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CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
.
THIS INDENTUR.E, made the
r5/F)
day of April, 2000
BETWEEN
Jeremy K. Forssell
82 Rugby Drive, Shirley, N.Y. 11967
/bL6 -/-~~
party of the first part, and Edward V. Werthner and Nancy E. Ryan,
as tenants in Qommon residing at
P. O. Box 450, Jamesp6rt, N. Y., 11947
NC.>1iM'\'i-l)", .
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 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,
at Laurel, known and designated as and by the Lots Nos. 24 and 25,
on a certain map entitled "Subdivision Map, Section One,of Property of
George 1. Tuthill and others " filed in the office of the Clerk of
the County of Suffolk on January 15, 1929 as Map No. 861.
TOGETHER with the privilege in common with others to use a
way leading from the Boulevard, so called, to Peconic Bay,
privilege is contained and recited in a deed to George I.
et al., dated April 17, 1928 and recorded August 13, 1928
County Clerk's office in Liber 1368 of Deeds, at Page 24.
SUBJECT to the following covenants and restrictions:
THAT the premises shall be used for residential purposes only and
no dwelling erected thereon shall be for the use or occupancy of
more than one family; that not more than one dwelling shall be cons-
structed on the premises for each 50 feet of road frontage; that no
building or any part thereof shall be erected within 25 feet of the
street line; that no outhouses shall be maintained on the premises
and no dwelling shall be constructed on the premises costing less
than $5000.00
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 granted unto the party of the second part, the heirs or successors and assigns of the party of
the second part forever. Being and intended to be the same premises conveyed to
Am; lI~lr8-~q,f t~em:st~rt~v~'ill!t~ t~ iffe~Jt{b~~llirSf'l>Sfnig~~otlc9oh~1oV ~uthi?e~g1l9 2 0
whereby the said premises have been encumbered in any way whatever, except as aforesaid. Page 567.
right
which
of
said
Tuthill.
in Suffolk
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" shall be construed as if it read "parties" when ever the sense of this 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 PRESENCE OF:
Standard N.Y.B.T.U. Form 8002 - Bargain and Sale Deed, with Covenant against Grantor's Acts - Uniform Acknowledgment
Form 3290
.
12042PG227
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40740
RECE'M:[)
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HEt,L ED/ATE
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J
{;IF'('n''
'''"Df:n
Number of pages
3
MAY 1 2 2000
00 NA r /2
PH /2: 36
[DWARf' ~
("/ ) r. fl' ''',I A
SUrr' -U?/, OfhlNE
O/If n
" r.OUNry
TORRENS
Serial #
1i=1ANSFEf\ T IV'
SUFFOLK
COUNn-
,40740
Certificate #
Prior C1f. #
Deed / Mortgage Instrument
Deed / Mortgage Tax Stamp
FEES
Recording / Filing Stamps
4
Page / Filing Fee
Handling 6____
TP-584 5
Notation ----
=k )l(
EA-52 17 (County) Sub Total
EA-5217 (State)
R.P.T.S.A. Ie;- _
Comm.ofEd. 50~
Affidavit
Mortgage Amt.
L Basic Tax
2. Additional Tax
Sub Total
Certified Copy
Reg. Copy
Spec.! Assit.
Or
Spec. / Add.
TOT. MTG. TAX
Dual Town Dual County
Held for Apportionmenl 4- ./
Transfer Tax L) 10
Sub Total
yj ---
~q
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.
Other
GR.AND TOTAL
\.--
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i:~'S'
Real Property Tax Service Agency Verification
Dist. Section B lock Lot
St nip'
I [I (:()
I d-I.t' , GO
01. eo
0;;':;, ceo
6 Community Preservation Fund
Consideration Amount $ , f) v:J .-/
CPF Tax Due $ .:u----
'.
$
1m oved
./
ac nt Lan~
Satisfactions/Discharges/Releases List Property Owners Mailing Addres
RECORD & RETURN TO:
,~ 19 he \.,- t{ eA,-/\LL,.} .
I fJ's \A\tQ.u C.i\.~J.c 1>~L-.v-e..
N\.A-rt~"L.LZk. I ~\-L~. II q I) d-
9
Suffolk Count
Recordin
ee&
,
(SPECIFY TYPE OF INSlRUMENT )
8 Title Company Information
Co. Name .'5a.-(( t'l.tbmr 1, -!.. e.
Title # Cis
& Endorsement Pa e
This page forms part of the attached
made by:
~~rsseLl
TO
vJ~>1..y..l.~~ ~
,
Pi~
The premises herein is situated in
SUFFOLK COUNIY, NEW YORK.
In the TOV\TIShipof So-l.l~~
In the VILLAGE
or HAMLET of
'iou. L-"l.-J
BOXES 5 THRU 9 MUST BE TYPED OR PRINIED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
OVER)
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING 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..5217 Rev31'J7
,. ""operty I
Location
?oJ?
-rr;, 2:>/1< [,"?- r
CITY OR TOWN
VILLAGE
I
1/9'-1?' I
ZIP CODE
STREET NUMBER
STREET NAME
1-19 IJ/(F:L
2. Buyer
Name
W;t~TH";EIZ
LAST NAME I COMPANY
IRL/.4I\J
LAST NAME I COMPANY
~'~il..u e.,-( b
FIRST NAME
F~~ENC i
/.... "/
:.~
3. Tax Indicate where future Tax Bills are to be sent
Billing jf other than buyer address (at bottom of form)
Address
T:~.- r' ~ ~
lAST NAME I COMPANY
FIRST NAME
A/"f?O
11'14"1,
ZIP CODE
4. Indicate the number of Assessment
Roll parcels transferred on the deed
. II # of Parcels OR 0 Part of a Parcel
5. Deed
Property
Size
FRONT FEET
Ixl
DEPTH
lOR I
'ACRES'
. -;,'31
(Only If Part of a Parcel) Check as they apply:
4A. Planning Board with Subdivision Authority Exists 0
G. Subdivision Approval was Required for Transfer 0
4C. Parcel Approved for Subdivision with Map Provided 0
6. Seller
Name
Po /l... -;,i?'~'--
LAST NAME I COMPANY
F1~.R. <!< M '1
LAST NAME! COMPANY
FIRST NAME
7. Check the box below which most accurately describes the use of the property at the time of sale:
A~ne Family Residential
B r 3 Family Residential
C Residential Vacant Land
D . Non-Resid~mtial Vacant Land
.--.
E ~ Agrl'"ltural I ~
F Commercial J
G Apartment K
H Entertainment / Amusement L
Community Service
Industrial
Public Service
Forest
t::heck 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
o
o
o
o
15. Check one or more of these conditions as applicable to b'ansfer:
11. Sale Contract Date
"? / 10 /2004>
Month Day )'ear
/f -- / 20{)~
/ J;,
Month Day Year
A
B
C
D
E
F
G
H
I
J
Sale Between Relatives or Former Relatives
Sele 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
her Unusual Factors Affecting Sale Price (Specify Below)
None
12. Date of Sale I Transfer
13. Full Sale Price
, ,,?,'1, 0, 0, ll, 0 , 0 I
, , .
(Full Sale Price is the total amount paid for the property including personal property.
This payment maybe 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. Indicma the valull of persoqal I 0 01
property included In the sale . , ' .' .' I , ~' _ .
fli~~~.'~~lIi~~~~!llIt'l4i!l;iJWi'"
16. Yaar of Assessment Roll &otn I at,;; 1E1tJ1 17. Total Assessed Value (of all parcets in transfer) I
which infonnetion taken ~
/
;
;
;
18. Property Class
I 7. I ,/ I-U 19. School District Name 1
L-JlftJ(:l.ti:t...-
/j ,S-T 12.
20. Tax Map Identifierls} I RollldantffierlsJ (If more than four, attach sheet with additional identifierls)}
I cS2~ - ( - ;;2,;)..
D vJ1
1000
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>J-C-
/2-(;..00
Y/t _ ,') c::I<:::
01. 00
.1,
I
~ ,
I certify that all of the items of information entered on this fonu are true and correct (to the best of my knowledge and belief) and I WKlerstand 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 ftIing of false instruments.
~ BUYER'S ATTORNEY
L-r y
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BUYER SIGNATURE
DATE
i /113/00
D. €.NtJri'1
TNAME
;2066,</
FIRST NAME
.p~ ~x 4'50
1
STREET NUMBER
STREET NAME (AFTER SALE)
~ 31
852. / b{,}
AREA COOE
TELEPHONE NUMBER
.-.-'
:..J A M c:>i'o i2.T
CITY OR TOWN
NV1
STATE
\ \q'-l7
,
ZIP CODE
,1./ \'.7-'1- I
- SELLER SIGNATU E
-7,J.0L-
ClTYrro~'A~SO.R
Con
SELLER
-