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PLE~SE~TYp-~-E-~R PRES~"-~-~ WHEN WRITING ON FORM
INSTRUCTIONS: http://VWNW.Orps.state.ny.us Or PHONE (518) 473-7222
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PflOPERTY SERVICES
RP - 5217
1, Pro.e.¥ 375
Location STREET NUMBER
t ~k~st ~rion
STREET NAME
I of c ul:_hold I 11939 I
V~LLAGE ZIP CODE
2. Buyer I ~ c'%q'~cq/%
FIRST NAME
Address
LAST NAME / COMPANY
Indicate where future Tax Bills are to be sent
if other than buyer address (at bortom of form) I
LAST NAME ! COMPANY
I
FIRST NAME
FIRST NAME
STREET NUMBER AND STREET NAME CITy OR TOWN
4. Indicate the number of Assessment J l I
Roll parcels transferred on the deedI # of Parcels OR Part of a Parcel
5, Deed
Property k I x I ] oR L , , · 6, 9 I
Size FRONT FEET DEPTH ACRES
Se.erI ~:,~r RP~i~y co~poration I
Name LAsl NAME / COMpANy FIRST NAME
STATE Z~p CODE
(Only if Part of a P~rcel} Check as they apply:
4A. Planning Board with Subdivision Authority Exists []
4B. Subdivision Approval was Required for Transfer []
4(:. Parcel Approved for Subdivision with Map Provided []
t I
LAST NAME / COMPANY FIRST NAME
7. Cheek the~box below which most accurately des~r~!~es the use of the property at the time of sale:
H [~ One Family Residential }i [~] Agricultural ~ Community Service
1~ [~ 2 or 3 FamUy Residentia[ i~ 1~ Commercial IndusIria,
C[~] Residential,Vacant Land (]~.[ Apartment Public Service
D[ [ Non-Residential Vacant Land HI__[ Entertainment / Amusement Forest
11. Sale Contract Date
12. Date of Sale / Transfer
i 04 / 24 / 02 i
Month Day Year
Month Day Year
13m FUg Sale Price ( , , ,4 ,5 ,5 , 0 ,0 , 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.
14. lndicatethevalueofpemonal I I I I r I I0 I ~) I 0I
property included in the sale ~ ·
Check the boxes below as they apply:
8. Ownership Type is Condominium iii
9. New Construction on Vacant Land []
10A. Property Located within an Agricultural District []
106, Buyer received a disclosure nstice indicagng r--]
that the property is in an Agricultural District
15. Check on'Or more of these conditions as applicable to transfer:
A Sale Between Relstives or Former Relatives
B Same Between Related Companies or Partners in Business
C One of the Buyers is also a Seller
D Buyer or Seller is Government Agency or Lending Institution
E Deed Type nat Warranty or Bargain and Sale (Specify Below)
I~ Sale of Fractional or Less than Fee Interest (Specify Below) ~
Significant Change in Properly Between Taxable Status and Sale Dates
Sale of Business is Included in Sale Price
) Other Unusual Factors Affecting Sale Price (Sp~ify Below}
f 1 2 0 oI
16. Year of Assessment Rolm from io3/,021 .. Total Assessed Value (of all parcels in transfer) I
which information taken
18. eropertyClass I 2, 1,
20, Tax Map Idenfifier{s) / Roll Identifier{s) (If more than four, attach sheet with additional identifier(s))
1000-35-3-5.01 1
I I I
I certify ffn~t all of tl~ items of infornmfion entered on this form are true and correct (to the best of my knowled~ and belief) and 1 understand that the making
of any willfld false ~tatement of material fact herein will subject me Io the provisions pf the penal law relative to the makin~ and fiBwl~ of false
BUYER BUYER'S ATTORNEY
BUYER SIGNATUR6 Richard 7;` ~-,~'~q[~"~ DAll' LAST NAME FIRST NAME
.I . ," .' - i ~ t 713 I 445-8345
STREET NUMBER STREET NAME (AFI~R SALEI AREA CODE TELEPHONE NUMBER
I
cnw OR TOWN STATE ZIp CODE
SELLER
SEE~R~GNATURE -