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$130.00
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$25.00
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PLEASE 'I:YPE OR PRESS FIRMLYWHEN WRITING-~---~N-~OR--~-'~'
INSTRUCTIONS: hep://www.orps.state.ny.us or PHONE (518) 473-7222
REAL PROPERTY TRANSFER REPORT
STATE OF NEW yORK
STATE BOARD oF REAL PROPERTY SERVICES
RP -5217
FIRST NAME
ZIp CODE
3. Tax Indicate where future Tax Bills are to be s~nt
Billing if other than buyer address (sf
4. Indicate the number of Assessment
Roll parcels transferred on the deed
FIRST NAME
CI1Y OR TOWN
# of Parcels OR ~] Part of a Parce
5. Deed
P,op0r , L
FIRST NAME
STATE ZIp CODE
4A. Planning Board with Subdivision Authority Exists []
48. Subdivision Approval was Required for Transfel []
4C. Parcel Approved for Subdivision with Map Provided [:~,
J
FIRST NAME
7. Check the box below which most accurately des~lbes the use of the prope~y at the time of sale:
A[] One Family Residential
}~ [] 2 or~ Family Resldentia
"~ C I~,L~dential Vacant Land
D L~ Non-Residential Vacant Land
Sale Contract Date
12. Date of Sale / Transfer
Communit~ Service
Industrial
Public Service
Forest
Commercial
Apartment
Entertainment / Amusemen~
, ,
13. Full Bale Price I ~ , ~
r~ull Sale Price is the total amopat paid fo- the property ~ncluamg personal property
This payment may be in the fdrm of cash. other proper:,/or goods, or the assumotien of
mortgages or other obligat~ns.) Please ~ound to the nearest whole dollar amount.
14. Indicate the value of personal
property included in the sale , , , , , , , 0 0 I
Cheek the boxes below as they apply:.
8. Ownership Ty~e is Condominium []
9. New Construction on Vacant Land []
10A. Prooerty Located wiif~ Agricultural District []
10~. Buyer received a disclosure notice indicating []
that the property ~s i~en Agricultural District
, ( i
15. Check one or mom of th~ conditions as applicable to tzansfec
B
C
D
E
F
Sate Between Relatives or Former Relatives
Sale Bet~veen Related Compant~l~'or Partners in Business
One of the Buyers Is a~'(~ 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)
Significant Change in Prope~y Between Taxable Status and Sale Dates
Sale of Business is Included in Safe Price
Other Unusual Factors Affecting Sale Price (S~ecif~ Below)
None
16. Year of ,6-$sessmeflt Roll flom ~ I
v/~ich information taken. . 17. Total Assessed Value (of all parcels in transfer)
18. Property Class I I-1 I 19. School District Name ..... .~ ~ /'~
20. Tax Map Identifier(s) / Roll Identifier(s} (If more then fora. attach sheet with additional identirmHs)]
qO-3-- '
I i I
BUYER'S ATTORNEY
LAST NAME FIRST NAME