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INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP-5217 Rev 3/97
C1. SWlS Code I ~, "'-~ -
, '/,J2,~,?,/I
C2. Date Deed Recorded I ~, / ,~ ~7/ ,,/~,2 I
Month Day Year
c3. Book I /, /,/I c4. ,a,e, ,
PROPERTY INFORMATION I
1. PropertyI 126 I Center Street
Location STREET NUMBER STREET NAME
I Southold I Greenport
CITY OR TOWN VILLAGE
2. Buyer I Wiggins I Richard J.
Name 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)'l .~ns
Address LAST NAME / COMPANY
I PO Box 266 I Greenport
111944
ZIP CODE
I R. Jonathan
FIRST NAME
i N,¥I 11944
STREET NUMBER AND STREET NAME CITY OR TOWN
4. Indicate the number of Assessment [~
Roll parcels transferred on the deed I ~~ i I # of Parcels OR Part of a Parcel
5. Deed
Property I .38' lXl 105' IORI .... · , I
Size FRONT FEET DEPTH ACRES
6. Seller I Wiggins I R.
STATE ZIP CODE
(Only if Part of a Parcel) Check as they apply:
4A, Planning Board with Subdivision Authority Exists []
4B. Subdivision Approval was Required for Transfer []
4C. Parcel Approved for Subdivision with Map Provided []
Jonathan
Name LAST NAME / COMPANY FIRST NAME
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:
2 or 3 Family Residential
Residential Vacant Land
Non-Residential Vacant Land
Commercial
Apartment
Entertainment / Amusement
Community Service
Industrial
Public Service
Forest
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 []
10B. Buyer received a disclosure notice indicating []
that the property is in an Agricultural District
I SALEINFORMATIONI
11. Sale Contract Date I N~A / , / :' '1 * : ,'
Month Day Year
12. Date of Sale / Transfer
I 09 / 09 / 02I
Month Day Year
'"Sale Betwe~en 8elatives ~r Former Relatives
Sale Between l~elated 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) *
15. Check one or more of these conditions as applicable to transfer:
A
B
C
D
E
F
H
J
13. Full Sale Price I , , , , , , , 0, , 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
mortgages or other obligations.) Please round to the nearest whole dollar amount.
14. Indicate the value of personal I ~ I I I --I 0 ~ --~ 0 I 0 I
property included in the sale ~ ' ~ ·
ASSESSMENT INFORMATION - Data should reflect the latest, Final ASSessmentRoll and Tax BillI
16. Year of Assessment Roll'rom I 0 ]1
which information taken ~ 17. Total Assessed Value (of all parcels in transfer) I
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
1 70 0I
, ½ , , ½ , , ½ ,
18. Property Class I 2, 1, 0 I-I I 19. School District Name I Greenport
20. Tax Map identifier(s) / Roll Identifier(s) (if more than four, attach sheet with additional identifier(s))
1__ 1001 - 004 - 02 - 025 J I J
CERTIFICATION ~ .........
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 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 rding of false instruments.
BUYER
BUYER SIGNA?RE
109/09/02
DATE
126 I Center Street
STREET NUMBER STREET NAME (AFTER SALE)
Gree~port I NY I 11944
CITY OR TOWN STATE ZIP CODE
SELLER
? / .': -. 09/09/02
SELLER SIGNATURE DATE
BUYER'S ATFORNEY
Price, Jr. I William H.
LAST NAME FIRST NAME
631 I 477-1016
AREA CODE TELEPHONE NUMBER
ICITY/TOWNASSESSOR1