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INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
STATE BOARD O1~ REAL, ~1 ~PERTY SERVICES
RP: §217
PROPERTY INFORMAT ON
I I I
J ~ {Only ~ Pa~ ~ a Pa~l) ~k ~ they apply:
~ST 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)
Address
STREET NUMBER ANO STREET NAME
4. Indicate the number of Assessment
Roll~arcels transferred on the deed I
5. Deed
Property
Size
Seller
LAST NAME J COMPANY FIRST NAME
7. Check the box below which most accurately describes the use of the property at the time of sale:
A One Family Residential
B 2 or 3 Family Residential
C Residential Vacant Land
Non-Residential Vacant Land
I ~ ~F~ATtON J
11. Sale Contract Date
Agricultural
Commercial
Apartment
Entertainment / Amusement
12. Date of Sale / Transfer
Month Day Year
Month Day Year
I [] Community Service
J ~.~ Industrial
K~ Public Service
L] I Forest
Check the boxes below as they apply:
Ownership Type is Condominium []
9, New Construction on Vacant Land []
10A. Property Located within an Agricultural District []
10B. Buyer received a disclosure notice indicating r~
that the pro~rty is in an Agricultural District
15. Check one or more of these conditions as applicable to transfec
A
B
C
D
E
F
13. Pull Sale Price J ,, , 31 ~10I C ~, ~), 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 j
mortgages or other obligations.) Please round to the nearest whole dogar amount.
14. Inificate the value nf personal
property included in the sale ~ ~ ·
J A~ESSMENT INFORMATION L Data Shou d ref oct the atest F[n~ AsseSsment Eel and Ta~
Roll from I ~'9~ ~ 17. Total Assessed Value (of all parcels in transfer)
16.
Year
of
Assessment
which information taken
18. ,,ppert~ Class ' ~.~. / '-J J 19. School District Name J &'fe~c~e'~/
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 Less than Fee Interest (Specify Below)
Significant 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)
7, ~, 0,01
20. Tax Map Identifier(s) / Roll Identifier(s) Jif more than four, at~ach sheet with additional identifier(s)}
[ CER~iFiCATION J
I certify that all of the items of infornmtion entered on this form are true and correct (to the best of my knowledge and belief) and I understand that the making
of any willful fa~e statement of material fact herein wiH subject me to the provisions of the penal law relative to the making and filing of false instrmnents.
· / /t~g~ER BUYER'S A"n"ORNEY
STREET NUMBER ~T,~EET NAMe'(AFTER SALEI
C~ OR TOWN ZIp CODE
,
FIRST NAME I
AREACODE TELEPHONENUMBER