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INSTRUCTION~i http://www.orps.state.r{~/.us or PHONE {518) 473-7222
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP- 5217
RP-5217 Rev 3/97
1175 Champlin Plac~
1. Property
Location i STREET NUMBER STREET NAME
I $outho:b:~ I Green~ort ~ I 11944
I Kamrow:s!ti I Robert J.
Buyer
Kamrow$ Ki Susa~ V.
3, Tax Indicate where future Tax Bills are to be sent
Billing if other than buyer address (at bottom of form) I
4, Indicate the number of Assessment
Roll parcels transferred on the deed I
5. Deed
Property I Ixl
Size FRONT FEET
6. Seller I BOt tof;
DEPTH
11 [-~ (Only if Part of a Parcel) Check as they apply:
# of Parcels OR Part of a Parcel 4A. Planning Board with Subdivision Authority Exists []
9 ~ 4B. Subdivision Approval was Required for Transfer []
I OR I .... o , I ~c. Parco, Approved for Subdivision with Uap Provided []
ACRES
I Christo~.~er Dean
Name I~ST NAME / COMPANY FIRST NAME
Harrin~ton Robert
[ 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:
iOne Family Residential
2 or 3 Family Residential
Residential Vacant Land
Non Residential Vacant Land
I s~~ I
11. Sale Contract Date
£
12. Date of Sale / Transfer
Agricultural I [] Community Service
Commercial J I~ Industrial
Apartment K!..~ PuNic Service
Entertainment/Amusement EL_J Forest
6 / 25 / o2 I
Month Day Year
/ /
Month Day Year
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 []
10B. Buyer received a disclosure notice indicating []
that the property is in an Agricultural District
15. Check one or more of these conditions es applicable to transfer:
A
B
C
D
E
F
G
H
I
J
Sale Between Relatives or Former Relatives
Sale Between Related Companies or Partners in Business
One of the Buyers is also 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 Loss than Fee Interest (Specify Below)
1 30 000
13, Full Sale Price I I I I I I I I I I 0 I 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. India. ate the value of personal ] ~ I ~ ~ ~ ~ 0
property included in the sale el 0 t 0 I
ASSESSMENT I~RM~TION - Data Should ~ the ~atest Rnal AssesSment Roll and Tax Bill
16. Year of Assessment Roll fTom t 0~ 2 I 17. Total Assessed Value {of all parcels in transfer) I
which information taken
18. Properly Class I ~ 6, Gl_I i 19. School District Name L GreenDort ~tl0
Significant Change in Properly Between Taxable Status and Sale Dates
Sale of Business is included in sa~e Price
Other Unusual Factors Affecting Sale ~¢[ce (Specify Betow)
I 800
20. Tax Map ,deotifier,s}, Roll Identifier{s) ,if more than four, attoch shect wlth additional ideotiSer,s)} 3~.~__ 9__ I~-
I 10oO-c 34.00--04.00-015.000 I [
l certify that all of the items of information entered on this form are true and correct (to the best of my knowledge and belief) and 1 understand that the malting
of any willful false statement of material fact herein will subjeet me to the provisions of the penal law relative to the making and filing of false instruments.
BUYER
DATE
SELLER SIGNATURE
CITY OR TOWN STATE ZIp CODE
SELLER
BUYER'S A'rFOR~IEY
Hughes I S£ian
LAST NAME FrRST NAME
631
AREA CODE
CITY/TOWN ASSESSOR
COPY