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CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT - THIS INSTRUMENT SHOULD BE USED BY LA WYERS ONLY
THIS INDENTURE, made the /.J day of /Y).I'I 1
two thousand and one
,"li~lmndreamut
BETWEEN
Harold J. Clark and Donna Clark, his wife, and George W. Kline and AI.ice D. Kline,
his wife, all as joint tenants in common and residing at 1505 West Mill Road,
Mattituck, N.Y. 11952
r
party of the first part, and S.
Fred M. Carter..K and Martha Carter, his
117 Sayville Boulevard, Sayville, N.Y.
wife, both residing at
11 782
party of the second part,
WITNESSETH, that the party of the lirst part, in consideration of Ten Dollars and other valuable consideration
paid by the party of the second part, does hereby grant and release 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 tin< at Mattituck, Town of Southold, County of Suffolk and State of
New York, bounded and described as follows:
at a concrete monument located on the westerly side of Mill road at the
line of the subject premises and land now or formerly of William Chudiak;
20' 20" West 175.0 feet to a point;
720 24' 00" West 653.82 feet to land now or formerly of
RUNNING
Stanley
RUNNING THENCE
now or formerly 0
Chudick;
18' '20" East 174.93 feet to a concrete monument and land
Fork Gree~ Community Association, Inc., and William
RUNNING THENCE
BEGINNING.
o 24' 00" East 656.98 feet to the point or place of
Subject to Covenants and Re trictions of record and Covenants and Restrictions
annexed hereto and made a pa
The subject premises
Subdivision made for
on July 14, 1986.
as Lot Number 4 on a Minor
the Southold Town Planning Board
These persons are the same persons as
which covers the subject premises and
in Deed, Liber 10327, Page 91
S.c:E SCHEOuLi:"" 'A"
A1/)'lCH~
TOGETHER with all right, title and interest, if any, of the party of the first Jart in and to any streett; and
roads abutting the above described premises to the center lines thereof; TOG' THER with the appurtenances
and all the estate and rights of the party of the lirst part in and to said premises, TO HAVE AND TO HOLD
the premises herein granted unto thc party of the second parL the heirs or successors and assigns of the parly of
the second part forever.
AND the party of the ,first part covenants that the party of the first part ha.s not done or suffered anything whereby
the said premises have been encumbered in any way whatever, except as a,foresaid.
AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party of the first
part will receive the consideration for this conveyance and will hold the right to receive such consideration as a
trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to
the payment of the cost of the improvement before using any part of the total of the same for any other purpose.
The word "party" $hall be construed as if it read "parties" whenever the sense of this indenture so requires.
IN WITNESS WHEREOF, the party of the lirst part h., duly executed his deed the ay nd year first ahove
writl~. 1 .
II! t RoSENe" ''b
.L~L 1,1/ !2~
-George W. Kllne
~-~~-
Alice D, Kline
Donna
AQUEBOGUE ABSTRACT CORP.
SCHEDULE A
TITLE NO: 632-8-6953
Amended 5/14/01
All that certain plot piece or parcel of land, situate, lying and being in the
Town of SOUTHOLD, at MATTITUCK, County of Suffolk and State of
New York being bounded and described as follows:
BEGINNING at a monument located on the westerly side of Mill Road, said
point being distant 140.00 feet southerly from the southerly end of a curve
cOilllecting the southerly side of Selah Lane and the westerly side of Mill
Road; THENCE south 19 degrees 20 minutes 20 seconds west, 175.00 feet
to a point; THENCE north 72 degrees 24 minutes 00 seconds west, 653.82
feet (653.31 feet as measured) to a point marked by a monument; THENCE
north 18 degrees 18 minutes 20 seconds east, 174.93 feet to a point marked
by a monument and lands now or formerly on map #9539; THENCE south
72 degrees 24 minutes 00 seconds east, along said lands, 656.98 feet
- . -
(656.54 feet as measured) to the point or place of BEGINNING.
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II Uniform Form Certificate of ACknowledgement
Ii
State of New York:
ss:
!I
I,
County of New York:
. On the 10ft, dayof )1-'16\-1 in the year 2001, before me, the undersigned, a Not....y Publ;.. ~ flfId-
-for said SUItt. personally appeared HAROLD J. CLARK and DONNA CLARK, personally known to me or
proved to me on the basis of satisfactory evidence to be the individual (s) whose name (s) fA (are) subscribed to
the within insttument and acknowledged to me that:~ / they have executed the same tO~1m I their
capacity (ies), and that by 1.i.__.':-7 their signamre (8) on the instrument, the individual (s), or the person upon
behalf of which the individual (s) acted, executed the instrument.
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ANNE; M. GOROON
Notary Public. State of New York
No. 01 G04626718
Qualified in Kings CounW;2.t1(, 2-.
Commission Expire. June 30. '--'-
Uniform Form Certificate of Acknowledgement
State of New York:
S8:
County of New York:
On the /o'f~ day of /11tL'l ;2001 in the year 2001, before me, the undersigned;-<aoNN"'1'4>o'Mic-in-and..
.fflY ,..; ~ E~, personally appearM GEORGE W. KLINE and ALICE D. KLINE, persoruilly known to me or
proved to me on the basis of satisfactory evidence to he the individual (s) whose name (s)'ii (are) subscribed to
the within instrument and acknowledged to me that-l-_~._L~ / they have executed the same tolitL C~I their
capacity (ies), and that by II w:-/ their signature (s) on the instrument, the individual (s), or the person upon
behalf of which the individual (8) acted, executed the insmunenl.
Cd Jr l j'
h1.J.~_'(~(:jtf~h'-
ANNE M. GORDON
Notary Public, Slale of New York
No.01G04626718
Oua,lified in Kings County. "I' _,
CommiSSion Expires June 30. ~.....-
E OF NEW YORK. COUNTY OF
fl1 VJA
On the day of I f( fA 'I
personally c e Harold J. Cl
Clark
OF NEW YORK. COUNTY OF
i"
,
Int\;
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IV" (.\, cl /L~
001
me
55:
, before me
Kline
e in vidual s described in and who
. strument, and acknowledged that
the in . iduaL~ described in and who
and acknowledged that
/71 Ie.! ~u(o->\
ANNE M. G DON
Notary Public, State New York
No. 01 G04626 8
Cuahlled In Kings C nty,
CommissIon Expires June ~oJ--
)I({/c( ,d,'.,c
ANN GORDON
Notary Public, ate 01 New York
No.OIGO 26718
~ua.lifjad in Kin County.., _
Commission Expires Ju 30 ,,-,.( ( 0 ~.-.
'-
STATE OF NEW YORK. COUNTY OF
2001
MX
55:
STATE OF NEW YORK. COUNTY OF
2001
j(g::
55:
On the day of
personally came
to me known, who, being by me duly sworn,
say that he resides at No.
, before me
On the day of
Ilel"SonaJly came
the subscribing witness to the foregoing instrument,
whom I am personally acquainted, who, bej"ng hy me
sworn, did depose and say that he resides at No.
, before me
did depose and
,,,'ith
dnly
that he is the
of
that he knows
, the corporation described
in and which executed the foregoing instrument; that he
knows the seal of said corporation; that the seal affixed
to said instrument is such corporate seal j that it was so
affixed by order of the board of directors of said corpora-
tion, and that he signed h name thereto by like order.
to be the individnal
described in and who executed the for('~()iru:?; instrument:
that he, said subscribing witness, was" pre'sent and saw
execute the same; and that he, said witness,
at the same time sub,:;.cri!wd h name as \vitness thereto.
j/jargain anb ~alt :mttb
WITH COVENANT AGAINST GRANTOR'S ACTS
TITLE No. ~ 3:1-<; ~ ~11:1 ~
Clark/Clark and Kline/Kline
DISTRICT:
SECTION
BLOCK
LOT
COUNTY OR TOWN
1000
106.00
09.00
008.00
Suffolk
TO
Fred M. Carter ft
Martha S. Carter
RETURN BY MAIL TO:
James Reynolds, Esq.
200 Motor Parkway
Hauppauge. N.Y. 11788
Zip No.
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Number of pages
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TORRENS
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ClXkf::: Of-
Serial #
~).i!::f~UL:< C:U:}..j",\-,
L. i_:'UCUl .L 1.
Certificate #
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L>l '!t OCi..qUO::::~;
Prior Ctf. #
Deed / Mortgage Instrument
Deed / Mortgage Tax Stamp
Recording I Filing Stamps
4
FEES
Page / Filing Fee
Mortgage Amt.
Handling
TP-584
I. Basic Tax
2. Additional Tax
Notation
Sub Total
EA-52 17 (County)
Sub Total
Comm. of Ed.
50~
Spec.! Assit.
Or
Spec. / Add.
EA-5217 (State)
R.P.T.S.A.
IS
Sub Total
,
TOT. MTG. TAX
Dual Town Dual County
Held for Apportio~m~ _
Transfer Tax Jr;;L7v:J
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.
Affidavit
~-~
( .Certified Copy ~
Reg. Copy
/:; ~{)
GR.AND TOTAL
Lot
6 Community Preservation Fund
Consideration AITIOunt $
diJ
Other
Ct,.)' c;~_,
'<' ;"'i:rv-'.1tv :)~,
..;i.{:-':'."':I,.rr.r'"
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Real Property Tax Service Agency Verification
Dist. Section Block
/ GOO
/o~.co
Ll ~. 00
o~ COI
CPF Tax Due
$ ~ 3Ul.L'r-()
rY.(.,)- 3-0(
Improved
L~/
Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD & RETURN TO:
Vacant Land
I()
TO
TO
TO
, J fr('>) 6..S
?t..'1 JJ OL-J)S I 2.'1'
02 c a n1/)f... ,o<,u (
1-/--4 ..Rf:4J 0 r:=:
N..'(, /I/J-JY
Suffolk Count Recordin
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Title Company Information
Title #
-S-,j,J
& Endorsement Pa e
This page forms part of the attached~
(SPECIFY TYPE OF INSTRUMENr )
~VDI~ ::r. C:U~.,f J( I Jion()fL (" (!ArK, 111e premises herein is situated in
~~. IN. /(//n~ tfHlFe)). kltl1i!.. SUFFOLKCOUNIY,NEWYORK
made by:
M~~-:e~a~
In the Township of
In the VILLAGE
or HAMLET of
IS () LJ])... 0 L~0
/Y1 A TT,-r...)e k'
BOXES 51HRU 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: 5
TRANSFER TAX NUMBER: 00-40083
Recorded:
At:
LIBER:
PAGE:
06/04/2001
11:08:53 AM
D00012121
738
District:
1000
Section:
106.00
EXAMINED AND
$318,000.00
Block:
09.00
CHARGED AS
Lot:
008.001
FOLLOWS
Deed Amount:
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $15.00 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 fl.PT $15.00 NO
SCTH $0.00 NO Transfer tax $1,272.00 NO
Comm.Pres $3,360.00 NO
Fees Paid $4,711.00
TRANSFER TAX NUMBER: 00-40083
THIS PAGE IS A PART OF THE INSTRUMENT
Edward P.Romaine
County Clerk, Suffolk County
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http:// www.orps.state.ny.us or PHONE {518} 473-7222
FO;l~:~~S:o~:E ONLY .1 i! 7,.3 J X r
C2. Date Deed Recorded I {r tJ 1 0/ I
(onth bay Year
ca. Book 1/ ,j..I ,), I C4. Page I 7. 3,J{
..,... 7''''
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PROPERTY INFORMATION
1. Property I
Location
/s-o J
STREET NUMBER
c.~ CST
STREET NAME
eu
2. Buyer
Name
I
, ,nJl1.. 0 L">J
CITY OR TOWN -
C~-;}y(
LAST NAME f CDMP NY
L^"N~;~LY
fY) J L-L
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP.S217 Rev 3197
ft7A II I ,UC t:""
VilLAGE
III ?Jj-L
ZIP CODE
tyl,
5.
R20
FIRST NAME
~~O {\H~fA
FIRST NAME
3. Tax Indicate where future Tax Bills are to be sent
Billing if other than buyer address (at bottom of form) I
Address
-t...,
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LAST NAME f COMPANY
FIRST NAME
STATE
STREET NUMBER AND STREET NAME
CITY OR TOWN
4. Indicate the number of Assessment
Roll parcels transferred on the deed
tJ # of Parcels OR D Part of a Parcel
5. Deed
Property
Size
. .~.t,.31
ACRES
lOR I
Ixl
DEPTH
FRONT FEET
6. Seller
Name
C LCl-tZ.\:C
LAST NAME I COMPANY
1f.r:::).{<IJL ~
FIRST NAME
,1:
W.
.,...-.J)D n n "--
't-A I,'(Q. 1:::>.
ZIP CODE
(Only if Part of a Parcel) Check as they apply:
4A. Planning Board with Subdivision Authority Exists
48. Subdivision Approval was Required for Transfer
4C. Parcel Approved for Subdivision with Map Provided
D
D
D
J([ I ,,) C-
LAST NAME I COMPANY
CL.oZCt::
FIRST NAME
70 Check the box below which 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 Non-Residential Vacant Land
E8Agricultural
F Commercial
G Apartment
H Entertainment / Amusement
I 8 Community Service
J Industrial
K Public Service
L Forest
Check the boxes below as they apply.
8. Ownership Type is Condominium
9. New Construction on Vacant Land
10A. Property located within an Agricultural District
108. Buyer received a disclosure notice indicating
that the property is in an Agricultural District.'
D
D
D
D
SALE INFORMATION
110 Sale Contract Date / /
Month Day Year
15. Check one or more of these conditions as applicable to transfer:
12. Date of Sale I Transfer
S-I / ,)'101
Month Day Year
,J, J ,t, {j 0, G, 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 the value of personal I, , t Q t 0 I 0 I
property included in the sale, , .
ASSESSMENT INFORMATION. Data should reflect the latest Final Assessment Roll and Tax Bill
13. Full Sale Price
A
B
C
D
E
F
G
H
I
J
Sale Between Relatives or Former Relatives
Sale Between 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
16. Year of Assessment Roll from I a I I 17. Total Assessed Value lof all parcels in transfer}
which information taken
18. Property Class
~ I, Ol-U 19. School ~istrict Nama 1
..=#- /d-
20. Tax Map Identifierlsll Rollldentifierlslltf more than four, attach sheet with additional identifier{sll
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I CERTIFICATION
I certify that all of the items of infonnation entered on this fonn are true and correct (to the best of my knowledge and beUef) and I understand that the making
of any willful false statement of material fact herein will subject me to the provisions of the oenallaw relative to the making and filing of falo;e instmments.
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AREA CODE TELEPHONE NUMBER
BUYER
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BUYER SIGNATURE
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STREET NUMBER STREET NAME (AFTER SALE)
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CITY OR TOWN
-.--' .
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STATE ZIP CODE
SELLER
L /2 a-4IfIl~(i
~ELL'~AT~' " '7
2/1})/
BUYER'S ATTORNEY
/'
CITYffOWN ASSESSOR
COPY
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