HomeMy WebLinkAboutL 12207 P 968EXEC~OR*S DEED ~DIVIDUAL OR COR.PO~~
ROB~ JOHN
~ I~ MD
~i~ m{ 3'/0 C~md P~_rk W., New Yod~ N'f
~ ~ ~ prcmi~ h~e ~ ~u~n~ in ~¥ way w~.
AND tho p~-~>' of~ fW~ IX~rL in comptim'~c~ w~Lh ~ 13 ~ L~ ~w. ~ ~ ~ ~
of~ ~ ~ will ~ivc ~ ~~ f~ ~is ~ ~ w~ll ~ ~ ~ ~ ~i~ ~h
~bove w~ltcn
ROBERT'ADAMS
CHICAGO 'TT~,,~E ~NSU~E COMPANY
STA~ OF t L,A~D
~bT~t ......
TOT, MTG. TAX
02028775 looo 02¢00 0200 o~6ooo
CPF T~c
TO
In th~
SUF~OI~ CO~UNTY
F~CORDS OF~I~
D00012207
0i6.000
the ~oliow~j ~eee For Abov~
N~ 02-05851
THIS
A PART OP ~ ~STR~]~I'
$5. O0
$25.00
$25.00 NO
$0. ao NO
$o. oo ~o
$6,800.00
$8,862
Coun=y Clerk, su£folk
PLEASE TYPE OR PRESS FiRMLY'WHEN WRii'IN~ ON '1~O~1 ........................
INSTRUCTIONS: hep://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
1. Property I]~gn
I Southold
CITY OR TOWN
STREET
3. Tax Indicate where future Tax Bills are to be sent
Billing if other than buyer address (at bottom of form) I
VILLAGE
Address
4. Indicate the number of Assessment
Roll parcels transferred on the deed I
5. Deed
Property
Size
6. Seller I
LAST NAME / COMPANY
CITY OR TOWN
FIRST NAME
Ix[
FRONT FEET DEPTH
L~ST NAME / COMPANY
r'~ (only if Part of a Parcel} C/~ee~aa ~y,&~dy:
, I# of Parcels OR Par~ of a Parcel 4A. Planning Board with Subdivision AuthorY~y Exists []
48. Subdivision Approval was Required for Transfer []
J OR I ,ACRES,. /,~. I~c. Parcel Approved for Subdivision with Map Provided []
I Robert John a/k/a Robert A, bmn as t~ecu~o~
FIRSTNAME 0]: the Estate O1'
LAST NAME / COMPANY FIRST NAMEL
7, Check the box below which most accurately describes the use of the property at the time of sale: Cheek the boxes below as they apply:
8. Ownership Type is Condominium []
i~ One Family Residential i: Agricultural i~ CommunityService 9' NeW COnstructiOn On vacant Land []
2 or 3 Family Residential Commercial Industrial 1gA. Property Located within an Agricultural District []
Residential Vacant Land Apartment Public Service 10B. Buyer received a disclosure notice indicating []
Non-Res{dential Vacant Land Entertainment / Amusement Forest that the property is in an Agricugural District
15. Check one or more of these condi~iorls aa al~icable to t~ansfer:
11. Sale Contract Data I .5 / [5 ! 02 I A Sale Between Relatives or Former Relatives
Month D~y Year B Sale Se[ween Rebated'Companies or Partners in Business
: C One of the Buyers is also a Seller
12. Date of Sale / Transfer I 7 / / 02 I D Buyer or Seller is Government Agency or Lending Institution
Month Day Year ~ Deed Type net Warranty or Bargain and Sale (Specify Selow)
F Sale of Fractional or Less than Fee Interest (Specify Below)
13. Full Sale Price I I I ~ 4 9 0 0 0 0 G Significant Change in Property Between Taxable Status and Sale Dates
i I ~ i I I 0 I 0 I H Sale of Business is Included in Sale Price
(Full Sale Price is the total amount paid for the property including personal property. ] Other Unusual Factors Affecting Sale Price (Specify BeJow)
This payment may be in the form of cash, other property or goods, or the assumption of $ None
mortgages or other obligations.) P/ease round to the nearest whole dollar amount.
14.1ndicatathevalueofpersonal I , , , , r3, o o I
16. Year of Assessment Roll from I ~, ~ t w. Total Assessed Value (of all parcels in transferl I
which information taken
18, Property Class I ;~) ?,E)I-I I 19. School Distrlst Name I
/ ,
I
I cen~ey that all~ t~items of information entered on tliis form~ true'ad correct (to ~he best of my I~wledge and ~ and [ m~demtand that ~he making
of any wmf~ ra~e ~temcnt of matcria~ fact herein win subject me to the provisioa~ Of me pcna~ l~w re~iive to ~ ma~g and ~ of fa~e in~rum~n~
BUYER
STREET NAME IAFTER SALE)
BUYER'S ATrORNEY
FIRST NAME
AREA CODE ~LEPHONE NDM~ER