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INSTRUCTIONS: h~p://vvww.orps.state.ny.us or PHONE (518) 473-7222
FOR COUNTY USE ONLY
Cl. SWlS Code
C2. Date Deed Recorded
C3. Book
PROPERTY INFORMATION
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP- 5217
RP-5217 Rev 3/97
2. Buyer
· Name
CITY OR TOWN VIL~GE ZIP CODE
LAST NAME / COMPANY F~RST NAME
I
LAST NAME / COMPANY FIRST NAME
3. Tax Indicate where future Tax Bills ars to be sent
Billing if other than buyer address (at bottom of form) I I
Address LAST NAME / COMPANY FIRST NAME
I STREET NUM~E~ ANO ST~EE~ ~E I el~ ORTOWN
Roll parcels transferred on the deed I ' ~' ), / I # of Parcels OR Part of a Parcel
{Only if Part of a Parcel) Cheek as they apply:
4A. Planning Board with Subdivision Authority Exists []
5. Deed
PropertyI J x I I oal ....
Size FRONT FEET DEPTH ACRES
6. Seller
Name LAST NAME / COMPANY FIRST NAME
Subdivision Approval was Required for Transfer []
Parcel Approved for Subdivision with Map Provided []
I H3_rol'I .Tr. as '?ruste2
I I 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 boxes below as they appl~,
8. Ownership Type is Condominium
B J_~ 2 or 3 Family Residential F ~.~ Commercial
C ~ Residential Vacant Land G~,~ Apartment
DLJ Non-Residential Vacant Land HLJ Entertainment / Amusement
I ,SA INFORMATIONI
11. S,leContractOate I 7 / 27 / 01 I
Month Day Year
12. Date of Sale / Transfer
/ ?(, / 02 I
Month Day Yea¢
Community Service
Industrial
Public Service
Forest
9. New Construction on Vacant Land []
10A. Prope~y Located within an Agricultural District []
10B. Buyer received a disclosure notice indicating []
that the property is in an Agricultural District
15. Cheek one or more of these conditions as applicable to transfer:
A
B
C
D
E
F
~ ~ ,0 ,0
13. FugSala'~¥ice I , , , ,7 ,-, ,0 , 0 , 0 I
(Full Sale Pri~;e is the total amount paid for the property including personal property. I
This payment may be in the form of cash, other properly or goods, or the assumption of
mortgages or other obligations.) Please round to the nearest whole dollar amount.
14. Indicate the value of personal I , , 0
property included in the sale ~ ~ ; O , 0 I
ASSESSMENT INFORMATION - Data sheuld reflect the latest Final AsSessment Bol[ and Tax Bill
16. Year of Assessment Roll from [ ;i ~1 17. Total Assessed Value (of all parcels in transfer)
which information taken
Sale Between Relatives or Former Relatives
Sale SeWveen Related Companies or Partners in Business
One of the Buyers is also a Seller
Buyer or Seller is Government Agency or Lending I~stltution
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)
None
18. Prope~y Class L~L--~z-~-I J 19. School District Name I 3outJ~old I
20. Tax Map Identifier{s) / Roll Identifier(s) (if more than four, attach sheet with additional identifier{s))
1090-~7-1 -~0
I I I
7-1-2_O
I I I I
I CERTIFICATION 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 beliel) and I 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 instruments.
BUYER BUYER'S ATrORNEY
J ~ C :qolclings, r,.?.
' i c- ~ SELLER CITY/TOWN ASSESSOR