )S5.:
On the :J.I."'" day of May , of year 2003 before me, the undersigned, a Notary Public in
and ror said State. personally appeared Dianna Shillo, personally known to me or proved to me on
the basis of satisfactory evidence to be the individual(s) whose name(s) is (arc) subscribed to the
within instrument and acknowledged to me that she executed the same in her capacity(ies), and
that by her signature(s) on the instrument, the individual(s) or the person upon behalr of whieh the
individual(s) acted. executed the instrument.
~~u!ftCP4flD c3
\WI'( B PAHKIEwtcz
tbBIy PubDc SIlIIB d New York
1tl~.a267950
~1.,1Itdoo &pial '11'30/01..
"
/[!] 2
":J
RECORDED
2003 tlay 30 01: 29: 37 PM
Edward P.Romaine
CLERK OF
SUFFOLK COUNTY
L DOOOl2253
p >324
DT# 02-41432
,
;
N umber of pag~s
TORRENS
Sc:riul #
Ccnificate #
Prior etf. #
Deed I Mongagc Instrument
Deed I Mortgage Tax Stamp
R~cnrJing I Fi ling SUlmp~
3
FEES
Page I Filing Fee
/-
:::>
-
TP-584
.:)
~
Mongagc Anll.
I. Basic Tax.
:!. Additional Tax
Sub Total
Spec .IAssit.
Handling
5" .-illL
NUlalinn
EA-52 J7 (County)
EA-52J7 (Stale)
R.P.T.S.A.
s-
.2:2 -
30
Suh Tnlal
$)'-
<>r
Cumm. l,r Ed.
5. 00
Spec. IAdd.
TOT. MTG. TAX
Dual Town _ Dual County
Hdd for Appuintment
Tr-..nsfcrT..lx _ _~ _
Mansion Tax
Aflid"vil
~~
. opy
Other
/~
--
Sub Tutal
~o--
/ /()-
~
The prupeny ..:overed hy this m('tnp.ug.t:' is
or will he improved hy a one: or two
family dwelling only.
YES ur NO
b
-
Grand Tuta)
4 Dislrk'1
Re".
Property
Tax Service
Agc=ncy
Vt:ri ticutiun
Section
Block
Lot
5 Community Preservation Fund
1000 00900 0200 008000
Consideration Amount $ 0/.00
CPF Tax Due
S
0.00
Satisfactions/Discharges/Releases List Pmpcny Owners Mailing Address
RECORD & RETt:RN TO:
/
I mpruvcd
xx
6
~:"~
TO
Linda U. Margolin. Esq.
Bracken, Margolin & Gouv1e,
One Suffolk Square
Suite 300
Islandia, NY 11749
LLP
TO
7
Title Com an
AQUEBOGUE
632-5-7343
Information
ABSTRACT CORP.
ell. Name
Tillc#
8
Suffolk Count
Recordin
& Endorsement Pa e
This page: I\)rms part ur lhe attached
DEED
mOld.: hy:
(SPECIFY TYPE OF INSTRUMENT)
FrSHERS ISLAND COMMUNITY
HEALTH FUND.~~.
The premises h~rcin is situated in
Sljl+OLK COUNTY. NEW YORK.
TO
In the Township of
SOUTHOLD
ISLAND HEALTH "'-Ii~1:,~._ In the VIl.LAGE
<>r HAMLET or
FISCHERS T~T.AN'n
BOXES 6 TIIRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
(u'\'e:r)
11111111111111111111111111111111 11111111111111111111111
1111111111111111111111111
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEEDS/DDD
NUmber of Pages: 5
TRANSFER TAX NUMBER: 02-41432
Recorded:
At:
LIBER:
PAGE:
05/30/2003
01:29:37 PM
D00012253
824
Deed AIIloUDt:
Section: Block:
009.00 02.00
EXAMINED AND CHARGED AS FOLLOWS
$0.00
Lot:
008.000
District:
1000
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $15.00 NO Handling $5.00 NO
COE $5.00 NO NYS SURCHG $15.00 NO
EA-CTY $5.00 NO EA-STATE $25.00 NO
TP-584 $5.00 NO Cert.Copies $5.00 NO
RPT $30.00 NO SCTH $0.00 NO
Transfer tax $0.00 NO Comm.Pres $0.00 NO
Fees Paid $110.00
TRANSFER TAX NUMBER: 02-41432
THIS PAGE IS A PART OF THE INSTRUMENT
Edward P.Romaine
County Clerk, Suffolk County
.
FOR COUNTY USE ONLY
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http:// www.orps.state.ny.u5 or PHONE (518) 473-7222
C1. SWIS Code
<(,7, 5<;<',9,~
*..........
.- .'
.
, n
<; CJ
C2. Date Deed Recorded
')1 ")0 lOr
Momh DBY Year
C3.Book I /.,;('~I ~ ~IC4.Pagel
PROPERTY INFORMATION
I? ,;2.5'1
1. Prop-:rtV LlliLJL
Loeatlon STREET ~UMBER
Fishers Island
Crescent
STREUNA"'E
Southold
C1TvORTOWN
VILUl.C;E
2. Buyer
Nom.
Island Health Project, Inc.
Ul.STNAME;COMPANY
clRSTNAMc
L.ASTNAMFICOMPANY
"IRSTNAM,
3. Tax
Billing
Address
IndicatE/where 'utureTax Bil's are 10 be sent
f other than buyer address (at bottom offo'ml
Island Health
L
Project Inc.
LAST NAME ICOMPANV
Fishers Island
I Main Street, FOB 344
STREE-'-JUt..!BERANOS':"llHTNAf\I,E
CITY OR TOWN
4. Indicate the numbllf of A$$essment
Roll parcels transferred on the deed
\ J # of Parcels OR D Part of a Pllrcel
5. Deed
Property
Size
.CI 8
lOR I
I X I
"ACRES
{lEP'~
~RONT "FET
6. Seller
Name
Fishers Island Community Health Fund. Ind.
lAST NAME I COMPANY
fIAST~N>o1E
L
l.ASTNf.ME ..COMPA~Y
FIASTNAME
7. Check the boJo: below whlGh most accurately describes the use of the property at the time of s~le'
A~onaFamiIYReS;der,tiai
B 2or3 Family Residential
C AesidentialVacant Land
o Non-Residential Vacant Land
~~
Agriculturill I~COr""'m\lr'itYserVice
Commercial J I~dustrial
Apartment K Pub'icService
Emertainment.l Ar""'l.;semant L Forest
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP.5217~yJ1'J7
I 06390
z,~ CODE
FIRST NAME
I NY I 06390
STATE ZIPCOJIo
(Only if Part ofa Parcel) Check as they apply.
4A, Plannir1g Soarl! with S~bdivision AuthoritY E~ists 0
4B. Subdivision Aporoval was Req\lired for T'ansfar 0
4C, Parcel Approved lor Subdivisior1 witl1 Map Provided 0
__--.-I
Check the boxes below as tnBY apply
8. Ownen;hip Type i!l Condomir1ium
9. New COr1str~ction on Vacant Lar1d
lOA, Property Locatedwithir1 an Agricultural :listr!cl
10B.lluve' received a disclosure noticeir1dicating
lMt the property is ir1 Br1 AgricullL'ral District
o
o
o
o
SALE INFORMATION
15. Cheek one or more of these conditions as applicable to transfer:
A Sale Betwear1 Relatives or Fonner Relatives
B Sale Bctv\l'een Belatod Compan:es or Partners in Business
COne of the Buyers is also a Sel!er
D Buyer or Seller is Government Agency or Lendirg lr1!ltitUlion
E Deed Type not Warranty or Bargain and Sale ~Specify Below~
p Sale of Fractional or Less thon ree lr1l0rcst (Specify Below)
G Significant Ch<lr1ge in Property 8etween Taxable Status and Sale DateS
H Sa'e of Business is Included in Salo Prir.e
1 Other Unusual Factors Affect"ng Sale Price lSpecify Belowl
J None
NO CONSIDERATION TRANSFER BETWEEN
CHARITABLE ORGANIZATIONS WITH SAME
11. Sale Contract Date
N/A I~
I
Morth Del' ,~,
05 26 I 03
Mo,,111 De, Year
-0- 0 0 I
12. Date of Sale I Transfer
13. FullSele Priow
, , .
(Full Sale Price is the total amount paid for the propertyincludir1Q pllrsor1al proper1y.
This payment may be in Ire form of cash. other property O. goods, or the assumptior1 of
mortgages cr other obligations,) Plea.~p. rolJnd to the nearest whole do/Ja' amount.
14. Indieate the value of personal
property inc.luded in tha .iIIla
-0-
o , 0 1
, , .
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill
16. Year of As.sessment Roll from ~ 17. Total Assessed Value (of all parcels in transferl [
which informadon taken
18. PropertvClass
,({, ,'-1 , d I-LJ
19. School Dirtrict Name
Fis_I:t_~rs Island
20. Tall Map ldentlfier(s) I Rollldentifierlsf (If more than four, attach sheet with additional identifier!sll
11000; 009.00; 02.00; 008.000
_.J
TWO
PURPOSE
8.,-\001
,
----.J
I CERTIFICATION
I certify that all of the iteJIU; of infomwtioll entered on tlris fonn are true and l.'OIn-ct l.to the best of 01)' knowledge and belief) and I understand that the making
of any wiUful fah.e statemenf of material fact herein will subject lIle to the Jlrovislous of fht> neua] 11IW rellltivc to the making and filing of false jnstrument.~.
Island Health Proj~t('(E,R Inc.
, liUw-,.
1051CJIID3
[>ATf
Margolin
CASTNAI.IE
XX 631
POB 344
~lriiuMaER
Main Street
ST~EET NAME IAFTER SALEJ
AREA CODE
Fishers Island
NY
06390
CI1YOII'OWN
STATE
ZlPCO()l;
Fund, Inc.
051d(:-103
OATE
BUYER'S ATTORNEY
Linda U.
'.IRSTNA~F
234-8585
~;:lEPHONE NUWBEH
[~W
YORK STATE
COPY