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IIOXES 5 TI B{U 9 MUST tl~'fYiq~ ORil{INZ'ED INBLACICIN~C ONLyIatlIOR'1qO~~ OR I.~
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
FOR COUNTY USE ONLY
PROPER~ INFORMATION ~
1. Prope~ 4~0 [ ALBACORE DRIV~
I SOUTHOLD I ~W YORK
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP -5217
RP-5217 Rev
I 11~711
CITY OR TOWN VILLAGE
2. Buyer ] J & (~ HOLDINGS~, L.P~* I
I
ZIP CODE
LAST 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) I
Address ~ST NAME / COMPANY
BTRE E~r NUMBER AND STREET NAME CIT~ OR TOWN
4. In,cate the number of Assessn]ent / ~
Roll parcels transferred on the deed I , J # of Parcels OR Part of a Parcel
5, Deed
Property I lxl IoRI , ,0 · 4,8 I
FIRST NAME
I , I I
· STATE ZIp CODE
(Only if Part of a Parcel) Check a~t~ they pppfy:
4A. Planning Board with Subdivisior~ Authority Exists []
4B. Subdivision Approval was Required for Transfer []
4C. Parcel Approved for Subdivision with Map Provided []
6. Seller I KANUC~- J GEORGE
Name LAST NAME / COMPANY FIRST NAME
r
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 bofuw as they apply:
8. Ownership Type is Condominium []
A J~ One Family Residential i ~ Agricultural !~ Community Service9. New cOnstructiOn On Vacant Land []
B j..=j 2 or 3 Family Residential Commercial Industrial 10A. Properly Located within an Agricultural District []
C J~ Residential Vacant Land Apartment Public Service 10B. Buyer received a disclosure notice indicating []
DLJ Non-Residential Vacant Land Entertainment / Amusement Forest that the proper,',/is in an Agricultural District
SALE INFORMATION ~ 15. Check one or more of these comliUons as applicable to transfer:
11: Sale,Contract Date ] 07 / 09 / O [ I A Sale Between Relatives or Former Relatives
Month Day Year Sale Between Related Companies or Partners in Business
One of the Buyers is also a Seller
12. Date of Sale / Transfer I / ~ /2- I D Buyer or Seller is Government Agency or Lending Institution
Month Day Year E 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
13. FullSalePrice I ~ I '~ i 8 l0 ~ 0 I 01 0 ~ 0 I 0 I Sale of Business is lncluded in Sale Price
(Full Sale Price is the total amount paid for the properly including personal property. I Other Unusual Factors Affecting Sale Price (Specify Below)
This payment maybe in the form of cash, other property or goods, or the assumption of .l '~lone
mortgages or other obligations.) Please round to the nearest whole dollar amount.
14.1ndicate the value of pemonal I 0 , 0I 0 I 0I 0 I 0I 0 I 0 I 0 I
property included in the sale ~ ~ ·
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill
16, Year of Assessmem Roll from
Res. Vac Land I
18. Property Class ~ ~L~.~- I 19. Schoof District Name I 239 - Greenport School I
I 473889 57,-1-43 I I
I I I I
CbI~IB"ICATION : 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) am] I understand that the making
of any wJllfof false stalement ~ material fact herein will ~bject me to the provisions of the penal law rela~ve to the maldng and filing of false instruments.
BUYER'S ATrORNEY
LAST NAME FIRST NAME
STREET NUMBER
I '¥1
SELLER
AREA CODE
TELEPHONE NUMBER