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FOR, OUNtY,ttSE ONLYIq I - REAL PROPERTY TRANSFER REPORT
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< . x STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
r RP - 5217
INFORMATION I
1.Property 1 7 I{80 1 Pecomic Bay Blvd
Location T STREET NUMBER STREET NAME
�aiurel 71 OA4
CIN OR TOWN VILLAGE SER COOS`
2.Buyer I Borland JA� p
Name LAST NAME I COMPANY Fq�$`T-d0i
LAST NAME/COMPANY FIRST NAME
3.Tax Indicate where future Tax Bills are to be sent
Billing if other than buyer address(at bottom of form) L_
-. Address LAST NAME COMPANY FIRST NAME
STREET NUMBER AND STREET NAME CITY OR TOWN STATE ZIP CODE
4.Indicate the number of AssessmentEl (Only R Part of a Parcell Check as they apply:
Roll parcels transferred on the deed 1 #of Parcels OR Part of a Parcel
4A.Planning Board with Subdivision Authority Exists ❑
5.Deed 4B.Subdivision Approval was Required for Transfer ❑
Property L_ 3 4 0 X I 127 OR I 4C.Parcel Approved for Subdivision with Map Provided ❑
Size FRONT FEET DEPTH ACRES
6.Seller I Haug I Pail W.
Name LAST NAME COMPANY FIRST NAME
I
LAST NAME/COMPANY FIRST NAME
7.Check the box below which most accurately describes the use of the property at the time of sale: Check the box"below as they apply:
6.Ownership Type is Condominium ❑
A One Family Residential E Agricultural I Community Service 9.New Construction on Vacant Land F-1B 2 or 3 Family Residential F Commercial J Industrial 10A.Property Located within an Agricultural District ❑
C Residential Vacant Land G Apartment KPublic Service 10B.Buyer received a disclosure notice indicating E]D Non-Residential Vacant Land H Entertainment/Amusement Lo Forest that the property is in an Agricultural District
Tk7 15.Check one or mom of these conditions as applicable to transfer:
11.Sale Contract Date- 0 9 / 10 / 99 A Sale Between Relatives or Former Relatives
Month Day Year B Sale Between Related Companies or Partners in Business
C. One of the Buyers is also a Seller
12.Date TSale/Transfer 11 / .30 / 99 I D Buyer or Seller is Government Agency or Lending Institution
Month Day Year E Deed Type not Warranty or Bargain and Sale(Specify Below)
F Sale of Fractional or Less than Fee Interest(Specify Below)
73.Full Sale Price
16 1 0 0 0 0 0 kj G Significant Change in Property Between Taxable Status and Sale Dates 7 H Sale of Business is Included in Sale Price
7
(Full Sale Price is the total amount paid for the property including personal property. I Other Unusual Factors Affecting Sale Price(Specify Below)
This payment may be in the form of cash,other property or goods,or the assumption of J None
mortgages or other obligations.) Please round to the nearest whole dollar amount.
14.Indicate the value of personal 0 0 1
property included in the sale ;
ASSESSMENT INIFORMATION-Date:should reflect the latest final.Assessment Roll.andTaic:But
16.Year of Assessment Roll from 1 7 - -
which information taken L- 17.Total Assessed Value(of all parcels in transferl �.
18.Property Class -1J 19.School District Name I Matt ituck—Cutchogue
20.Tax Map Identifier(sl/Roll Identifier(s)(K more than four,attach sheet with additional idemNerts)) /_2
11000-1z�_ no-11 _no-01 � _ nnD I I I
l I I I
I certify that a8 of the items of information entered on this form are time and correct(to the best of my knowledge and belief)and I understand that the making
of any willful false statement of material fact herein will subject an,to the provisions of the penal In relative to the making and filing of false instruments.
BUYER ,$UYEIS','ATTORNEY
i
''" I` j Goggins I William
UYEP e1GNATURE i DATE LAST NAME FIRST NAME
/
yX1;eE1 P. Borland
145 1 East 16th Street, Apt. 18 516 1 298-4200
STREET NUMBER STREET NAME IAFTER SALE) AREA CODE TELEPHONE NUMBER
New York New York 10003
I
CITY 0
/ BE LER STATE ZIP CODE
,\\ CITY/I,CITY/I, ASSESSOR
COPY
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. �LF@e111IWEE Haug DATE
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