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hie or N~ Yo~ boan~ and
h~b ~ ~ httd Mlrdl |8, :|:~ lad Md M:trch ~6, t98! h ~ o~ dt~~ of
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02-08538
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09/26/2002
09: XI :$3 JWi
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02-08538
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INSTRUCTIONS: http://www.orps.state.ny, us or PHONE (518) 473-7222
l ibOR C(~UNTY USE ONLY
Cl. SWIS Cod~
C2. Date Deed Recorded
C3. Book
PROPERTY INFORMATION
Mohth Day
CA. Page
1. Property I I ~ ~ (~ ~---~-'-' ~ [-'[~'-'"~ ~
Location STREET NUMBER STREET NAME
CITY OR TOWN
Name .AST NAME COMPANY ' I FIRST NAME
REAL PROPERTY TRANSFER REPORT,
STAT~O~. NEW YORK
STATE BOARD OF'I~4 PROPERTY SERVICES
RP - 5217
RP-5217 Ri~v 3~
VILLAGE ZIP CODE
I
LAST NA~/IE / COMPANY FIRST NAME
,
3. Tax Indicate where future Tax Bills are ,o be sent
Billing if other than buyer address (at bottom of form) i ~ ,
Address LAST NAME COMPANY
%o, (o¥
~ STREET NUMBER AND STREET NAME CITY OR TOWN
4. Indicate the n~lmber of Assessment ,
Roll parcels transferred on the deed I ,/', I # of Parcels ORU Part of a Parcel
5. Deed
Prope,y I JXl IORI , , , D.
Size =RONT FEET DEPTH ACRES
6. Seller
STATE ZIP CODE
(Only if Part of a Parcel) Check as they apply:
4A. Planning Board with Subdivision Authority Exists []
48. Subdivision Approval was Required for Transfer []
4C. Parcel Approved for Subdivision with Map Provided []
- ' Name LAST NAME f COMPANY FIRST NAME
I I I
LAST NAME COMPANY FrRST 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 ~..~ Commercial Industrial
Residential Vacant Land ~ Apartment Public Service
Non-Residential Vacant Land HL_J Entertainment / Amusement 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 SALE INFORMATION
11, Sale Contract Date
12. Date of Sale / Transfer
Month Day Year
Month Day Year
13. Full Sale Price
(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 personalproperty included in the sale [ ,I , i ,I i i ®1 0, 0 [, O ~..3t--.-~._::~-~, ? (_-~.~.¢31~- (~ ~'(LSo, ~. ~
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Taxx Bill~
16' Year °f Asse"ment R°ll fr°m ~ 17. Total Aeseesed Value Eof all parcels in transfer)I ..... /.~.
which information taken ~ ~ , ~
18. Property Cia, Iq 7 ~'U 19. School District Name C~~ }'~ ;")J~"'~'
20. Tax Map Identifier(s) / Roll Identifier{s) {If more than four, attach sheet with additional identifier(s))
15. Check one or more of these conditions as applicable to transfer:
A Sale Between Relatives or Form~FRelatives
B Sale Between Related Compames or Partners in Business
C One of the Buyers is also a Seller
D Buyer or Seller is Government Agency or Lending 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
H Sale of Business is included in Sale Price
[ Unusual Factors Affecting Sale Price (Specify Below)
J None
--..
CERTIFICATION '
l ce~ ~t ~ of the i~ of ~o~fion en~ on ~ fo~ ~ ~e ~d co~t (~ ~e ~t of. my ~owl~e ~d ~e~ ~d I ~dem~d ~t ~e m~g
of ~y ~ f~ s~ment of ma~H~ fact he~in ~ ~bj~ me to ~e p~ iota of ~e ~ ~w ~lafive ~ ~e ~g ~d ~ of f~ ~t~en~.
BUYER - BUYER'S A~ORNEY
DAT FIRST NAME
~ /BUYER SIGNATURE
STREET NUMBER. STREET NAME (A~ER SALE)
CI~ OR TOWN SLATE
~LtER
SELLER SIGNATURE
i 'itq'Y- '
AREA CODE TELEPHONE NUMBER