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CONSULT YOUR LAWYER BEFORE mGN1NG 1~1~ IN~TRUMENT-11~I:B IN~'n:IUMENT SHOULD BE USED BY L.AWYERB ONLY
THIS INDENTURE, made the 16th day of September 2004.
BiETWEEN
DA~F~q GRACE COLLINS, restdin8 at 165 L~Houu~edleu~ SouthoZd, Ney York
11971
pa~y of the first part, and
FKANK KEELEY, residing at 165 L'Homedteu, Southold, New York 11971 and
DA~ G~CE ~LL~NS, restdtn8 aC 165 L~*Ho~dleu, Sou~hold, New York 11971, as Joint
Te~nts ~th RIsh~ Of~lSu~tvors~p.
~ ~ ~e s~d ~,
WITNESS~H, that ~e ~ ~ the first ~d. In ~usi~ation ~
pa~ by ~ ~ ~ t~ ~d pa~ M hem~ g~l a~ mlM~ unto ~ ~ M ~e 8~nd p~ ~e hMm
or su~om ~ ~g~ of ~e p~ ~ ~e ~ pa~ fo~r.
~ that ce~ p~t. M~ or ~1 ~ ~. w~ t~ ~din~ ~d imp~m~ ~e~n embed, shuate.
~and~ththe ~o~ of SouthoZd. Count~ at Su~toZk and State sE Nev York.
and dec,snared ~,'~.7 and 8 on a certain ~p enC~t[ed~ "~p o~ Eoundece Estates"
and f~Zed $n theO~E~ce at the CZerk of ~h~bn~uo~?Su~fo[k on ~ 10. 1927
as ~p No. 834. sa~d part of Zots beSns and bounded and descc~bed as
"See Schedule A ~de A Pact Hereof and Attached Haters'
BE[NC AND INTENDED TO BE ~ ~ame prea~tses conveyed to the party of the first part
by'deed dated May II, 1998 and filed in the Office of the Clerk of the County of
Suffolk 6u~tJuhg 1~1998 in Libor 11896 at Page 6&2.
TOGETHER with all right, titis and interest, if any. of tho psC~y of the first part in and to any streetS and roads
abutting tho above dascribe~l premises to tho center lines thereof; TOGETHER with the appurtenances and all
the estate end rightS of tho party of the first part In and to seld premises; TO HAVE AND TO HOLD the
premises herein granted u~to the party of tho second part. ~ helm or successom and assigns el the party of
the second part forever.
AND the party of the first part covenants that the party of the first part has not done er suffered anything
whereby the ~ald premises have been encumbered in any way whatever, except as aforesaid.
AND the party of the first part. in compliance with Section 13 of the Uen Law. covenantS that the party of the
first p~t will receive the cenelderetlon for this oonveyance and will hold the right to receive such consideration
es a trust lurid to be applied first for the puqx~e of paying the cost of the Improvement and will apply the same
first to the payment of the cost of the Imprevernant belore using any part of the total of the same for any other
purpose. The word "pmly' shell he construed ss If It re~d "parties" when ever the ashes of this Irldenture es
requires.
IH WITNESS WHEREOF. the p~ly of the first part he~ duly executed this deed the day and year first above
IN PRESENCE OF:
DAWN CRACE COLLINS
TO BE U~tED ONLY WHEN THE ACKNOWLEDGMENT 18 MADE IN NBW YORK ~'rATE
Form ~290
Stale of New Yod(, County of Suf folk es: State of New York. Courtly of M:
On the 16tt~, of Sept:e~ber In the year 200& On the dsy of In the year
before me, the undomlgned, personally appeamcl Imlom me, the undemlonecl, personally appeared
Dawn Grace Collins
pemoneJJy known to me or proved lo me on the basl~ of peraonaSy known to me or proved to me on the basS8 ot
satJetactmy eviderioe to be the Iri~v~dual(i) whose name(e) i~ satis~ctory e~[ence to be the In(Miua/(s) w~e name(i) Il
(are) lUW to the M1hin InMnJment and anknMedged to (ate) ~ub~c~oecl to the w~thln instrument end acknMedged to
me that heMheflhey executed the i~me In hta~herflhelr me that he~shWthey executed the seme Iff hlW'nerJtheir
cepac~t~le~), and that by hi~er,lhelr signature(s) on the naperies), and that by hiWherflhelr signature(e) on the
icstnJrnam, the IndMduat(e). or the person upon behatf of which inatrurnem, the IndMdual(s). or the person upon behm! of which
the indlMduaJ(,) Wed. executed ~e Inatrumant. the individuaKs) anled, executed the instrument.
(Mgnatum and office o! Indlvldtml biking acknowledgment)
Notary ~blic
Notaly~LAJNE ~8~LLANO
Fu~ · o/New Yom
T MAD OUTStDE NEW
(signature end office of IndlvtduM taking acknowledgment)
State (or DMbk=t ol Ccdumbia, Territory, or Foreign Country) of 88:
On the day of In the year before me, the uncler~necl, pemonelly
appeared
pemonelly known to me m' proved to nm on the basM of Md~fectory evtdence to be the Incrn~duef(s) whoee name(e) Is (are)
subsGn'bed to the within InsmJment 8nd acknowledged to nm that he/ahe/Ihey exe~uled the eenm in hla/her/Ihel; capectty(le~), and
that by hlWhor/thelr signature(a) o~ the InatnJmem, the Inm'~lual(e), or the pemon upon behalf of which the InclNtdu~l(e) ~ctecl.
executed Ihe InstnJment, and thet such InGrlVlduel made such appearance bMom the undemlgnecl in the
(insert the Clly or c~her J~llflcal ~r,J bclMslMt) (and insert the Stale (~ Countw or other pla~e the acknowMdgrne~t was teXen)
(8 J~l~.ture ~id office 04 IndlMduB] tek]ng acknowled~ntent)
BARGAIN AND SALE DEED
Wn'H COVENANT AOAIN~T GRANTOR'B ACTS
Title No.
Da~m Grace Co111ns
TO
Frank Keeley and Da~n Grace Collins
Commonwealth
SECTION 64.00
BLOCK 02.00
LOT 023,000
COUNTY OR TOWN Sputhold
STREET AODRES$ 165 L'Hommedteu
Southold, New York
11971
Reco~ed ~ Re~ue~ ~
COMMONWEALTH LAND TITLE INSURANCE COMPANY
RETURN BY MAIL TO:
William C. Gogglhe,FC
P.O. Box 65
Mactttuck, New York 11952
SCflEDULE A
' ~LL Ihi! c~rta!n p~l. piece or I~..e, of hndi'wlth the'b~i~i~
ym~ .and ?n! ta t~,Tovn o~ SouthoXd, County of Suffolk and State of Ney York, known
naa sesxina~ed~/~ ~ and 8
and flied ~n ~he O~//ce o~ ~he Clerk si ~he Count7 of Suffolk on ~7 10, 1927
aa ~p No. 834, said part o~ lots bein~ bounded and described as ~o110~B:
BEGINNING a~ a mou~ent'o~ the Northerly side of L'l~ed/eu Lane distant ~5 feet
~es~erly fr~ the corner lo.ed by the in~eraec~ion of the Northerly side of
L'Ro~edieu Lane and the ~es~arly side si Founders Path;
RUNN~ TH~C~ Sou~h 61 de,roes
L~Ho~edieu Lane 75 fee~' ~o a monuaentl.
TII~NCE North 25 desrees 55 sinuses goat alonS the Easterly sides si Lo~s ] and-i,
100 feet to the Southerly side
TliENCE No~h 61 de,roes 05 minutes ~as~ alonS the Southerly eldi of Lo~ 6, ~5 feet
~o a point;
~IENCE throuih Lots. 7 and 8,' ~ouCh ~5 desreea 55 minutes East, 100 £eet Co the
Northerly olde of L'Nommedieu Lane at the point or place'.o~ BEGINNING.
Number of pages
TORRENS
Serial #,
Cart(fiesta #,
Prior Cfi. #
Deed / Moflgngc Instrument
'1
Handling "~ __
TP-5~I
Deed / Mortgage Ten Stamp
FEES
Nolntiofl
EA-52 17(Coumy) ~
EA-5217 (Slate)
R.P.T.S.A.
Comm. of 'Ed. ~ GO
Affldnvit
O, he,
f
5 I Real I~n'ly Tax Servie~ Agency Verification
Slantp ~5 1000 06400 0200 023000
Initials i ' -. .... m - · - "
· ~l Satisfnctions/Disehatses/Releases List Property Owners Mn(lifts Address
RECORD & R~TURN TO:
Wflllam C. Ofisstns,PC
P.O. Sox 65
Hacclcuck, New York 11952
Suffolk
Thi~ gal~ forms part ofthe atlachccl
Da~m Grace COZ]L:L*us
TO
Daw~ Grace Co111ne
Fran~ Keeley
_4304 Sip 16 04:47;05 PM
Edward P.RoMaine
~K 0F
~JFFOLg ~ITV
L ~0012~
~ 797
0T~ 04-072~
Recording / Filing Stan~ps
I 6
Mmtpge Atnt.
I. Basic Tax
2. Additimml Tax
Sub Totel
SpecJAssit.
0r
Spec. 1Add.
TOT. MTG. TAX
Dual Town Dual Culmty
Held for Appoflionment
Transfer Tax
Manaion Tax
The property covered by this nmrlgage is or
will be improved by a one or two family
dwelling only.
YES__or NO
If NO, see approprime tax clanae on pale #
Community' Preservation Fund
Connldcralion Amou.t
CPF Tax Due
Improved '
Vacant Land
· )'D //9
Title Company Information
Co. Namn
Title #
& Endorsement
· Bargaln and Sale
(S 'PEC'IFY TYPE OF 1 N S'['R. UIVdENT )
The ix~nlses herein is situated in
SUFFOLK COUNTY, NEW YORK.
In the Township of Soul;hold
In the VILLAGE
or HAMLET of Sou£hold
made by:
BOXES 5 1TIRU 9 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FI I.ING.
(OVER)
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type o£ Instrument: DEEDS/DDD
Number o£ Pages: 4
Receipt Number : 04-0102877
TRANSFER TAX NUMBER: 04-07288
District:
1000
Deed Amount;
Recorded~
LIBER:
PAGE:
Section: Block:
064.00 02.00
~aMIN~D AND C~.~.RGED ~ FOLLOWS
$100,000.00
09/16/2004
04~47=05 1~
D00012343
797
T.ot; ~
023.000
Received the Following Fees For Above Instrument
Exempt
Page/Filing $12.00 NO Handling
COE $5.00 NO NYS SRCHG
EA-CTY $5.00 NO EA-STATE
TP-584 $5.00 NO Cert. Coptes
RP? $30.00 NO scm
Transfer tax $400.00 NO Coam. Pres
Fees Paid
TRANSFER TAX NUMBER~
04-07288
THIS PAGE IS A PART OF THE INSTRUMENT
THIS 18 NOT A BZLL
$5.00
$~s.oo
$75.00
$5.oo
$o.oo
$0.00
$557.00
NO
NO
NO
NO
NO
Edward P.Ro~aine
County Clerk, Su££olk County
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
FOR COUNT~ USE ONLY
c, ~w,s Cod. I ,~, '7, 3, ~, :~, ,~r
C2, Date Deed Recorded I ~/ //~/ / ~l I
PROPER~ INFORMATION I
t erop'"vL 165 [ L'Ho~edieu
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE SOARD OF REAL PROgERTY SERVICES
RP - 5217
Southold
Collins
Keeley
Southold
111971
Dawn Grace
Frank
IOR[ · I 4C Parcel Approved for SubdMsion w~th Map provided []
Collins Dawn Grace
11Sale Contract Date J 9' / 14 / 04 J
12. Date of Sale / Transfer
I 9 / 16 / 04 I
1000
02.00
L
064.00
023.000
I CERTIFICATION I
B YER
Southold NY 11971
I
.~ SELLER
] 9- 16 -04
- - ~A~F Grac~ ~olfins DATE
BUYER'S ATTORNEY
Goggins I William C.
NEW YORK STATE
COPY I