HomeMy WebLinkAbout02/2004SUFFOLK COUNTY TREASURER'S OFFICE
JOHN C. COCHRANE, Treasurer
330 CENTER DRIVE
RIVERHEAD, N.Y. 11901-3311
852-1500
REPORT OF REVENUE PAYABLE TO SUFFOLK COUNTY TREASURER
DATE
TOWN OF SOUTHOLD
ELIZABETH NEVILLE, TOWN CLERK
P.O. BOX 1179
SOUTHOLD, N.Y. 11971
THIS STATEMENT TO ACCOMPANY PAYMENTS TO THE COUNTY TREASURER
PURSUANT TO SEC, 2205 (B) OF THE SUFFOLK CHARTER
3/10/04
CHECK NUMBER EXPLANATION AMOUNT CODE
LICENSE AND TAGFEES FOR FEB. 04 $116.32
For Treasurer's Use Only
$116.32
T570
i HEREBY CERTIFY THAT THE SUM OF $116.32 DESCRIBED ABOVE WAS ALL THE MONEYS RECEIVED AND DUE
THE COUNTY OF SUFFOLK TO THE BEST OF MY KNOWLEDGE AND BELIEF.
NAME
TITLE
RECEIVED BY COUNTY TREASURER 3/10/04
BY PHYLLIS TEPPER
APPROP.NO. DATE
[4AR 2 5 2004
FOR TREASURER'S USE ONLY
RECEIPT NO.
47566
CODE AMOUNT
NK $116.32
%uthold Town der
PAY TO THE
ORDER OF
$OUTHOLD TOWN CLERK
53095 MAIN ROAD, TOWN HALL
SOUTHOLD, NY 11971
SOUTHOLD, NY 11971 . 50-666Z214
2JI0P_804
Suffolk County Tmmum~ John C Coctane ] ~ **94.32
DOLLARS
MEMO.
2004 Dos L~ccme~
SOUTHOLD TOWN CLERK o3-ol wm .=.~.ON .~.AL.~K 13 2 3
53095 MAJN ROAD. TOWN HALL 54970 MAIN ROAD
SOUTHOLD. NY 11971 sOLrFHOLD, NY 11971
504t86/214
2/10/2004
MEMO.
2004 8p-yhmett~'
SOUTHOLD TOWN CLERK o3-ol
53095 MAIN ROAD, TOWN HALL
SOUTHOLD, NY 11971
o s o o,,, o ~, s ~, r. r",,dr'' - -
THE BRIDGEH~PTON NATIONAL B~NK 1 3 2 4
54970 M/MN RO~M)
SOUTHOLD. NY 11971
50-6~14 2/]0/2004
MEMO
2004 MardaSe IAc
,'OO~-)~N,' ~:08
0 500,,,0 I, SN
READY TO REORDER? CALL 1-800-433-8810 OR VISIT US AT www. intuitmarket.com ·
Wanuary
Suffolk
Town Of Southold
Elizabeth A. Neville
02/02/2004
2004
47
DOG $CENSE MONTHLY REPORT
10
Southold Town Clerk
Send Copy To: Dept. of Ag. & Markets
County Financial Officer
LICENSE TYPES Column A Column B Column C Column F
AND FEES # Each Statutory Local Unneutered
Total Unspay 6 mo. & up
1. Spay/Neuter 52 ® 2.50 130.00 ® 7.50 390.00 NO FEE
2. Unspay/Unneuter 9 7 ® 7.50 67.50 ® 7.50 67.50 ~ 3.00 21.00
3. Exemption 0 NO FEE NO FEE NO FEE
4. Voids red & green 0 NO FEE NO FEE NO FEE
5. Purebred (1-10) 0 0 ® 25.00 0.00 ® 0.00 0.00 3.00/Dog 0.00
6. Purebred (11-25) 0 0 ® 50.00 0.00 ® 0.00 0.00 3.00/Do9 0.00
7. Purebred (26+) 0 0 ® 100.00 0.00 ® 0.00 0.00 3.00/Dog 0.00
8. Void Purebred 0 NO FEE NO FEE NO FEE
9. TOTALS 61 7 $197.50 $457.50 $21.00
REPLACEMENT AND PUREBRED
TAG ORDERS PROCESSED
10.Replacement Tags
11. Purebred Tags
12.TOTALS
Column D Column E
# Each Tag Fees
1 1.50
0 0.00
i $1.50
DISBURSEMENTS
13. Local% of 9B $104.68
14. Local% of 9C $457.50
15. Total $562.18
(to T.C.V.)
16. Stat% of 9B $92.82
17. Stat% of 12E $1.50
18. Total $94.32
(to County)
19. 100% of 9F $21.00
(AG. and Markets)
Amount paid to: County Treasurer for Dog Licenses ........................ $94.32
Amount paid to: NYS Ag. & Markets for spay/neuter program ................ $21.00
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Accounts Management
Coming Tower - ESP
Revenue Section - Room 1258
Albany, New York 12237-0016
~tONTHLY REPORT OF MARRIAGE
LICENSES ISSUED
SEE INSTRUCTIONS AT BOTTOM OF PAGE
Report for the month of DEP NO.
January 2004
$
City or Town of Southold Check #
County of Suffolk DO NOT WRITE IN ABOVE SPACE
Pursuant to the provisions of Section ! 5 of the Domestic Relations Law, as last amended by Chapter 61 of the Laws of 1989, I herewi~ transmit
to the State Commissioner of Health a fee of twenty two dollars and fifty cents for each marriage license issued by me during the month covered
by this report.
Licenses issued were numbered from I to 10 inclusive.
(If ONE license was issued place number in the first space only!) (If NO licenses were issued write "NONE" in the above space.)
Make remittance by CHECK or Name of City or Town Clerk (Please Print)
MONEY ORDER payable to the State
Department of Health Elizabeth A. Neville
Signature of City or Town Clerk Date
DO NOT SEND CASH ~~,. ~ 02/02/2004
Mailing Ad~
Amount of remittance with this report P.O Box 1179
$ 225.00 Southold, NY 11971
THIS MONTHLY REPORT OF MARRIAGE LICENSES ISSUED MUST BE TRANSMITTED TO THE STATE DEPARTMENT OF
HEALTH FOR EACH MONTH regardless of whether or not any licenses were issued. If no licenses were issued, indicate NONE in the space
provided for license numbers.
The issuance of a marriage license makes you responsible for the remittance fee of $22.50, regardless of whether or not the marriage ceremony is
ever performed.
Marriage licenses must be numbered and reported consecutively throughout the year starting with number I at the beginning of EACH calendar
year.
P'ursuant to the authority of Section 19 of the New York State Domestic Relations Law, the comrmssioner of Heaith has directed that this report,
together with any fee must be transmitted to the State Department of Health by the 15th of the month following the month which the report covers.
New York State Domestic Relations Law 22 provides that any Town or City Clerk who violates or fails to comply with any of the above
mentioned reporting or filing requirements, shall be deemed guilty of a misdemeanor and shall pay a fine not exceeding the sum of one hundred
dollars on conviction thereof.
DOH-963 (1/90) VS 9M OFM 23
· 03/10/2004 Page: I
Own Clerk Monthly Report Monthly Report
February 01, 2004 - February 29, 2004
To the Supervisor:
Pursuant to Section 27, sub 1, of the Town Law, I hereby cediPj that the foregoing is a full and true statement of all fees and monies
received by me, Elizabeth A. Neville, Town Clerk, Town of Southold dudng the period stated above, in connection with my office, excepting only
such fees and monies, the application of which are otherwise provided for by law.
Account~ Account Description Fee Description Qty Local Share
AGENCY & TRUST Agency & Trust
Park & Playground
FISW Fishers Island Sewer District Sewer District
Interest Now Account
INTEREST
Building Department Fees
Certified Death Trans.
Moratorium Waiver
Ordinance Fees
Planning Board
Yard Sale
Zoning Board
PART
PT-HIGHWAY Highway Excavation
SAND Sand & Gravel
Solid Waste Management District
SWMD
Interest NOW Account
2 25,000.00
Sub-Totah $25,000.00
26 8,850.00
Sub-Totah $8,850.00
I 18.32
Sub-Total: $18.32
Application Fees 18 31,821,32
Death Trans. 79 790.00
Death Trans. - Genealogical 1 11.00
Moratorium Waiver 1 250.00
Code Updates - Annual 36 3,060.00
Code Updates - Tax Exempt 1 85.00
Zoning Books 1 50.00
Zoning Updates - Annual 56 1,680.00
Application Fees 5 7,277.70
Permits 5 75.00
Application Fees 8 2,900.00
Sub-Total: $48,000.02
Permits 10 450.00
Sub-Totah $450.00
Sand & Gravel 2 2,257.22
APPL (Appliances)
Bags - On Account
Bags - Retail - Large
Bags - Retail - Medium
Bags - Retail - Mini
Bags - Retail - Small
Bags - Vending Machine
Bags - Wholesale - Large
Bags - Wholesale - Medium
Compactor Permit - 1+ Ton Single
Rear
Contractor Permit - 1+ Ton Single
Contractor Permit - Up To 1 Ton
CS30 (Comm Contract Single Entry)
Sub-Totah $2,257.22
18 270.00
2 10,275.66
422 949.50
135 202.50
77 30.80
132 99.00
7 4,715.00
11 2,205.28
1 337.50
I 200.00
7 1,400.00
35 2,100.00
8 240.00
03/10/2004
Own Clerk Monthly Report Monthly Report
February 01, 2004 - February 29, 2004
Page: 2
Account Description
Fee Description
Qty Local Share
SWMD
WHOLE
Solid Waste Management District
Alarm Fees
Beach Permits
Bingo proceeds
Certified Marriage Trans.
Conservation (DECALS)
Dog Adoption
Dog Licensing
Dog Redemption
Marriage License
Passport Fee
Photocopies
Postage
Returned
Disposal Permit - Agricultural
Disposal Permit - Guest
Disposal Permit - Lessee
Disposal Permit - Replace
Disposal Permit- Res 1st
Disposal Permit - Res. Add'l
Disposal Permit-VOIDED
Outgoing Leaf Mulch
Propane Tanks - Used
Refrigerants (appl)
Residential Single Entry
Resse (resid. Single Entry)
Tipping Charges
Tipping Fee Deposit
Tipping Interest
Initial
Renewal
Guest
Motel
Non-Resident Seasonal
Replacement Sticker
Resident
Voided Sticker
Bingo Proceeds
Marriage Trans.
Conservation (DECALS)
Dog Adoptions
53% License Fee
Female, Spayed
Female, Unspayed
Male, Neutered
Male, Unneutered
Dog Redemption - 1st
Dog Redemption - 2nd
Marriage License
Passport Fee - Town Portion
Photocopies
Postage
Check Charge
3 180.00
2 20.00
1 10.00
39 0.00
812 8,120.00
126 630.00
2 0.00
2 28.40
50 100.00
15 300.00
14 1,400.00
339 678.00
3 10,673.07
26 23,456.80
3 123.59
Sub-Total: $68,745.10
1 25.00
2 20.00
10 300.00
1 20.00
5 500.00
12 0.00
578 3,468.00
2 0.00
4 22.39
10 100.00
3 2.17
6 60.00
85 131.18
43 322.50
6 45.00
35 262.50
1 7.50
7 70.00
2 40.00
2 35.00
22 660,00
903 225.75
2 1.27
I 20.00
.03/10/2004
Own Clerk Monthly Report Monthly Report
February 01, 2004 - February 29, 2004
Page: 3
Accoun~
Account Description
Fee Description
Oty Local Share
WHOLE
WWDD
Shellfish
Vending Machine
Wastewater Disposal District
Commercial
Free - Non-Commer.
Resid. - Non-Comm.
Temporary
Voided
Laminating
Scavenger Waste Gallonage Fees
Septic Permit - Construct - Resid.
Septic Permit - Operation - Resid.
Septic Permit - Operation Non-Resid.
11 385.00
83 0.00
66 330.00
3 30.00
4 0.00
1 24.27
Sub-Total: $7,107.53
1 3,000.00
8 80.00
I 10.00
1 25.00
Sub-Totah $3,'115.00
$163,543.19
Total Local Shams Remitted:
Amount paid to: Agency & Trust: Sales Tax (Ordinance) ..................................................................................................... 419.50
Amount paid to: County Treasurer for Dog Licenses ................................................................................................................................... 116.32
Amount paid to: NYS Ag. & Markets for spay/neuter program ......................................................................... 21.00
Amount paid to: NYS Environmental Conservation .............................................................................................................. 36.83
Amount paid to: NYS Health Dept. For Marriage License ....................................................................................................... 45.00
Total State, County & Local Revenues: $164,181.84 Total Non-Local Revenues: $638.65
Elizabeth A. Neville being duly sworn, says that she is the Town Clerk, that the foregoing is a full and true statement of all fees and monies
received by her during the month stated above, excepting only such fees and applications and payments of which are otherwise provided for by
law.
Southold Town Supervisor Date Southold Town Clerk Date
08/03 '04 M0N 12:22 FAX 631 765 6145
SOUTHOLD TOWN CLERK
$** TX REPORT
~ OOl
TRANSMISSION OK
TX/RX NO
CONNECTION TEL
CONNECTION ID
ST. TIME
USAGE T
PGS. SENT
RESULT
0314
08/03 12:22
00'34
1
OK
76516O5
ELIZABR'rn A. NEV~,LE
TOWel CLERK
REGISTP, AR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGF, M~NT OFFICER
FREEDOM OF INFORMA'PION OFFICER
Town Hall, 53095 Main Road
P.O, Box 1179
Southold, New York 11971
Fax (631) 765-6145
TelQpho~e (631) 765-1800
southoldtown.northfork~net
OFFICE OF THE TOWN CI.I~.RK
TOWN OF SOUTHOLD
F A X
To:
l~rom:
Re:
Date:
Pages:
Linda Carlson , ~
Elizabeth A. Neville
Transfer of Funds
March 8, 2004
1 including cover
Please Transfer $54.78 flora the Town Clerk Non-Public Funds Account 0500015466 to Town
Clerk Public Account Fund Account 500027685, Thank You,
ELIZABETH A. NEVILLE
TOWN CL~,P,K
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOHMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
F A X
To:
From:
Re:
Date:
Pages:
Linda Carlson ~ ~
Elizabeth A. Neville
Transfer of Funds
March 8, 2004
1 including cover
Please Transfer $54.78 from the Town Clerk Non-Public Funds Account 0500015466 to Town
Clerk Public Account Fund Account 500027685. Thank You.
03/08/20~ .
~Town Of Southold
Sunffi~lry Daily Cash Report
February 01, 2004 - February 29, 2004
Page: I
Cash Category
Adoption
Agency & Trust
Alarm Fees
Beach Permi~
Building Dept. Fees
Certification, Death
Certification, Marriage
Conservation (DECALS)
Dog Licenses
Fishers Island Sewer District
Highway Excavation
Interest Now Account
Misc. Cash
Moratorium Waiver
Ordinance Fees
Sub-Category
Original
Renewal
Qt¥ Description Amount
6 Dog Adoptions 60.00
6 Category Sub-Total... $60.00
2 Park & Playground 25,000.00
2 Category Sub-Total... $25,000.00
I Initial 25.00
2 Renewal 20.00
3 Category Sub-Total.,. $45.00
10 Guest 300.00
I Motel 20.00
5 Non-Resident Seasonal 500.00
12 Replacement Sticker 0.00
578 Resident 3,468.00
2 Voided Sticker 0.00
608 Category Sub-Total... $4,288.00
18 Application Fees 31,821.32
18 Category Sub-Total... $31,821.32
79 Death Trans. 790.00
1 Death Trans. - Genealogical 11.00
80 Category Sub-Total... $801.00
10 Marriage Trans. 100.00
10 Category Sub-Total... $100.00
3 Conservation (DECALS) 39.00
3 Category Sub-Total... $39.00
9 Female, Spayed 90.00
3 Female, Unspayed 54.00
8 Male, Neutered 80.00
20 Category Sub-Total... $224.00
34 Female, Spayed 340.00
3 Female, Unspayed 54.00
27 Male, Neutered 270.00
1 Male, Unneutered 18.00
65 Category Sub-Total... $682.00
26 Sewer District 8,850.00
26 Category Sub-Total... $8,850.00
10 Permits 450.00
10 Category Sub-Total... $450.00
I Interest NOW Account 16.56
1 Category Sub-Total... $16.56
903 Photocopies 225.75
903 Category Sub-Total... $225.75
I Moratorium Waiver 250.00
1 Category Sub-Total... $250.00
36 Code Updates - Annual 3,327.84
03/08/2004
Cash Catagor~
Passport Fee
Planning Board
Postage
Racing And Wagering
Redemptions
Returned
Sand & Gravel
Shellfish
Solid Waste Management
District
Town Of Southold
¥ Daily Cash Report
February 01, 2004 - February 29, 2004
Page: 2
Sub-Catagor~
Bingo
Qt7 Description Amount
I Code Updates - Tax Exempt 85.00
1 Zoning Books 54.38
56 Zoning Updates - Annual 1,827.28
94 Category Sub-Total... $5,294.50
22 Passport Fee - Town Portion 660.00
22 Category Sub-Total... $660.00
5 Application Fees 7,277.70
5 Category Sub-Total... $7,277.70
2 Postage 1.27
2 Category Sub-Total... $1.27
4 Bingo Proceeds 22.39
4 Category Sub-Total... $22.39
7 Dog Redemption - 1st 70.00
2 Dog Redemption - 2nd 40.00
9 Category Sub-Total... $1~10.00
1 Check Charge 20.00
I Category Sub-Total... $20.00
2 Sand & Gravel 2,257.22
2 Category Sub-Total... $2,257,22
11 Commercial 385.00
63 Free- Non-Commer. 0.00
66 Resid. - Non-Comm. 330.00
3 Temporary 30.00
4 Voided 0.00
147 Category Sub-Total...
18 APPL (Appliances)
2 Bags - On Account
422 Bags - Retail - Large
135 Bags - Retail - Medium
77 Bags - Retail - Mini
132 Bags - Retail - Small
7 Bags - Vending Machine
11 Bags-Wholesale-Large
I Bags - Wholesale - Medium
I Compactor Permit - 1+ Ton Single
Rear
7 Contractor Permit - I+ Ton Single
35 Contractor Permit - Up To 1 Ton
8 CS30 (Comm Contract Single
Entry)
3 Disposal Permit - Agricultural
2 Disposal Permit- Guest
I Disposal Permit- Lessee
39 Disposal Permit - Replace
812 Disposal Permit- Res 1st
126 Disposal Permit - Res. Add'l
$745.00
270.00
10,275.66
949.50
202.50
30.80
99.00
4,715.00
2,205.28
337.50
200.00
1,400.00
2,100.00
240.00
180.00
20.00
10.00
0.00
8,120.00
630,00
03/08/2004. Page: 3
~Town Of Southold
Su~ry Daily Cash Report
February 01, 2004 - February 29, 2004
Cash Category
Sub-Category
Vending Machine
Vital Statistics
Wastewater Disposal District
Marriage
Yard Sale
Zoning Board Of Appeals
Payment Method Received Thru
CASH $20,151.75 COUNTER $144,436.40
CHECK $144,028.33 MAIL $19,743.68
Qty Description Amount
2 Disposal Permit-VOIDED 0.00
2 Outgoing Leaf Mulch 28.40
50 Propane Tanks- Used 100.00
15 Refrigerants (appl) 300.00
14 ResidentiaJ Single Entry 1,400.00
339 Resse (resid. Single Entry) 678.00
3 Tipping Charges 10,673.07
26 Tipping Fee Deposit 23,456.80
3 Tipping Interest 123.59
2293 Category Sub-Total... $68,745.'10
1 Laminating 24.27
1 Category Sub-Total... $24.27
2 Marriage License 80.00
2 Category Sub-Total... $80.00
I Scavenger Waste Gallonage Fees 3,000.00
8 Septic Permit - Construct - Resid. 80.00
1 Septic Permit - Operation - Resid. 10.00
1 Septic Permit- Operation 25.00
Non-Resid.
tl Category Sub-Total... $3,115.00
5 Permits 75.00
5 Category Sub-Total... $75.00
8 Application Fees 2,900.00
8 Category Sub-Total... $2,900.00
Grand Total ......................... $164,180.08
03/0,8/2004
E~ Town Of Southold
D LS Import Transaction Report
February 01, 2004 - February 29, 2004
Page:
Date
Agent Total Sales
Less Commission
Net Due to Encon
02/13/2004 19.00 1.05 17.95
02/23/2004 15.00 0.84 14.16
02/24/2004 5.00 0.28 4.72
02/27/2004 19.00 1.05 17.95
Report Totals: $58.00 $3.22 $54.78
~ebruary
Suffolk
Town Of Southold
Elizabeth A. Neville
03/08/2004
2004
47
DOGeICENSE MONTHLY REPORT
10
Southold Town Clerk
Send Copy To:
Dept. of Ag. & Markets
County Financial Officer
LICENSE TYPES Column A Column B Column C Column F
AND FEES # Each Statutory Local Unneutered
Total Unspay 6 mo. & up
1. Spay/Neuter 78 @ 2.50 195.00 @ 7.5o 585.00 NO FEE
2. Unspay/Unneuter 7 7 @ 7.50 52.50 @ 7.50 52.50 ~ 3.00 21.00
3. Exemption 0 NO FEE NO FEE NO FEE
4. Voids red & green 0 NO FEE NO FEE NO FEE
5. Purebred (1-10) 0 0 @ 25.00 0.00 @ 0.00 0.00 3.00/Dog 0.00
6. Purebred (11-25) 0 0 @ 50.00 0.00 @ 0.00 0.00 3.00/Dog 0.00
7. Purebred (26+) 0 0 @ 100.00 0.00 @ 0.00 0.00 3.00/Dog 0.00
8. Void Purebred 0 NO FEE NO FEE NO FEE
9. TOTALS 85 7 $247.50 $637.50 $21.00
REPLACEMENT AND PUREBRED
TAG ORDERS PROCESSED
10. Replacement Tags
11. Purebred Tags
12. TOTALS
Column D Column E
# Each Tag Fees
0 0.00
0 0.00
0 $0.00
DISBURSEMENTS
13. Local% of 9B $131.18
14. Local% of 9C $637.50
15. Total $768.68
(to T.C.V.)
16. Stat% of 9B $116.32
17. Stat% of 12E $0.00
18. Total $116.32
(to County)
19. 100% of 9F $21.00
(AG. and Markets
Amount paid to: County Treasurer for Dog Licenses ........................ $116.32
Amount paid to: NYS Ag. & Markets for spay/neuter program ................ $21.00
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Accounts Management
Coming Tower - ESP
Revenue Section - Room 1258
Albany, New York 12237~0016
~,~ONTHLY REPORT OF MARRIAGE
LICENSES ISSUED
SEE INSTRUCTIONS AT BOTTOM OF PAGE
Report for the month of DEP NO.
February 2004
$
City or Town of Southold Check #
County of Suffolk DO NOT WRITE IN ABOVE SPACE
Pursuant to the provisions of Section 15 of the Domestic Relations Law, as last amended by Chapter 61 of the Laws of 1989, I herewith transmit
to the State Commissioner of Health a fee of twenty two dollars and fifty cents for each marriage license issued by me during the month covered
by this report.
Licenses issued were numbered fi.om 11 to 12 inclusive.
(If ONE license was issued place number in the first space only!) (If NO licenses were issued write "NONE" in the above space.)
Make remittance by CHECK or Name of City or Town Clerk (Please Print)
MONEY ORDER payable to the State
Department of Health Elizabeth A. Neville
Signature of City or Town Clerk Date
DO NOT SEND CASH ~.~~ ~ 03/08/2004
Mailing ~ess
Amount of remittance with this report P.O Box 1179
$ 45.00 Southold, NY 11971
THIS MONTHLY REPORT OF MARRIAGE LICENSES ISSUED MUST BE TRANSMITTED TO THE STATE DEPARTMENT OF
HEALTH FOR EACH MONTH regardless of whether or not any licenses were issued. If no licenses were issued, indicate NONE in the space
provided for license numbers.
The issuance ora marriage license makes you responsible for the remittance fee of $22.50, regardless of whether or not the marriage ceremony is
ever performed.
Marriage heenses must be numbered and reported consecutively throughout the year starting with number I at the beginning of EACH calendar
gear.
Pursuant to the authority of Section 19 of the New York State Domestic Relations Law, the commassioner of Health has directed that this report,
together with any fee must be transmitted to the State Department of Health by the 15th of the month following the month which the report covers.
. New York State Domestic Relations Law 22 provides that any Town or City Clerk who violates or fails to comply with any of the above
mentioned reporting or filing requi~ments, shall be deemed guilty of a misdemeanor and shall pay a fine not exceeding the sum of one hundred
dollars on conviction thereof.
DOH-963 (1/90) VS 9M OFM 23
SOUTHOLD TOWN CLIE~
53095 MAIN ROAD, TOWN HAD-
SOUTHOLD, NY 11971
THE BRIDG~4H97~oA~NAL BANK
SOUTHOLD, NY 11971
504661214
1328
3/8/2004
PAY TO THE IN'~S ,a4~eulture & Ma~e~
ORDEROF I$
*'21,00
T~n~,-O~ aaa***********************************************************************************
DOLLARS I~1.~'
MEMO.
Feb 04 Sp~y/nueter ,
""00
SOUTHOLD TOWN CLERK o3~1
53095 MAIN ROAD, TOWN HALL
SOUTHOLD, NY 11971
THE BRIDGEHAMPTON NATIONAL BANK
54970 MAIN ROAD
SOUTHOLD, NY 11971
50~66/214
1329
3/8/2004
ORDER oFPAY TO THE NY8 Depa,'lme~t of HeaJth i $
**45,00
DOLLARS
MEMO.
"'OD I, ii 8 q,' ':0 ;~ i, LO g, g, g, ?': 0 500,,,0 I, 5
SOUTHOLD TOWN CLERK O3Ol
53095 MAiN ROAD, TOWN HALL
SOUTHOLD, NY 11971
THE BRIDGEHAMPTON NATIONAL BANK
54970 MAIN ROAD
SOUTHOLD, NY 11971
50666/214
1330
3/8/2004
ORDER oFPAY TO THE ~upet'"v~ot* .log'hua, Y. ~-[OttOr, j ~
63,960.93
One Hundred Sixty-Three Thousand Nine Hundred Sixty and ************************************************
OOLt~.s
MEMO
,'00 & 330,' ':0 a &t, 0F=66 ?,: 0500,,,0 i, 5t~&6,'~ -
· READY TO REORDER? CALL 1-800-433-8810 OR VISIT US AT www. intuitmarket.com ·
PAY TO YHE
ORDER OF
$OUTHOLD TOWN CLERK o.~o~
53095 MAIN ROAD1 TOWN HALL
SOUTHOLD, NY 11971
SufFolk Coun~ Tre~ur~ $ohn C Co~ne
' 1327
THE BRIDGE~T~_ ?~RAL
54970 MAIN RO~D
SOUTHQLD. NY 1'19'PI
50-666/214
3/~;/2004
*'116,32
DOLLARS
MEMO
185397 (11/02}
Feb 04 Do~ ~ ·
,'001, 3, ~ ?,' I:O~)-hO&&f~?l: 0500'"O& ' ~
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