HomeMy WebLinkAboutL 12205 P 196i
e,.t, O?ug~.aston, New York
There~e Ciampa of 182 ~111 Springs Road, Nenba~set, New York 11030
000
TN WITNESS WHEREoE ll~e ~
State of New York
On the
to be the
~thM ~r~ment and ac~owle~
the ~e
Signature(s) on ~e ~um~ ~e M~du~s), or ~e ~ npon
behalf
GRAND TOTAL
o7o00 ~ os~woo
Tide #
Tr~
~ i~'e~en~_~on Fund
CPF T~ Due S
TD
TO
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TAX N~: 02-03650
~Amount:
oe/2~/2oo2
10:26:47 AM
~0012205
196
000
~ved r~. Followi~g F~s £or
Page/Filing $9.00
~-C~ $5.00
~-~$4 $5.00
RPT $30.00
Transfer tax
TAX ~_~mL~: 02-03650
A PART OF ~ ZNS~T
Clerk, Suffolk Count~
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http://www.orps.state.ny.us or PHONE (518) 473-7222
PROPER~ INFORMATION ~
REAL PROPERTY TRANSFER REPORT
STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP -5217
Location
STREET NUMBER ~REET NAME
I
ZIP COD~
I
LAST NAME / COMPANY
3. Tax Indicate where future 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 transferred on the deed I
5. Deed
Property [
Size FRONT PEET
DEFP~
FIRST NAME
LAST NAME / COMPANY
I'
CI~ OR TOWN
/I #of Parcels OR ~] PartofaParcel
IORI .....
ACRES
(Only if Part of a Parcel) Check a~ they apply:
4A. Planning Board with Subdivision Authority Exists []
4B. Subdivision Approval was Rsquimd for Transfer []
4C. Parcel Approved for Subdivision w~th Map Provided []
Name
L~ST NAME / COMPANY FIRST NAME
, . ~
LAST NAME / COMPANY FIRST NAME
7. Check the box below which most accurately desc~ibe, the use of the property at the time of sale: Check the boxes below as they apply:
8. Ownership Type is Condominium
A [~One Family Residential E [~ Agrlcultural i~ Commudity Service 9, New Construction on Vacant Land
B ~12 or 3 Family Residential F I~1 Commercial Industrial 1gA, Property Located within an Agricultural District
C ~Residential Vacant Land G I~1 Apartment Public Service lgB, Buyer received a disclosure notice indicating
~/D [~ Non-Residential Vacant Land HI I Entertainment/Amusement Forest ' that~he property is in an Agricultural District
I SALE INFORMATION I ' ::~"
11. Sale Contract Date I
Month Day Year
12. Date of Sale / Transfer
15. Check one or more of these conditions as applicable to transfer:
Month Day Year
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 , , , ~, /, O, o, ~, o, 0 , 0 I G
~ H
(Full Sale Price is the total amount paid for the property including pe~onal property,
This payment may be in the form of cash, other property or goods, or the assumption of j
mortgages or other obligafions.) Please round to the nearest whole dofiar amount.
14. Indicate the value of personal I .... o, 0 , 0 I
property included in the sale ~ ~ ·
ASSESSMENT INFORMATION - Data should reflect the latest Rnal Asses~ R~( and Tax B II
16. Yesr of Assessment Roll from I ~ ~' I 17. Tntdi Assessed Value (of all parcels in t~ansfer) l
which information taken ~
Significant Change in Property Between Taxable Status and Sale Dates
Sale of Business is Included in Sale Price
Other Unusgal Factors Affecting Sale Price (Specify Below)
None
?,3,O,ol
18. Property Class ~'1 I 19. School District Name I I
20. Tax Map Identifier(s) / Roll Identifier(s) (if more than four, attach sheet with edditionM identifier(s))
I J I I
I CEe~!E~AT~ON: ]
I certify that all of the i~ans 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 willful false statement of material fact herein will subject me to the provisions of the penal law relative to the malting and f'ding of false ~ents.
BUYER
SELLER ,
ICITY/TOWN ASSESSOR~
COpy