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TPSB4 P~ R~otdhq~ t Filing Z A~mmll Ta~ O, [~1 Tu~-. tlka[ C~umy YF~. ~ NO 02033610 ~ooo ovooo 0200 02?000 RECORD & RETUR~ TO: T~e ~ Office of 1421 ~h Suffolk Counl *l!~s pa~ ~n~ of the PreRervaljon Fund I'D Title Company Information Co, N~m~ Recordin & En~rsement Pa SUFFOLK CO~JN'FY, ]'~:W YOf{g_ IOXl~ $ I1 IRU ~ MUS] i1[ 'i'll D ~ ~l/ID IN ,llb':Cl INK ONLY ~OR 'lO RtZ~llb,~ OR FLUNG. Ill Illll IIt~ IIl~ ~ll ~ ~ ~11 fill ~l[ I lli~ltlltIlllll~l~ SUFFOLK CC4/~"~Y CLE~K RECORDS OFFICE P~F, CO~D rNG PAGE 02-08518 1000 LIBER PAGE S~c bion: Block: 070.00 02.00 ~-*- AND ~ AS FOLLOMS $0,00 $5.00 $5. O0 ~5. O0 $0,00 A I~ART 01~ ~ INSTI~UM~J~ Cour~...,y Clegk, Suffolk Coun~7 09/26/2002 0V:$7:3~ AM D00012211 372 017.000 $5.00 mO $15.00 tm $25.00 ~SO $0.00 m:~ $0.00 tm $0,00 NO $99.00 FOR COUNTY ~E~LY PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM II~ISTRUCTIONS: hep://wvvw.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 1. Property Location 495 STREET NUMBER So d ld I I Jtr]! th A. CITY OR TOWN 2. Buyer I ~ 3. Tax Indicat'e ~vhere f~ure Tax Bills are to be sent Billing if other than buyer address (at bottom of form) Address STREET NUMBER AND STREET NAME 4. Indicate the number of Assessment Roll parcels tranderred on the deed I 5. Deed Property 6. Seller [ FIRST NAME I , I STAI~ ZIp CODE -----] (Only if Part of a Parcel} Check as they apply: ~ ]-[ ii of Parcels OR Part of a Parcel 4A. Planning Board with Subdivision Authority Exists r--] Approval was Required for Transfer [] Subdivision ~J~ OR I iACRES' ,3, 8 I 4C. Parcel Approved for Subdivision with Map Provided [] FIRST NAME I LAST NAME / COMPANY I FIRST NAME I 7. Check the box below which most accurately describes the use of the property at the time of sale: 2 or 3 Family Residential F ~ Commercial Industrial Residential Vacant Land . GI~I Apartment Public Service Non-Residential Vacant Land HI I Entertainment / Amusement Forest I SALE INFORMATION I 11, Sale Contract Date 12. Date of Sale / Transfer ~1 /n/a / I .. M o~,h , pay Year '~ Month Day Year Cheek the boxes bdow as they apply: 8. Ownemhip Type is Condominium r~ 9. New Construction on Va~t Land ~' [] IOA. Property Lo, cited within a~ Agri~ultura~ Distric~ [] 10B. Buyer received a disclosure notice indicating e that ~he property is in an Agricultural District · 15. Check one or more of these conditions as applicable to Wander: A Sale Between Rel;tives or Former Relatives Sale Between Related Companies or ~artners in Bu~ineA.~ One offhe Buyers is also a Seller Buyer or Seller is Government Agency or Lending i~titution 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 ~ , I . ,' , I , I 01 0 , 0 I (Full Sale Price is the total amount paid for the proper~y 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 personal I ' I I I I I I 0 I 0 I 0 I property included in the sale ASSESSMENT INFORMATION ;Data should,~ }~mt Asse~h~enfR011 and Tax Bill i6. Yea~ of Assessment Rbll from Which ioformation taken I 0 ~ I 17, Total Assessed Value (of all parcels in transfer) 18. Property Class I 2, 1, I~ I'[ [lS. School District Name I 6lfl/f~frhnlt] 20. Tax Map Identifier(s) / Roll Identifier(s) {If more than four, attach sheat, with additional identifier{s)) Significant Change in Proper~ Between Taxable Status and Sale Dates Sale of Business is Included in Sale Price Other Unusual Factors Affecting Sale Price (Specify Below) None ½ ½ ,4,6,0,01 I 70. - 2- 17 I [ I ICER~n~AT~ON :! ? ' 1 certify that all of the items of information entered on this form are true and correct (to the best of my knowledge and I~lief) 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 495 I ~ C~eek Drive STREET NUMBER STREET NAME (AFTER SALE) souU~old [ t~Y I lliI1 C1~¢ OR TOWN STATE ZIp CODE SELLER BUYER'S A'FrORNEY LAST NAME ITY/TOWN ASSESSO COPY