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Bargain and Sale Deed, with Covenant against Grantor's Acts-Individual or Corporation (single sheet)
THIS INDENTURE, made tile ?jdaY of ~,two thousand
BETWEEN () ()
BETTY OLSEN
354 Gibbs Pond Road
Nesconset, NY 11767
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party of the first part, and
THOMAS OLSEN, as Trustee of the BETTY A. OLSEN
a/k/a ELIZABETH A. OLSEN IRREVOCABLE TRUST
2804 South Main Street
Newfane, NY 14108
party of the second part,
WITNESSETH, that the party of the first part, in consideration of Ten Dollars and other valuable consideration paid
by the party of the second party, does hereby grant and release unto the party of the second part, the heirs or
Sllccessors 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, at Mattituck, County of Suffolk and State of New York, known and designated as
Lot Number 33 on a certain map entitled, "Map of Captain Kidd Estates", filed January 19, 1949 in the Office of the
Clerk of the County of Suffolk as Map #1672.
BEING AND INTENDED TO BE the same premises conveyed to the party of the first part by Deed dated August
1, 1972 and recorded in the Suffolk County Clerk's Office on August 14, 1972 in Liber 7218 at page 212.
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.
AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the
said premises have been encumbered in any way whatever, except as aforesaid.
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" whenever the sense of this indenture so requires.
IN WIT~ESSiWHEREOF, the part~.:~f-;;"first part has duly executed this deed the day and year first above
WrItten. "',
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In Presence of:
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BETTY. LSEN
.
12069PGO05
5492
[12
RECEfVED
$__--0-.
REAL ESTATE
SEP 0 7 2000
"l;FlANSFER TAX
$UFFOLK
roUNTY
5492
FH;C0R1DEO
TORRENS
OOSEP-l PM~:re
Number 0f pages
Serial #
I ~ I ' ~
",j.;, I., ;/,litS
CI.::I;I\ lil:
SUiTOU( CClUUTY
Certificate #
Prior Ctf. #
Deed I Mortgage Instrument
Deed I Mortgage Tax Stamp
Recording I Filing Stamps
4
FEES
Page I Filing Fee
Handling
')
C;
Mortgage AmI.
I. Basic Tax
TP-584
2. Additional Tax
R.P.T.S.A.
)
oS-
If;, aD
, -
Sub Total
I
(1-(
Sub Total
Notation
EA-52 17 (County)
Sub Total
SpecJAssit.
Or
Spec. I Add.
EA-5217 (State)
GRAND TOTAL
TOT. MTG. TAX
Dual Town Dual County
Held for Apportionment
Transfer Tax G--
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.
Comm. of Ed.
50~
Affidavit
Certified Copy
Reg. Copy
Other
Real Property Tax Service Agency Verification
Dist. Section Block
Lot
6 Community Preservation Fund
Consideration Amount $
jooD
106 .00
01,00
7 31 .OOcJ
CPF Tax Due
$
Improved
RECEIVED
(';;
Vacant Land
Satisfactions/Discharges/Releases List Property Owners Mailing Ad ess
RECORD & RETURN TO:
SEP 0 7 2000
In
.
NANCY BURNER, P.C.
46 ROUTE 25A, SUITE 4
SETAUKET, NY 11733
COMMUNITY
RESERVATION
FUND
TO
TO
TO
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8 Title Company Information
Co. Name
Title #
9
Suffolk Count Recordin & Endorsement Pa e
Tlus page fonns part of the attached
DEED
(SPEOFY TYPE OF TNSTRIJM~NT)
made by:
---~-J<-""'--
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,
~iI!l!rTYPE OR PRESSFIRML Y WHENINRITING ON FORM ----------.,
INSTRUCTIONS: http:// www.orps.state.ny.us or PHONE (518) 473-7222
1. Prope.rtv I
Location
1600
.04'.>~'i""''''
Sound Beach DrIve
STREET NUMBER
STREET NAME
Southold
CITY OR TOWN
Mattltuck
VILLAGE
REAL PROPERTY TRANSFER REPORT
STAn; OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP-5217Rev 3m
I
~5''YI
ZIP CODE
2. Buyer
Name
I Thomas Olsen as Trustee of the Betty A.IOlsen a/k/a Elizabeth A. Olsen
LAST NAME I COMPANY FIRST NAME
Irrevocable
Trust
I
LAST NAME I COMPANY . f. ," 1'.J.
3. Tax '~ndica;e wh'ere future,Tax Bills a~ to be sent'
Billing if other than buyer address (at bottom of form) I
Address
I
.. '4j FIRS1'~AME'
~~,
~
I '.
Olsen
LAST NAME { COMPANY
STREET NUMBER AN.D STREET NA E
Grove
P.O. Box 289
... Indicate the number of Assessment
Roll parcels transferred on the deed
, , 0
# of parcel~~:O~" .
Part of a Parcel
1
5, Deed
Property
Size
I OR I
'ACRES'
.1 , 8 I
Ixl
FRONT FEET
DEPTH
6. Seller
Name
Olsen
Betty
FIRST NAME
LAST NAME I COMPANY
\
r
;i
Betty A
FIRST NAME
(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
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:
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,
A~ One Family Residential
B 2 or 3 Family Residential
C Residential Vacant land
D Non-Residential Va.~ant land
SALE INFOlIMA1l'lON
{~,:, ~,o m munity Service
J 'Industrial
K ' - ru/lic Service
L' Fqrest
E ~ Agricultural
F Commercial
G' Apartment
H Entertainment I Amusement
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
1
Year
i
\
15. Check one or more of these conditions as applicable to transfer.<
11. Sale Contract Date
, .
NONE
~
. Day
1
Mo~~
I
if' <
12. Date of Sale I Transfer
l
'C
1::/ i 1 DC'JI
A
B
C
D
E
F
G
H
I
J
Sale Between Relatives or Former Relatives
'Selle ~~~e~ Ff~latEkt combahies or Parlners in Business '
One of the Buyers is:'~lso 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
X Other Unusual Factors Affecting Sale Price (Specify Below)
None
Month
Day
Year
, , 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.
13. Full Sale Price
14. Indicate t~e value .of personal I I I I 0 I 0 I 0 I
property Included In the sale, , .
I ASSESSMENTINFClRMATION - OataSliQuId tollOct' tlloJaIeSt FiQ8I Asa8ssmeritftOlt;_J'axBUtl
Transfer to trust
16. Year of Assessment Roll from 1 99
which information taken '
17. Total ~d Value (of all parcels in-transferjl
18. Property Class
12 , 1, Ol-U 19. School District Nama I 11382" Mattltuck
4 0 0 01
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20. Tax Map Identifierls)I RollldentilierlsllH more than four, attach sheet with additional identifierl~ 0
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473889 106 1 31 , I"
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I certify that all of the items ofinfonnation"-+tered on this fo~ ..arttrf\and correct (to the best.o(.my knowledge . I understand that the making
of any willful false statement of material fact herein will subj~the nrovisions of the 1'Il101 Uw rdative to ~ land' of false instroments.
;,' . BUYER j-\ t-- ~ (__ A C:h (/ pt'a'GY, Y,IER S, ATTO NEY
~m""..<V-~ (')PAv- , <; " ,.." ~ 1,.-
Tn C\ .,T f.. r=. ZIT,"/'> ': Iou p::. Ij [I .
I Bu I 1 I Nancy
BUYER SIG~TURE DATE J LAST NAME,>) I " I ,,' , . FIRST NAME
Thomas ulsen,' Trustee 1\ ,,\ ') "-' , , v
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2804 South Main Street 631 941-3434
STREET NUMBER
STREET NAME (AFTER SALE)
AREA CODE
Newfane
NY
14108
CITY OR TOWN.
STATE
ZIP CODE
SELLER
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SELLER SIGNATURE
OATE
TELEPHONE NUMBER
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CITYlfOWN ASSESSOR
COPY