HomeMy WebLinkAboutL 12581 P 981SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: MISCELLANEOUS - DEED
Nnmher of Pages: 3
Receipt ~,mher : 09-0022502
TRAN$~'~R TAX NUMBER: 08-16750
District:
1000
Deed Amount:
Recorded:
At:
LIBER:
PAGE:
Section: Block:
048.00 02.00
EXAMINED AND CHARGED AS FOLLOWS
$0.00
Received the Following Fees For Above Instrument
Exempt
Page/Filing $0.00 YES Handling
COE $0.00 YES NYS SRCHG
EA-CTY $0.00 YES EA-STATE
TP-584 $0.00 YES Notation
Cert. Copies $0.00 YES RPT
Transfer tax $0.00 YES Comm. Pres
Fees Paid
TRANSFER TAX NUMBER: 08-16750
THIS PAGE
IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
Judith A. Pascale
County Clerk, Suffolk County
03/04/2009
11:44:29 ~
D00012581
981
Lot:
042. 000
Exempt
$0 00 YES
$0 00 YES
$0 00 YES
$0 00 YES
$0 00 YES
$0 00 YES
$0 00
Number of pages
TORRENS
Serial #
Certificate #
I'rior Cfi. #
Deed / Mortgage Instrument
Page / Filing Fcc I ~
J landling *d'~
'1'P-584
Deed / Mortgage Tax Stamp
FEES
Nolalion
LA-52 I 7 (County)
LA-5217 (State)
R.P.T.S.A.
Comm. or Ed.
Affidavit
Cerlified Copy
Reg. Cop:,'
Other
-'1
$1amp
Dale
Inidals
__ Sub Total
500
Reap Property Tax Service Agency Verification
Dist. I Section I n h-.-~- I
1000 04800 0200 042000
7~ eases Property Owners ~ailing Addres~
Satisfac
Ions/Discharges/Re
List
RECORD & RETURN TO:
Suffolk County Dept. of Social Services
3085 Veterans Menorial Hwy.
Ronkonkoma, NY 11779
Attn: A&R
RECORDED
2009 Mar 04 11:44:29
Judith R. Pascale
, CLERK OF
SUFFOLK COUNTY
L D00012581
P 981
DT~ 08-16750
Recording / Filing Stamps
Mmlgagc Ami.
I. Basic Tax
2. Additio.al Tax
Sub Tolal
Spec./Assit.
Or
Spec./Add:
TOT. NITG. TAX
Dual Town Dual Counly~
Ilcld for Apportiunmcnl ~
Transfer Tax
Mansion Tax
The property covered by this mortgage is or
will be improved by a one or two £amily
dwelling only.
YES or NO
II'NO, see appropriate tax clanse.on page #
__ of this instrument.
6 Community Preservation Fund
Consideration Amount $
CI'F Tax Due
$
Improved
Vacant Laad
TD
TD
TD
Title Company Information
Co. Name
Title #
Suffolk C( Recordin & Endorsement
q]lis ~age forn~s part of the attaci~ed Affidavit ~ate Claim (miscellaneous deeds ) made by:
(SPECIFY ~PE OF INSTR~I~ )
/ ~e pre.scs hcrcin is sit.ted in
SU~OLK COUP, NEW YOR~
TO In the To--hip of. ~O 0~OZ*
dane~ De~a~zo, Commiss~one~ln the VILLAGE
Su~o~R County D~p~. o~ 8oc~ S ~'
BOXES 5 'lt. IRU 9 MUST BE TYPED OR PRINTED IN BI.ACK INK ONLY I'RIOR TO RECORDING OR FILING.
STATE OF NEW YORK)
.... -'SS
COUNTY OF SUFFOLK)
AFFIDA. VIT OF ESTATE CLAIM
FILE: 1149P2008
CASE #: MOO A52161
PATRICIA A. CLARK as Director of Management and Research of the Suffolk County Department of Social
Services with offices located at 3085 Veterans Memorial H'wy., Ronkonkoma, Suffolk County, New York, being duly
sworn deposes and says, on information and belief: That the Estate of Daisy N. Crenshaw is indebted to the Suffolk
County Dept.of Social Services in the amount of $21,780.83 representing the cost of Medical Assistance granted to the
deceased Daisy N. Crenshaw from March, 2007 to July, 2007. That the amount of $21,780.83 is now due and owing to
the Suffolk County Dept.of Social Services.
That this liability is against the Estate of the deceased and that no payment has been made thereupon and the same is
not secured by judgment or mortgage upon, or expressly charged on the real estate of the deceased or any part thereof and
that no note has been given for the same.
Any beneficiary of the estate, or the estate fiduciary on the beneficiary's behalf, may request that recovery be waived
on the basis of undue hardship. Undue hardship may exist when the estate asset subject to recovery is the sole income-
producing asset of the beneficiaries, such as a family farm or family business, and income produced by the asset is
limited; the estate asset subject to recovery is a home of modest value (i.e. of a value no higher than 50% of the average
selling price in the district) and the home is the primary residence of the beneficiary; or there are other compelling
circmnstances. Undue hardship will not be found to exist based solely on the inability of any of the beneficiaries to
maintain a pre-existing lifestyle, or if the alleged hardship is the result of Medicaid or estate planning methods involving
divestiture of assets.
That the sources of her information and the grounds for her belief are the official records of the Suffolk County
Department of Social Services.
STATE OF NEW YORK)
.'SS
COUNTY OF SUFFOLK)
Patricia A. Clark as Dtrector of Management and Research
of the Suffolk County Department of Social Services
On the{''~43' day of January in the year two thousand and nine, before me the undersigned personally
appeared, PATRICIA A. CLARK, personally known to me or proved to me on the basis of satisfactory evidence to be
the individual whose name is subscribed to the within instrument, and acknowledged to me that she executed the same in
her capacity, and that by her signature on the instrument, the iadividual, or person upon behalf of which the individual
acted, executed the instrument.
AR211 Afl. Of Estate Claim (Rev. Mar.04)
Notary Public
Nota~ laublie.
No. 01AN6188~8.~
Qualil'm;I in Suffolk
Schedule "A"
MOO A52161
ALL those certain lots, pieces or parcels of land, with the buildings and improvements
thereon erected, situate, lying and being at Greenport, Town of Southold, County of
Suffolk and State of New York, known and designated as and by the lots numbered 47 to
50, inclusive, on a certain map entitled, "Greenport Dirving Park", surveyed by C.H.
Bateman and laid out into lots by C.H. Hall, C. E., August 1909, and filed in the Office of
the Clerk of the County of Suffolk on December 1, 1909, as map number 369.
Said premises being known as 1095 7th Street, Greenport, NY.
TAX MAP #1000-04800-0200-042000