HomeMy WebLinkAboutL 12209 P 165
~ ~ a c~r~. nW a~i~ "M~ o[C'cm~ti~ P, ~los~ ~ m~ bcin~ ~1~1 in
~ O~c~ o~1~ CI~ of SuP'~oE ~1¥ ~ $~29. 1985 al ~ by ~
TO ~ ~D ~LY WI~N ~ .A~KN~E~iIT ~ MADE IN N~f ¥Oi~[. 8tTATF
~FE HAR~R TITLE AGEN~
1~ ~
LOT
~o~ ......................
~*TOT^C / 0 (~
UNDA ~
~ InJ'orma~n
Title #
lO
IiUX~ S*II'IRU 9 ~ BE~OR ~ i~ Ig~,.CK ~ ~y ~ ~ ~ ~ F!~
1000
At:
059. O0 01. O0
$90,000. OD
$12.00
~ $5.oo
~t~CTY $5,00
~-584 $5,00
R.a,,r $30.00
Transfer ~ $360.00
02-06807
~ZS PAGE ZS
PART OF ~ ~H~tR~4ENT
County C].erk, Suffolk ~t~
0~/17/2002
12:02:~ ~
D00012209
165
021.003
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
FOR COUNTY USE ONLY
c .Sw,scod '* L./ '/E/
,I 'l ',~, ~,
' ~ Day Year
PROPER~
1. Prope.yI I
Location STREET NUMBER
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP -5217
RP-5217 Rev 3/97
Lake Drive
I Southo!d I Southold
CiTY OR TOWN VILLAGE
2. Buyer I ~ I .Theresa
Name L~ST NAME / COMPANY FIRST NAME
11971
Zip CODE
Tax Indicate where future Tax Bills are to be sent
Billing if other than buyer address (at bottom of form( I
Address
I 42-20 Kisse_na Boulevard
FIRST NAME
I Flu ~-2%ing
STREET NUMBER AND STREET NAME
4. indicate the number of Assessment
Roll parcels transferred on the deed I
CITY OR TOWN
~ 1 I #of Parcels OR ~] Part of a Parcel
5. Deed
Property [ J x I I OR I 1. 0. 0 t
Size FRONT FEET DEPTH IACRESI
FIRST NAME
I~ I 11355 I
STATE ZIP CODE
)Only if Part of a Parcel) Check as they appl~
4A. Planning Board with Subdivision Authority Exists []
4B. Subdivision Approval was Required for Transfer []
4C. Parcel Approved for Subdivision with Map Provided []
6. Seller I Georqio~oulos I Constantine
Name LAST NAME / COMPANY FIRST NAME
t Georgiop~llos 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:
B I~ 2 or 3 Family Residential F ~ Commercial Industrial
C [,~ Residential Vacant Land Gl~ Apartment Public Service
DI I NomResidential Vacant Land HI I Entertainment / Amusement Forest
I SALE INFORMATION I
11. Sale Contract Date I 01/ 02 / 01 I
Month Day Year
12. Date of Sale / Transfer
] ~/ /(/o~ I
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 r~
10B. Buyer received a disclosure notice indicsti~J [~
that the property is in an Agricultural District
Check one or more of these conditions as applicable to transfer:
A
B
C
D
E
F
G
H
I
$
Sale Belween 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 Less than Fee Interest (Specify Below)
Signdicant Change in Property Between Taxable Status and Sale Dates
Sale of Business is Included in Sale Price
Other Unusual Factors Affecting Sale Price (Specify Below)
None
13. FulI Sale Price I , , , 1, 4, 5, 0, 0, 0, 0 , 0 I
(Full Sale Price is the total amount paid for the property including personal property.
This payment h~ay 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.
14.1ndicate the value of personal I I I I I I I0 , o , o I
property included in the sale ~ ~ ·
I ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill I
16. Year ef Assessment Roll from I 0 0 I 17. Total Assessed Value Iof all parcels in transfer) I
which information taken ~
' '~ I-I I 19. School District Name I Southold
18. Property Class I /', ,
20. Tax Map Identifier(s) / Roll Identifier(s) (fi more than four, attach;sheet with addRionsf identifier(s))
I 1000, 59, 1~ LOt 21.3
I J I I
I CERTIRCAT!ON I
I 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 ! understand that the making
of any willful false statement of material fact herein will subject me to the provisions of the penal law relative to the making and filing of false instnunents,
BUYER
BUYE~ $1GNATUF~ ~, DA~
42-20 I ~s~a
STREET NUMBER STREET NAME (AFTER SALE)
Flushing, I-~TY I 11355
CI~Y OR TOWN \ / STATE ZIP CODE
BUYER'S ATTORNEY
Dieterich I Linda
LAST NAME FIRST NAME
631 [ 369 3311
AREA CODE T~LEPHONE NUMBMR
~CITY/TOWN ASSESSOR~