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THIS INDENTURE, made as of the 25 day of May, 2001
BETWEEN Lil"di"" L. MaRigaylt, Michael Baldwin, Andrew W. Regan, Trustees, u/a dated
12/21/31 by John Sanfordf/b/o Gertrude S. Legendre c/o Baldwifrothers, 3 Barnabas Road,
Marion, MA 02378 /00 {J _ J _ !t>.. (
party of the first part, and r ( 1::)
George R. Ireland & Elizabeth W. Ireland, 2025 East 4'" Avenue, Denver, CO 80206, as tenants
by the entirety .
party of the second part,
WITNESSETH, that the party of the first part, in consideration of Eight Hundred Thousand
Dollars ($800,000.00), lawful money of the United States, 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 the Town of Southold, County of Suffolk and State of New
York, and being particularly described as follows:
PART A
)\(
Beginning at a stone monument set on the Southerly side of a road forty feet wide, said
monument being four hundred and twelve and forty-three hundredths feet East of a point which
is five hundred and thirty-one and eighty-seven hundredths feet South of another monument
marking the U.S. Coast and Geodetic Survey Triangulation Station "Chocomount 2" (which said'
"Chocomount 2" monument is located on the summit of the highest hill on Fishers Island, N.Y.
about two and one-quarter miles West of the Eastefll end of Fishers Island and lies South
seventy-nine degrees twenty-nine minutes and forty-six seconds East of North Dumpling Light
.
in Fishers Island Sound); and running thence South thirteen degrees fifty-eight minutes and forty
seconds West one hundred and fifty-eight and fifty-six hundredths feet to a stake; thence South
thirty-five degrees nineteen minutes and fifty seconds West two hundred and ninety and fifty-one
hundredths feet to a stake; thence South five degrees two minutes and thirty seconds East one
hundred and eighty-eight and fifty-two hundredths feet to the shore of Block Island Sound;
thence, with the meanders of said Sound, South Eighty-one degrees twenty-nine minutes and ten
seconds West one hundred and twenty-two and ninety-two hundredths feet, and South seventy
degrees one minute and fifty seconds West one hundred and sixty and forty-six hundredths feet
to a stake; thence North five degrees forty-eight minutes and thirty seconds West one hundred
and seventy-nine and seventy-two hundredths feet to a stake; thence North seventy-eight
degrees, forty-one minutes and twenty seconds East seventy-two and forty-seven hundredths feet
to a stake marking a point of curve to the left whose radius is seventy-three and fifty-hundredths
feet and the direction of whose radius at that point is North eleven degrees eighteen minutes and
forty seconds West; thence Northeastwardly (following the arc of said curve) one hundred and
forty-one and seventy-nine hundredths feet to a stake; thence North thirty-one degrees fifty
minutes and twenty seconds West two hundred and three and eighty-nine hundredths feet to a
stake set on the Southerly side of said road; thence Eastwardly along the Southerly side of said
NYDOCS03/582313.2
1
Lot ]5-8
."'\
road (and following the arc of a curve to the left, whose radius is three hundred and eight and
forty-nine hundredths feet and the direction of whose radius at that point is North one degree
nineteen minutes and forty seconds West) seventy-five and twenty-seven hundredths feet to a
stake; thence stilI along the Southerly side of said road North seventy-four degrees forty-one
minutes and fifty seconds East one hundred and seventy-three and thirty-four hundredths feet to
a stake marking a point of curve to the left whose radius is three hundred and fifty and twenty-
two hundredths feet and the direction of whose radius at that point is North fiftcen degrees
eighteen minutes and ten seconds West; thence Eastwardly along the Southerly side of said road
(and following the arc of said curve) eighty-nine and eighty-two hundredths feet to a stake; and
thence, along the Southerly side of said road, North sixty degrees and ten seconds East one
hundred and sixty-seven and three hundredths feet to the place of beginning; containing three
and seventeen-hundredths acres, more or less.
PARTB
BEGINNING at a stone monument setoOn the Southerly side of a road forty feet wide, said
monument being four hundred and twelve and forty-three hundredths feet East of a point which
is five hundred and thirty-one and eighty-seven hundredths feet South of another monument
marking the U.S. Coast and Geodetic Survey Triangulation Station "Chocomount 2" (which said
"Chocomount 2" monument is located on the summit of the highest hill on Fishers Island, N.Y.,
about two and one-quarter miles West of the Eastern end of Fishers Island and lies South
seventy-nine degrees twenty-nine minutes and forty-six seconds East of North Dumpling Light
in Fishers Ikland Sound); and running thence along the Southerly side of said road North sixty
degrees and ten seconds East one hundred and fifty-five feet to a stake; thence South four
degrees twenty minutes and forty seconds East eight hundred and three and eighty-seven
hundredths feet to the shore of Block Island Sound; thence, with the meanders of said Sound,
North fifty-two degrees two minutes and twenty seconds West two hundred and fourteen and
ninety-one hundredths feet, South eighty-seven degrees ten minutes and forty seconds West one
hundred and forty-two and seventeen hundredths fyet, and North seventy-four degrees thirty-
seven minutes and ten seconds West seventy-six arid sixteen hundredths feet to a stake; thence
North five degrees two mInutes and thirty seconds West one hundred and eighty-eight and fifty-
two hundredths feet to a stake; thence North thirty-five degrees nineteen minutes and fifty
seconds East two hundred and ninety and fifty-one hundredths feet to a stake; and thence North
thirteen degrees fifty-eight minutes and forty seconds East one hundred and fifty-eight and fifty-
six hundredths feet to the place of beginning; containing four and twenty-four hundredths acres,
more or less.
EXCEPT AND EXCLUDING: Beginning at a stone monument on the Southeasterly line of a
road, said monument being 531.87 feet South of a point which is 412.43 feet East of another
monument marking the United States Coast and Geodetic Survey Triangulation Station
"CHOCOMOUNT 2" and thence running along said road line North 600.00' 10" East 155.0 feet
another monument; thence South 4020' 40" East 803.87 feet to the shore of Block Island Sound;
thence following the meanders of said shore line on the following three courses: North 520, 02'
20" West 214.91 feet, South 870 10' 40" West 142.17 feet and North 740 37' 10" West 31.82
feet; thence North 13058' 40" East 608.56 feet to the point of beginning.
NYDOCS03/5823 I 3.2
2
Lot 15-8
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 thc center lines thereof,
TOGETHER with the appurtenances and all the estate and rights of the party of the first part in
and to said premises,
TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the
heirs or successors and assigns of the party of the second part forever.
AND the party of the first part covenants that the party of the first part has not done or suffered
anything whereby the above described premises have been incumbered in any way whatever,
except as aforesaid.
AND WITNESSETH that the party of the first part, for the consideration recited hereinabove,
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 the Town of Southold, County of Suffolk and State of New
York, and being particularly described as follows:
(See attached Exhibit A)
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 the estate and rights of the party of the first part in
and to said premises,
TO HAVE AND TO HOLD the premises herein ~ranted 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 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 "pruty" shall be construed as if it read "parties" whenever the sense of this indenture
so requires.
NYDOCS03/5823 13.2
3
Lot 15-8
PARCEL III (BLOCK 15 - LOT 10)
ALL that certain plot, piece or parcel of land, lying and being in the Town of Southold, Suffolk
County, State of New York, with the buildings thereon, being a part of that portion of Fishers
Isiand (which portion is hereinafter called the "Park"), iying easterly of the following line, viz.:
BEGINNING at the southeasterly corner of land owned by the United States, known as the Fort
H. G. Wright Military Reservation, Mount Prospect Tract on the shore of Block Island Sound or
the Atlantic Ocean; and
RUNNING THENCE northerly following the east boundary of the said land of the United States
to the southerly line of East End Road (sometimes called Oriental Avenue) and which point Is
the northeasterly corner of land of the United States;
THENCE crossing the East End Road and following the same course as the last to the shore of
West Harbor or Fisher Island Sound, said lots or parcels of land being bounded and described
as follows:
BEGINNING at a stone monument set on the southerly line of East End Road (which
monument is six hundred seventy-four and six hundredths feet south of a point which is three
hundred ninety-nine and fifty hundredths feet west of another monument marking the
aforesaid U.S. Coast and Geodetic Survey Triangulation Station "Chocomount 2";
RUNNING THENCE south ten degrees eighteen minutes fifty seconds west sixty-one and sixty-
nine hundredths feet to a stake;
THENCE south seven degrees forty-nine minutes thirty seconds west, eighty-four and seven
hundredths feet to a stake and land now or formerly of Boocock;
THENCE along said land now or formerly of Boocock the following three (3) courses and
distances:
1. south eighty degrees fifty-four minutes ten seconds west, ninety-three and four
hundredths feet to a stake;
2. south seventy-five degrees twenty-five minut~s thirty seconds west, one hundred three
and thirty-two hundredths feet to a stake; and
3. south eighty-six degrees fifteen minutes thirty seconds west, one hundred five and thirteen
hundredths feet to a point marking a point of curve to the right whose radius is one thousand
two hundred twenty and eighty-one hundredths feet and the direction of whose radius at that
point is north forty degrees thirty-six minutes thirty seconds east;
THENCE northwesterly (following the arc of said curve), one hundred and three hundredths
feet to a stake marking a point of curve to the right whose radius at that point is one hundred
eighty-two and ninety-four hundredths feet and the direction of whose radius at that point is
north forty-five degrees eighteen minutes ten seconds east;
THENCE following the arc of said cunie in a northerly direction one hundred forty and fifty
hundredths feet to a stake;
THENCE north no degrees forty-one minutes forty seconds west, twenty-two and fifty-nine
hundredths feet, marking a point of curve to the right whose radius is seventeen and forty-
nine hundredths feet and the direction of whose radius at that point is north eighty-nine
degrees eighteen minutes twenty seconds east;
THENCE following the arc of said curve twenty-~ine and forty-five hundredth feet to a stake on
the southerly side of the aforesaid road;
THENCE along the southerly side of said road south eighty-four degrees twelve minutes .
twenty seconds east, four hundred twenty-eight and fifty-seven hundredths feet to the pOint
or place of BEGINNING.
PARCEL II (BLOCK 15 - LOT 9)
ALL that certain plot, piece or parcel of land, lying and being in the Town of Southold, Suffolk
County, State of New York, with the buildings thereon, being a part of that portion of Fishers
Island (which portion is hereinafter called the "Park"), iying easterly of the following line, viz.:
BEGINNING at the southeasterly corner of land owned by the United States, known as the Fort
H. G. Wright Military Reservation, Mount Prospect Tract on the shore of Block Island Sound or
the Atlantic Ocean; and
RUNNING THENCE northerly following the east boundary of the said land of the United States
to the southerly line of East End Road (sometimes called Oriental Avenue) and which point is
the northeasterly corner of land of the United States;
THENCE crossing the East End Road and following the same course as the iast to the shore of
West Harbor or Fisher Island Sound, said lots or parcels of land being bounded and described
as follows:
BEGINNING at a stone monument set on the southerly line of East End Road (which
monument is six hundred seventy-four and six hundredths feet south of a point which is three
hundred ninety-nine and fifty hundredths feet west of another monument marking the
aforesaid U.S. Coast and Geodetic Survey Triangulation Station "Chocomount 2"
RUNNING THENCE along the southerly side of said road, south eighty-four degrees twelve
minutes twenty seconds east three hundred six and forty-one hundredths feet to the point of a
curve to the left whose radius is three hundred eight and forty-nine hundredths feet and the
direction of whose radius at that point is north five degrees forty-seven minutes and forty
seconds east;
THENCE eastwardly still along the southeriy Side of said road (following the arc or said curve)
thirty-eight and thirty-two hundredths feet to a stake;
THENCE South thirty one degrees fifty minutes twenty seconds east, two hundred three and
eight-nine hundredths feet to a point of a curve to the right whose radius is seventy-three and
fifty hundredths feet and the direction of whose radius at that point is south fifty-eight degrees
nine minutes forty seconds west; ,
THENCE southerly (following the arc of said curve), one hundred forty-one and seventy-nine
hundredths feet;
THENCE south seventy eight degrees forty-one minutes twenty seconds west, seventy-two
and forty-seven hundredths feet to land now or formerly of Boocock;
THENCE along said land now or formerly of Boocock the following three (3) courses and
distances:
1. north sixty-six degrees fifty-one minutes forty seconds west, one hundred five and twenty-
six hundredths feet to a stake;
2. north sixty-two degrees twelve minutes no seconds west, one hundred sixty-five and sixty-
nine hundredths feet to a stake;
3. north fifty-eight degrees twenty-five minutes forty seconds west, one hundred thirty and
two hundredths feet to a stake;
THENCE north seven degrees forty-nine minute~ thirty seconds east, eighty-four and seven
hundredths feet to a stake;
THENCE north ten degrees eighteen minutes fifty seconds east, sixty-one and sixty-nine
hundredths feet to the stone monument on the south side of East End Road and the point or
place of BEGINNING.
AMENDED 5/10/2001
PARCEL I (BLOCK 15 - LOT 8 AND BLOCK 15- LOT 11 (PORTION)
ALL that certain plot, piece or parcel of land, lying and being in the Town of Southold, Suffolk
County, State of New York, with the buildings thereon, being a part of that portion of Fishers
Island (which portion is hereinafter called the "Park"), iying easterly of the following line, viz.:
BEGINNING at the southeasterly corner of land owned by the United States, known as the Fort
H. G. Wright Military Reservation, Mount Prospect Tract on the shore of Block Island Sound or
the Atlantic Ocean; and
RUNNING THENCE northerly following the east boundary of the said land of the United States
to the southerly line of East End Road (sometimes called Oriental Avenue) and which point is
the northeasterly corner of land of the United States;
THENCE crossing the East End Road and following the same course as the last to the shore of
West Harbor or Fisher Island Sound, said lots or parcels of land being bounded and described
as follows:
BEGINNING at a stone monument set on the southerly side of a road forty feet wide, said
monument being four hundred and twelve and forty-three hundredths feet east of a point
which is five hundred and thirty-one and eighty-seven hundredths feet south of another
monument marking the U. S. Coast and Geodetic Survey Triangulation Station "Chocomount
2" (which said "Chocomount 2" monument is located on the summit of the highest hill on
Fishers Island, New York, about two and one quarter miles west of the easterly end of fishers
Island qnd lies south seventy-nine degrees twenty-none minutes and forty-six seconds east of
North Dumpling Light in Fishers Island Sound and;
RUNNING THENCE south thirteen degrees fifty-eight minutes forty seconds west six hundred
eight and fifty-six hundredths feet to the shore of Block Island Sound (the said line passing
through a stone monument erected in 1968 four hundred eighty-four and forty hundredths
feet southwesterly from the point or place of beginning);
THENCE with the meanders of said Sound north seventy-four degrees thirty-seven minutes ten
seconds west, forty-four and thirty-four hundredm,s feet to a stake;
THENCE with the meanders of said Sound south eighty-one degrees twenty-nine minutes ten
seconds west one hundred twenty-two and ninety-two hundredths feet to a stake;
THENCE with the meanders of said Sound south seventy degrees one minute fifty seconds
west one hundred sixty and forty-six hundredths feet to a stake;
THENCE north five degrees forty-eight minutes thirty seconds west one hundred seventy-nine
and seventy-two hundredths feet to a stake (the said line passing through a stone monument
one hundred two and twenty-seven hundredths feet southeasterly from the last mentioned
stake) ;
THENCE north seventy-eight degrees forty-one minutes, twenty seconds east, seventy two
and forty-seven hundredths feet;
THENCE northerly along an arc of a curve bearing to the left having a radius of seventy three
and fifty hundredths feet, a distance of one hundred forty-one and seventy-nine hundredths
feet;
THENCE north thirty-one degrees fifty minutes twenty seconds west, two hundred three and
eighty-nine hundredths feet to the southerly line of East End Road;
THENCE eastwardly along the said southerly line of East End Road along an arc of a curve
bearing to the left having a radius of three hundred eight and forty-nine hundredths feet, a
distance of seventy-five and twenty-seven hundredths feet;
THENCE still along the southerly side of said road, north seventy-four degrees forty-one
minutes and fifty seconds east one hundred seventy-three and thirty-four hundredths feet to a
stake marking a point of curve to the left whose radius is three hundred fifty and twenty-two
hundredths feet and the direction of whose radius at that point is north fifteen degrees
eighteen minutes and ten seconds west;
THENCE eastwardly along the southerly side of said road (following the arc of said curve),
eighty-nine and ninety-two hundred~hs feet to a stake; and
THENCE along the southerly side of said road, north Sixty degrees ten seconds east one
hundred sixty-seven and three hundredths feet to the place of BEGINNING.
Number of pages
TORRENS
Serial #
Certificate #
Prior Ctf. #
[I 2
4
Deed / Mortgage Instrument
FEES
Page / Filing Fee
Handling
TP-584
Notation
EA-52 17 (County)
EA-5217 (State)
R.P.T.S.A.
Comm. of Ed.
Affidavit
Certified Copy
Reg. Copy
Other
frJit-;1-V/
Ini~0
Deed / Mortgage Tax Stamp
3q~
S--
5'-
~~
.s
Sub Total
S-I/ ---
~s-
is
,-
50~
Sub Total
GRAND TOTAL
Real Property Tax Service Agency Verification
Dis!. Section Block
Lot
1000
004.00
07.00
Db;:>, ceo
7 Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD & RETURN TO:
9
Stephen L. Ham, III, Esq.
Matthews & Ham
45 Hampton Road
Southampton, NY 11968
Ff'~C::-:PL'Fr
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E002rd RomaIne
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Recording / Filing Stamps
Mortgage Am!.
I. Basic Tax
2. Additional Tax
Sub Total
Spec./Assit.
Or
Spec. / Add.
TOT. MTG. TAX
Dual Town Dual County
Held for Apportinnment
Transfer Tax ~ L'l-()
Mansion Tax
The property c vered by this mortgage is or
will be imp ved by a one or two family
dwelling on
Y. :S or NO
If NO, s 'appropriate tax clause 011 page /I
r this instrument.
6 Comn unity Preservation Fund
Con ' Amount $ 800 , 000
"-
C~PF Tax I)uc )
$ 14,5.09
.-----.
Improved
Vacant Land V
TO
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TO
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.
8
Title Company Information
Conunom,ealth Land Title Ins. Co.
Co. Name
Title # RH80012044
Suffolk Count Recordin & Endorsement Pa e
This page forms part of the attached
Deed
(SPECIFY 'IYPE OF INSTRUMENr)
_ made by:
" T I..WflTlW T 1!l..r"Jll1 .ULl, MICHAEL BALDWIN and
The premises herein is situated in
SUFFOLK COUNrY, NEW YORK
ANDREW W. REGAN, as Trustees of John Sanford
Real Estate Trust
TO
GEORGE R. IRELAND and
In the Township of
In the VILLAGE
or HAMLET of
SOUTHOLD
FISHERS ISLAND
BOXES 5 THRU cj MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
(OVER)
ELISABETH W. IRELAND
. .
1111111111111111111111111111111111111111111111111111111
1111111111111111111111111
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEEDS/DDD
Number of Pages: 13
TRANSFER TAX NUMBER: 00-41159
Recorded:
At:
LIBER:
PAGE:
06/11/2001
10:39:30 AM
000012123
255
District:
1000
Section:
004.00
EXAMINED AND
$800,000.00
Block:
07.00
CHARGED AS
Lot:
003.000
FOLLOWS
Deed Amount:
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $39.00 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 $0.00 NO RPT $15.00 NO
SCTM $0.00 NO Transfer tax $3,200.00 NO
COIIIIII.Pres $14,500.00 NO
Fees Paid $17,799.00
TRANSFER TAX NUMBER: 00-41159
THIS PAGE IS A PART OF THE INSTRUMENT
Edward P.Romaine
County Clerk, Suffolk County
PLEASE PE OR PRESS FIRMLY WHEN Wfl NG ON FORM ?
INSTRUCTIONS: http:// www.orps.state.ny.us or PHONE (518) 473-7222
'REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP-5:n7Rn3l!n
I. Pn>peny I
location
STREET NUMBEa---
cil5""- COIl ~
STREET~
,} '(r^f~
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'._,', ,', C
2. Buyer
Name
Cit"
LAST NAME I COMPANY
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I
ZIP CODE
,,(:1_(.0.
CITY OR TOWN
',tILLAGE
._,~---._----
FIRST NAME
LAST NAME I COMPANY
FIRST NAME
3. Tax Indicate where future Tax Bills are to be sent
Billing if other than buyer address (at bottom of form)
Address
LAST NAME I COMPANY
FIRST NAME
STREET NUMBER AND STREET NAME
CITY OR TOWN
ST~TE
ZlPCODE
... Indic8te the number of Assessment
Roll parcels transferred on the deed
DE""
lOR I
.
(Only If Part of a Parcell Check as they apply:
4A. Planning Board with Subdivision Authority Exists D
48. Subdivision Approval was Required for Transfer 0
. Parcel Approved for Subdivision with Map Provided 0
# of Parcels OR 8' Part of a Parcel
5._
Property
Size
L~
FRONT FEET
'ACRES'
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.T-fl--(uA--~
6. Seller
Name
LAST NAME f COMPANY
LAST NAME I COMPANY
FIRST NAME
7. 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
--
E ~ Agricultural
F Commercial
G Apartment
H Entertainment I Amusement
I ~ 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
1OA. Property Located within an Agricultural District
108. Buyer received a disclosure notice indicating
that the property is in an Agricultural District
o
o
o
o
15. Check one or more of these cOnditIons as applicable to transfer:
11. Sale Contract Date
,,-~ ( 11/ ( LV
Mo"," Day Year
, ( ,:)C ( () (,
M_ Day Year
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
12. Date of Sale I Transfer
13. Full Sale Price . t . '-" .\J I O. 0 1 0 . 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.
16. Veer of Aueament Roll from I () I U I 17. Total Assessed Valuelof all parcels in transfer) I
which Informetion taken
a 0
18. Property Class
,- , 0
I ' ,', I-LJ 19. School DIstrIct Nama I
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20. Tax M.p ldentifi...c:sJ I RoIlldentIflerls) (If more than four. attach sheet with additionalldentifier(sl)
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-"
I cet1lfy _ aD of the Items of lnfOnnatiCHI _ CHI this forlb .... true and oorrect (to the best of my knowledge and beIIeI) and I _ that the making
of aoy willful false sta_ of IIIIl1<l"iaI fad herein wiD subject'me to the orovisi.... of the _law .....tive to the making and llIIog of false _.
BUYER BUYER'S ATTORNEY
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''7 '? /t'(...... Ltc.... rrr ,\~'/f
BUYER SIGNATURE DATE
~/i-' /01
l!;i)/'
57?v1f1 M
LAST NAME
FIRST NAME
'Z <.0>7..)
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FOv{; ,., Ave ,JJ[
(,31
;),(:~- ac/u..;
STREET NUMBER
STREET NAME (AFTER SALE)
AREA COllE
TELEPHONE NUMBER
T)fNvFR-
(0
~j u 2. Ob
Cl1Y OR TOWN
STATE
ZlPCODE
SELLER