HomeMy WebLinkAboutL 12209 P 488September ,m~ 2002
Of ~ first pa~ and
120 00 ftet ~o land no~ Or [O~ly of ~niel Ch~'m~;
~ T~
P~t i%~'dy T~x ~kz A .~c-~cy
020~1~ looo o6ao~ DiDO ol~ooo
~0
RE ORD & RETURN TO:
~at~icuck, i~'ev Yo~k [1952
Co Name
Suffolk Count &
1 D
4SPIi1FY '~lq~ C~' ll~TFRU ~,rr )
NEW YORK.
tn file VILL~;~
or I bmuM{ jq]' Of eec on~
Ia ~l~ S'iZ~U 9 M~r BE iYt,~ ~ PRI~ ~ I~X INK ~LY IqU~ ~ ~~ {~ }:l{.l~ L
i llillllJilBlll l llll[l iil lll l ll Nl]
I IIIIIIl!llllllll!lilllll
TPJ~SFF~R T~J( N',/z,i~_E:R:
!000
10:47:50 AM
D00012209
488
014.000
$12.00
~ $5.0,0
~-CTY ~5,00
~-584 $5.00
PmT $30,00
Tranafer ~ax $0.00
TRANSFER TA~NUI, iBER: 02-07053
THIS PAGE IS
NO ~-STAT~
NO SC~
C~, Pres
A PART OF ~; I~S~b~T
£xe~pt
$S.00 ~
$15.00 ~
$25,00 NO
$0.00 ~
$0.00 ~O
$0.00 NO
$102,00
£dward P.~ine
~un~ Clerk, Suffoik Coun~
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
BTAi'E OF NEW YORK
STA~ B~0 ~L~ SERVES
5217
1. Property 2555
Locat on
STREET NUMBER
Cl3~ OR TOWN
2. Buyer I Andrew~
Name LAST NAME / COMPANY
:1
I YounKs Avenue
LAST NAME / COMPANY
3. Tax Indicate wher~a future Tax Bills are to be sent
Billing if other than buyer address (at bottom of form)
Address
S~EET NUMBER AND S~EET NAME
LAST NAME / COMPANY
CITY OR TOWN
I Southold
IMuriel
FIRST NAME
FIRST NAME
111971
ZIP CODE
ZIp CODE
4. Indicate the number of Assessment
Roll parcels transferred on the deed
5. Deed
Property [
Size FRONT FEET
6. Seller
Name
DEPTH
, 1 I #ofParcels OR ~'~ PartofaParcel
ACRES
{Only if Part of · Parcel) Check as they apply:
4A. Planning Board with Subdivision Authority Exists []
4B. Subdivisiod Approval was Required for Transfer []
4C. Parcel Approved for Subdivision with Map Provided []
LAST NAME / COMPANY
7. Check the box below which moat accurately describes the use of the property at the time of sale:
2 or 3 Family Residential Commercial 3 ~ Industria~
Residential Vacant Land Apartment ~ Public Service
Non-ResidenBal Vacant Land Entertalnment/Amusement bJ.~ Forest
11. Sale Contract Date ,
I / /
Mo~th Day Year
12. Date of Sale / Transfer
I 09 / 12 / 02
Month Day Year
13. Full Sale Price I I I
(Full Sale Price is the total amount paid for the properb/including personal property.
This payment may be in the form of cash, other property or goods, or the assumption ef
mortgages or other obligations.) Please round to the nearest whole dogar amount.
10 ,,2~, , , , , , O, O I
14. Indicate tbe value of personal
property included in the sale
Check the boxes below as they apply:
8. Ownership Type is Condominium []
g. New Construction on Vacant Land
10A. Property Located within an Agricultural District []
I~B. Buyer received a disclosure notice indicating r~
that the property is in an Agricultural District
15. Check one or more of these conditions es applicable to transfer:
A
B
C
D
E
F
Sale Between Relatives or Former Relatives
Sale 8ebNeen Related Companies or Partners in Business
One of the Buyers is also a Seller
Buyer or Seller is Government Agency or Lending lostitution
Deed Type net Warranty or Bargain and Sale (Specify Below)
Sale of Fractional or Less than Fee Interest (Specify Below)
Significant Change in Property BeWveen Taxabre Status and Sale Dates
Sale of Business is Included in Sale Price
Other Unusual Factors Affecting Sale Price (Specify Below)
None
Seller retained life estate
16. Year of Assessment Roll from I 0 2 I 17. Total Assessed Value {of all parcels in transfer}
which information taken '
18. Property Class I 4,1 , I I-[ I 19. School Diatdct Name I Southold
20. Tax Map Identifier(s) / Roll Identifier(s) (if more then four, attach sheet with additional identifier{s))
J 1000-063.01-01.00-014.000
BUYER'S A'I-rORNEY
BUYER SIGNATURE DATE LAST NAME FIRST NAME
ARE~ EODE TELEPHONE NUMBER
772 I Indian Neck Lane
STREET NUMBER STREET NAME (AFTER SALE)
Peco~ic NY 11958
I I
CtT~ OR TOWN STATE Zip CODE
SELLER SIGNATURE DATE
~I ASSESSOR
COPY
L