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TOGETHER
AND thc ~y t~f ~ f~ p~ ~ ~p}~C~~ I~ of~ ~.~~ ~y ~'~ ~1
and cl'~ ~ fo~
~MM~NC~G ~ a point
RD~NING THENCE easm~:e
Ro~ ~ ~ now ~ f~y oFR~
Ro~
T'r~I~NC~ ~e:rly alo:~ l~nd of~ C~ri ~ck~ 135 fi~t. ~ or'~ ~ fi~ ~
TORRENS
~ O0
GRAND TOTAL
Or
Safi~fact~harg~'R~t~ Li~ ~y ~ M~ii~ Addm~
R~I~ & R~TU~ TO:
Con~id~n~tion Amounl $
Tille
Land
Suffolk
TO
~ C~L~NTY. NEW ~
~ ~e YLLLAGE
_ I
fllll ~ lB lllli ~ W lie Ill] ~
il!llflHllllllglllgl
~ of X~at..cumen~: DEE~/DDD
~ ~ ~: 02-028,65
Oia t~i ~t:
1000
08/lg/2002
lO:OO:3e R~[
D0001~04
23~
006.000
TAX HUN;~gR: 02-02B65
,~5. CIO
$15.00
a2$.oo
64.00
$0.00
F. dwa rd P.~ne
County Cl~k, Su££olk Coun~
FOR COJJI~i'Y USE ONLY
CI; SWIS Code
~_~: T~q-~'~~ r'~r~LY wr~_~ vvm fw~ u~ ruN~
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
I ~, ~ ~,~ ,,~ ~1 REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
C2. Date*Deed R~orded
C3, Book ] /~ ~,. ~ ,~'~),~ I C4. Page
FO '~
PROPERTY I,N RMATION ~
RP - 5217
RP-5217 Rev 3/97
1. Property I
Location
STREET N.~U~MBER STREET NAME
c,w ~ ~ow. v,~?
Name ~ST NAME / COMPANY FIRST NAME
ZIP CODE
FIRST NAME
3. Tax Indicate where future Tax Bills are to be sent
Biffing if other than buyer eddress (at bottom of form) I
LAST NAME , COMPANY
',Address
STREET NUMBER AND STREET NAME CITY OR TOWN
4. Indicate&he number of Assessment ~~:~p
Roll parcels transferred on the deed I , , I I # ofl~ee~ arcel
IORI , a !, ('1
~ ~ ~ACRES
Deed
Property I
Size
FRONT FEET
Ixl
6. Seller I : ....
Name LAST NAME / COMPA~JY ~ ·
I
DEPTH
FIRST NAME
STATE ZIP CODE
(Only if Part of a Parcel) Check aa they apply:
4A. Planning Board with Subdivision Authority Exists []
4B. Subdivision Approval was Required for Transfer []
4C. Parcel Approved for Subdivision with Map Provided []
I ~ ~'~ I
FIRST NAME
I I I
LAST NAME I 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
I SALE INFORMATION I
11. Sale Contract Date I
Commercial
Apartment
Entertainment / Amusement
Month Day Year
Community Service
Industrial
Public Service
Forest
12. Date of Sale / Transfer
I -~
Month Day Year
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 []
lOB. Buyer received a disclosure notice indicating []
that the property is in an Agricultural District
15. Check one or more o~ these conditions as applicable to transfer:
A
B
C
D
E
F
Sale Between Relatives or Former Relatives
Sale Between Related 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)
13. Full Sale Price I , , , U, ,~, ,~,,· :..~, u, 0, 0 I
(Full Sale Price is the total amount paid for the property including personal property.
This payment may be in the fq~m 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 0 ~ 0 I
property included in the sale
~ ~, a
I ASSESSMENT !N?ORMATtON. ~ should reflect, the latest Final Assessment Rolt'~tnd Tax Bill I
I ~-" I I 17. Total Assessed Value (of all parcels in transfer)
16.
Year
Assessment
Roll
from
which information taken ~ '
18. Property Class I k ~ , a-L__J 19. School District Name 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
20. Tax Map Identifier(s) I Roll Identifier(s) (if more than four, attach sheet with additional identifier(s))
I I I I
I certify that all of the item~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 ~ false statem~ti~of, material fact herein will subject me to the provisions of the penal law relative to the making and filing of false instruments.
BUYER BUYER'S ATTORNEY
DATE
STREET NUMBER STREET NAME (AFTER SALE)
CITY OR TOWN ~ ' ~ STATE
· ~r'ELLER SIGNATURE ,'
ZIP CODE
DATE
LAST NAME FIRST NAME
AREA CODE TELEPHONE NUMBER