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ROR COUNTY USE ONLY
C1. SWIS Code
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INSTRUCTIONS: http://www.orps.state.n¥.us or PHONfi (§18) 473-7222
C2. Date' Deed Recorded I <? / .,;~. ~ / 12,3
Modth Day · Y~ea~r
PROPER~ INFORMATION I
1. Prope~yI 168 I Central Avenue
Log~tion STREET NUMBE~ STREET NAME
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217
RP-5217 Rev 3/97
2. Buyer
Name
Southold I Greenport I t19441
CITY OR TOWN ~!LLAGE ZIP CODE
Hildreth I Jean B.
LAST NAMECOMPANY FIRST NAME
· ..,. ,, ~, ,~ ? ¢' ,:.
ndicate"v~ere future Tax Bills are to I~ sent l~ ~ 'x '
FIRST NAME
3. Tax i ~' .... +
Billing if other than buyer address (at bottom of form) J
Address LAST NAME, COMPANY FIRST NAME
I
STREET NUMBER AND STREET NAME CITY OR TOWN
4. Indicate the number of Assessment
Roll parcels transferred on the deed I , , ! I # of Parcels ORU Part of a Parcel
5, heed
Property I 52.45' Ixl 122-28'1ORI , , · I
Size FRONT FEET DEPTH {ACRESI I
I , I
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 []
6. Seller I Htldreth t Jean B.
Name LAST NAME / COMPANY FIRST NAME
I Wasser I Ronaid B.
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
Agricultural ][~ Community Service
Commercial i~] Industrial
Apartment Public Service
Entertainment/Amusement Forest
Check the boxes below as they apply:
8. Ownership Type is Condominium []
9. New Construction ~n Vacant Land []
10A. Property Located within an Agricultural District []
10B. Buyer received a disclosu.re notice indicating []
that the property is in an 'Agricultural District
I SALE INFORMATION I
11. Sale Contract Date I ---- / -- / --
Mont~ Day Year
12. Date of Sale / Transfer
Month Day ~- Year
13. Full Sale Price { { , I , , I I , 0 , 0 , 0 I
~ ~ ·
(~'ull 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.
15. Check one or more of these conditions as applicable to transfer:
A Sale BebNeen Relatives or Former Relatives
Sale Between Related Corn panies or Partners~'~n Business
On~'~,f the Buyer~is, also a Seller. ,,'-.-"
E~uyet or Seller is ~3overnment Ager~cy or Len~i'ng Institution
E Deed Type not Warranty or Bargain and Sale (Specify Below)
F Sale of Fractional or Less than Fee Interest (Specify Below)
G 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)
J None
Transfer from Wife and Hudband to
14. Indicate the value of personal I , I { I , I 0 ~ 0 ~ 0 { Wife
property included in the sale ~ ~ ·
16. Year of Assessment Roll from I 0, 21 17. Total Assessed Value [of all parcels in transfer} I I
which information taken ' ' ~ ' ' ½ ' ' ~ ' '
18. Property Class I 2, [, 01.1 I 19. School District Name I Greenport I
20. Tax Map Identifier(s) / Roll Identifier(s) (If more than fou,, attach sheet with additional identifier(s)) /~ I--~--
I 1001-005.00-01.00-011.000 I [
[ certify that all of the items of information entered on this form are true and correct (to the best of my knowledge and beliefl 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
BUYr~GNATURE JeaD 8. ~ildz'eLh
168 I Cemtral Avenue
STREET NUMBER STREET NAME IAFTER SALE)
Greenport NY
CITY OR TOWN
~ .SELLER
Jean 'B;
STATE
SELLER SIGNATURE Rona~a B. Wasser
11944
ZIP CODE
Dar
BUYER'S ATTORNEY
Btrtwhistle
L. Alan
LAST NAME
FIRST NAME
AREA CODE TELEPHONE NUMBER
[ ITY/TOWN ASSESSOR
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