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HomeMy WebLinkAboutL 12206 P 887THIS I~DE, NTURE, madcm~ .'~/ d~y of Ju L y . in thc yca~ 2002 ~w~ a~ ~a~ as ~ions o~ ~ N~. 29, 30 ar~ ~ l, on a ~ ~p ~ 'M~ of May ~, ~96~, a~ r~ bn ih~ Off~¢ ~ LE~ C~ ~ ~ C~nty of SuE~k ~ ~ ~ ~y o[ LOT 023.00! Cu£cho~ue~ ~Y ]~935 d __ Sub IO~J F~IES Copy ..... Cop? S~b l~ 02032)07 ~ooo ossoo o4~.o o2~02 L Suffolk Cout rD ~ Title Com~uy Information CO. Name & Endo~emmt TO ..... ~L, ":' In t~ Vl~ t,AGE ar ! IAMLEF o~ t:IOXI~ ~; 'I14.RU 9 MU.~r I11~ i¥?ED OR iq~l~ IN ttL&CK iNK Ca'~LY Iq~lOR*lO RFZ~1JRDING OR HUNG, RECORDS 0FFI~ P~CO~ING PAG8 ~ of ~:~Ut;: DEEDS/DDD TR~SF~ TA~ NUi.'~BER: 02-04983 Sect:ton ~ Block: 055,00 04.00 gX~J~II, rgD AND ~G~D AS ;50.00 LIBERt ~ $5,00 ~0 NY8 S~C~G TP'SSt $5,00 NO Cer:.C0p~e~ ~PT $30.00 NO scrM Trane£er tax ~0.00 N0 C~,~rea ~FER TAX NUMBER~ 02-04383 THIS P~ IS A PART O~1' T~ ZN8TR~ County Clerk, Su£folk Cou.n~y 09/0~/2002 D00012206 887 023. 002 $S.00 ~ $15.00 NO $25.00 NO $0.00 NO $0.00 NO $0.00 ~ $102.00 PLI=ASb I Y{"E OH FI'iES~ FIRMLY WHEN WRITING ON FORM INSTRUCTION~ http://www, orps.state.ny.us or PHONE (518) 473-7222 STATE OF NEW YO~K STATE BOARD OF R~AL PROPERTY SERVICES RP - 5217 1. Property Loca'don 400 { Long Creek D{ive Southold ] Suuthold ]11971 [ Johnson ~l~'I Todd ] $~erliq~., ~ ~ ", ~ r~s~,~M~P~achel Indi~te where future Tax ~lls am t0 ~ ~nt ? ) ~ if mher than buyer addr~s (~ ~om ~ ~) ~ ~ 2. Buyer Name 3. Tax Billing Address I STREET NUMBER AND STREET NAME 4. Indicate the number of A~s~mmtt Roll parcels transferred on the deed [ CITY OR TOWN Deed Prope. I I xl Ioml 6. Seller I, Mosher Name La~T NAME / COMPANY I , I STATE ZIP CODE (Only if Part of a Parcel) Check as they ap~y: 4A. Planning Board with Subdivision Authority Exists [] 4B. Subdivision Approval was Required for Transfer [] ·, ~ [ 4C. Pamal Approved for Subdivision with Map Provided [] { Mosher William FIRST NAME Ella H. RRSTNAME 7. Check the box below which most a~uratoly describes the use of the property at the time of ~ele: 2 or 3 Family Residential Residential Vacant Land Non-Residential Vacant Land I SA E I 11. Sale Com%'agt Date 12, Date of Sale / Transfer Che~k the boxes below as they apph~. 8. Ownership Type is Condominium [] 9. New Construction on Vacant Land [] 10A. Property Located within an Agricultural District 1OB. Buyer received a disclosure notice indicating that the property is in an Agricultural Distric~ 15. Check o~e or more of theee conditions as applicable to transfer, Sale Between Relatives or Former Salst[vas Sal~i~stween.~er~ed ~ompames~or Pa{tne~ m Bus ness One of the Buyers is also a Seller E Deed Type not Warranty or Bargain and Sa)e (Specify Below) F Sale of Fractional or Less then Fee Interest ISpecify Below) Significant Change in Propert~ Between Taxable Status and Sale Dates Bale of Business is Included in Sale Price Other Unusual Factors Affecting Sale Price (Specify Below) J None Agricultural I [] Community Service Commercial J ~_~ Industrial Apartment K[~ Public Service Entertainmenl Amusement LU Forest I 07 / 29 / 02. I Month Day Year 13. Full Sale Price Full Sale Price ia the total amount paid for the property including personal property. This payment may be in the form of cash, otbdf property or goods, or the assumption of mortgages or other obligctionsJ Please round to the nearest whole dollar amount. 14.1ndicate the value of pereonal I , ~, 0 , 0 I property Induded in the sale · 16. 0 2 ½ ½ ,5,'7 ,o ,o I 18. Prope,'tyCla,p, { 2, l, q-[__J 19. SohoolDistristName L Southold 20. Tax Map Identifie~(a) / Roll IdenBfieHs) (ff mo~e than four, attach ~h~et with addl'donal ide~ithw(s)) I lOO0-055.00-04.00-part of 023.001 I certify that all e~ Ifle items of infommttoa e~tered on this form are true and correet (to the best of my knowledge and belie~ and I undersfand that the making of any wlllfol false statement of material fact herein wtB subject me to the prov~ons of the penal law relative to the making and filing ~ false iustmment~ BUYER'S A'ITORNEY SELLER Olsen David Worthington L~T NAME FIRST NAME 631 I 734-7666