The URL can be used to link to this page

Home My WebLink AboutMitchell, Paul L TrustSouthold Town Board - Letter Board Meeting of August 11, 2009 RESOLUTION 2009-683 ADOPTED Item # 5.8 DOC ID: 5209 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2009-683 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON AUGUST 11, 2009: RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs Supervisor Scott A. Russell to execute the Grant of Drainage Easement and all other necessary documents to effectuate same between Trust U/A Paul L. Mitchell and the Town of Southold, subject to the approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Vincent Orlando, Councilman SECONDER: Albert Krupski Jr., Councilman AYES: Ruland, Orlando, Krupski .~r., Wickham, Evans, Russell Generated August 17, 2009 Page 14 ORIGINAL SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: EASEMENT Number of Pages: 9 Receipt N,,mher : 09-0107864 TRANS~R TAX NUMBER: 09-04181 District: 1000 Deed Amount: Recorded: At: LIBER: PAGE: Section: Block: 065.00 01.00 EXAMINED AND CHARGED AS FOLLOWS $0.00 09/21/2009 10:20:40 AM D00012600 599 Lot: 002. 000 Received the Following Fees Page/Filing $45.00 COE $5.00 TP-584 $5.00 Cert. Copies $5.85 Transfer tax $0.00 TRANSFER TAX NUMBER: 09-04181 For Above Instrument Exempt NO Handling NO NYS SRCHG NO Notation NO RPT NO Comm. Pres Fees Paid THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL $20.00 $15.00 $0.00 $30.00 $0.00 $125.85 Exempt NO NO NO NO NO Judith A. Pascale County Clerk, Suffolk County Number of pages gerial # Certificate # Prior Cfi. # TORRENS Deed. Mortgage Instrument 31 Page / Fihng Fee L~ Handling TP-584 Notation EA-5217 (County) EA-5217 (State) R.P.T.S.A. Comm. of Ed. 5. 00 Affidavit Reg. Copy Other Deed / Mortgage Tax Stamp FEES Sub Total Sub Total Orand Total Recording / Filing Stamps Mortgage Amt. 1. Basic Tax 2. Additional Tax Sub Total Spec. / Assit. or Spec. / Add. TOT MTG. TAX Dual Town Dual County __ Held for Appointment __ Transfer Tax Mansion Tax The property covered by this motgage is or will be improved by a one or two family dwelling only. YES or NO If NO, see appropriate tax clause on page # of this instrument. 4 Pr, Ta Ag. Verification 1000 06500 0100 002000 P$O oL~t'UUU S~sfacdon/Dis~ges/Rebase ~stPropertyOwners MallingAd&ess RECORD&RETURNTO: Martin D. Finnegan, Town Attorney TOWN OF SOUTHOLD P.O. Box 1179 Southold, NY 11971-0959 Preservation Fund Consideration Amount $. 0 CPF Tax Due $. 0 Improved Vacant Land Title Company lnfomafion Co. Name Title # Suffolk County Recording & Endorsement Page This page forms part of the attached Grant of Drainmgm 'Rm ~m~e made by: (SPECIFY TYPE OF INSTRUMENT) Trust U/A Paul L. Mitchell TO Town of Southold The premisis herein is situated in SU~e'OLKCOUNTY, NEWYORK. In the Township of Southold In the VILLAGE or HAMLET of Southold BOXES 6 THROUGH 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. (nvar/ Dear Taxpayer, Your satisfaction of mortgage has been fried in my office and I am enclosing the original cop~ 'or your records. If a portion of your monthly mortgage payment included your property taxes, you will now r :ed to contact your local Town Tax Receiver so that you may be billed directly for all future prol~: rty tax bills. Local property taxes are payable twice a year: on or before January, 10th and on or before L lay 31st. Failure to make payments in a timely fashion could result in a penalty. Please contact your local Town Tax Receiver with any questions regarding property ax payment. Babylon Town Receiver of Taxes 200 East Sunrise Highway North Lindenhurst, NY 11757 (631) 957-3004 Riverhead Town Receiver of Taxes 200 Howell Avenue Riverhead, NY 11901 (631) 727-3200 Brookhaven Town Receiver of Taxes 250 East Main Street Port Jefferson, NY 11777 (631) 473-0236 Shelter Island Town Receiver of Taxes Shelter Island Town Hall Shelter Island, NY 11964 (631) 749-3338 East Hampton Town Receiver of Taxes 300 Pantigo Place East Hampton, NY 11937 (631) 324-2770 Smithtown Town Receiver of Taxes 99 West Main Street Smithtown, NY 11787 (631) 360-7610 Huntington Town Receiver of Taxes 100 Main Street Huntington, NY 11743 (631) 351-3217 Southampton Town Receiver of Taxes 116 Hampton Road Southampton, NY 11968 (631) 283-6514 Islip Town Receiver of Taxes 40 Nassau Avenue Islip, NY 11751 (631) 224-5580 Southold Town Receiver of Taxes 53095 Main Road Southold, NY 11971 (631) 765-1803 Sincerely, Edward P. Ramaine Suffolk County Clerk GRANT OF DRAINAGE EASEMENT THIS indenture made thi,~,) day of August, 2009, by and between Trust U/A Paul L. Mitchell, dated 10/12/94, c/o 1630 Town Harbor Lane, Southold, Suffolk County, New York (the "Grantor" ) and the Town of Southold, a municipal corporation of the State of New York, having its office at 53095 Main Road, Town of Southold, Suffolk County, New York (the "Grantee"). WHEREAS, the Grantor is the owner of a certain parcel of land containing 0.375 acres, more or less, of land identified by Suffolk County Tax Map number 1000-65-1-2;. located on the southwestern side of Town Harbor Lane in the Hamlet of Southold, Town of Southold, Suffolk County, New York; WHEREAS, the Grantee, for drainage purposes proposes to construct, install, maintain, and repair culvert pipes and leaching pools to provide drainage for road runoff from Town Harbor Lane; WHEREAS, the Grantor has agreed to grant to the Grantee an easement over a portion of Grantor's land as described in Schedule A attached hereto on the condition that the Grantee re-grade the rear of the property and raise the grade to minimize flooding on the property to the greatest extent practicable; NOW THEREFORE, IN CONSIDERATION OF Ten Dollars ($10.00) and other good and valuable consideration paid by the Grantee to the Grantor, the receipt of which is hereby acknowledged, this agreement witnesseth that: -1- 1. The Grantor does hereby donate, grant, transfer and convey to the Town of Southold, a drainage easement in gross, of the nature, character and to the extent hereinafter set forth, over and upon the premises described in Schedule A. follows: The nature, character and extent of the easement hereby granted are as (a) (b) The right of the Grantee to enter upon the premises at all reasonable times: (i) To install, create and maintain culverts, pipes, leaching pools on the premises and to repair, replace or remove same as needed for the effective drainage of road runoff from Town Harbor Lane as illustrated on Schedule B attached hereto. The easement area for the subsurface culverts and/or pipes is limited to an area that is five feet in width as indicated on Schedule B. The parties acknowledge that a portion of the existing subsurface pipe/culvert may be outside of the easement area set forth above. However, should the Grantee replace said pipe/culvert, the Grantee shall relocate the pipe/culvert within the easement area illustrated on Schedule B or outside the boundaries of Grantor's premises. (ii) To perform such grading, excavation and the installation of such facilities as shall be required for the construction, operation, repair, replacement and maintenance of said culverts, pipes, and leaching pools for the collection of highway drainage waters. The right of Grantee to enter upon the premises at all reasonable times to access the underground drainage features installed and constructed under the terms of this easement. Said easement for access is limited to the 15 foot area set forth in Schedule C attached hereto. -2- 3. The Grantor reserves the right to the use and enjoyment of the Grantor's premises to the fullest extent possible without unreasonable interference by the Grantee in the exercise of the Grantee's rights granted herein. Grantees acts shall not inhibit any access other than on a temporary basis to replace existing culverts or pipes. 4. The Grantee further agrees to pay all reasonable damages to the premises of the Grantor sustained as a result of the construction, maintenance and/or operation of the drainage easement thereon by the Grantee and shall be obligated to restore the affected area in a timely fashion to the condition prior to the damage. Restoration may include, but is not limited to repairing damage caused by the Grantee to the asphalt driveway and curbing. 5. The Grantee further agrees to obtain all necessary permits from all governmental agencies necessary to carry out the operations contemplated by this agreement. Grantee agrees to construct no fences, walls or other obstructions as part of this project. 6. This easement shall be deemed a "minor utility easement" and the Grantor agrees to that the easement area shall be included in the in the lot area (buildable area) and that the setbacks for the principal structure shall be measured from the property line and not the easement area. This is a material element of this agreement. 7. This agreement and the easements and rights granted herein shall run with the land and be binding upon the parties hereto and their respective successors and assigns. 8. Grantee shall indemnify and hold harmless Grantor against all liability associated with its own acts or omissions in connection with the use of the premises. 9. The terms of this easement may not be changed orally, and this writing constitutes the entire agreement of the parties. Each party represents to the other that -3- no representations have been made or relied upon by or to either party except those set forth herein. 10. If any term of this easement shall be determined by a court of competent jurisdiction to be unlawful, null or void, all other terms shall remain in full force and effect. 11. Grantor represents to Grantee that the execution of this Easement does not violate any covenant, regulatory restriction, court order or agreement to which its lot may be subject, and that the undersigned is the sole owner of the lot and possessed of full authority to execute same. 12. This easement shall be perpetual unless, by judicial decree or determination or by written agreement of all parties, the beneficial use of the easement or either of them shall cease by operation of law or otherwise. IN WITNESS WHEREOF, the parties hereto have executed this agreement the day and year first above written. Paul L. Mitchell By:~~7 Scott A. Russell, Supervisor STATE OF NEW YORK) ) SS.: COUNTY OF SUFFOLK) On this~5~'day of August, in the year 2009, before me personally appeared Paul L. Mitchell, 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 he executed the same in his capacity and that by his signature on the instrument, the individual, or the person upon behalf of which the i~ual acted, executed the instrument. Notary Public STATE OF NEW YORK) ) SS.: COUNTY OF SUFFOLK) PATRICIA C. MOORE Notary Public, State of New York Suffolk Count,/- No. 4861668 Commission Expires June 16, ~ On this _~ day of August, in the year 2009, before me personally appeared Scott A. Russell, 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 he executed the same in his capacity and that by his signature on the instrument, the individual, or the person upon~vidual acted, executed the instrument. Notary Pu il~' "' I~OI~/'IIE J. DOROSKI I'/otary Public, State Of New Yo~ No. 01D06095328 Surf0 k C0,an~ Term Exp res July 7, 20__.~ -5- Schedule "A" Drainage Easement For the Mitchell Property SCTM #: 1000-65-01-02 All that certain plot, piece or parcel of land, lying on the property of Paul L. Mitchell and shown on the filed map of Property of Jonathan T. Overton, file No. 1055, filed January 4, 1931 and being situate in the Town of Southold, County of Suffolk and State of New York, being bounded and described as follows; BEGINNING at a point on the South Westerly side of Town Harbor Lane distant North 31 degrees 31 minutes 10 seconds West, 140.33 feet from a concrete monument at the intersection of the North Westerly side of Terry Lane; RUNNING THENCE from said point of beginning; South 58 degrees 28 minutes 50 seconds West, 193.07 feet; THENCE THENCE THENCE THENCE THENCE THENCE North 87 degrees 15 minutes 00 seconds West, 36.69 feet; North 27 degrees 26 minutes 20 seconds West, 29.42 feet; North 58 degrees 28 minutes 50 seconds East, 61.30 feet; South 31 degrees 31 minutes 10 seconds East, 45.00 feet; North 58 degrees 28 minutes 50 seconds East, 160.00 feet; South 31 degrees 31 minutes 10 seconds East, 5.00 feet; To the point or place of BEGINNING. Schedule EASEMENT POINT OF BEGINNING SCHEDULE C PO{NT OF BEGINNING TP-584 (3/07) Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax Recording office time stamp See Form TP-584-1, Instructions for Form TP~584, before completing this form. Please print or t~'pe. Schedule A -- Information relating to conveyance Grantor/Transferor [] Individual I-~ Corporation [--] Partnership [] Estate/Trust [] Other Name (if individdal; last, first, middle initial) TRUST U/A PAUL L MITCHELL Mailing address C/O MITCHELLL; 1630 TOWN HARBOR LANE Social security number Social security number City State ZIP code Federal employer ident, number SOUTHOLD NY 11971 Grantee/Transferee Name (if individuafi last, first, middle initial) Social security number [] Individual TOWN OF SOUTHOLD [] Corporation Mailing address Social security number [] Partnership PO BOX 1179 [] Estate/Trust City State ZIP code Federal employer ident, number []Other SOUTHOLD NY 11971 [J.-- ~ 0~[c~_..~7 Location and description of property conveyed Tax map designation Address City/village Town County Section Block Lot 1630 TOWN HARBOR LANE SOUTHOLD SOUTHOLD SUFFOLK 65 1 2 Type of property conveyed (check applicable box) I [] One- to three-family house 5 [] Commercial/Industrial 2 [] Residential cooperative 6 [] Apartment building 3 [] Residential condominium 7 [] Office building 4 [] Vacant land 8 [] Other EASEMENT Date of conveyance Percentage of real proper~y I I conveyed which is residential real property .% month day year (see instructions) Condition of conveyance (check all that apply) a. [] Conveyance of fee interest b. [] Acquisition of a controlling imerest (state percentage acquired %) c. [] Transfer of a controlling interest (state percentage transferred %) d, [] Conveyance to cooperative housing corporation e. [] Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest (attach Form TP-584. I, Schedule E) For recording officer's use f, [] Conveyance which consists of a mere change of identify or form of ownership or organization (attach Form TP-584. I~ Schedule F) g. [] Conveyance for which credit for tax previously paid wifl be claimed (attach Form TP-584, I, Schedule G) h. [] Conveyance of cooperative ap~rtrnent(s) i. [] Syndication · [] Conveyance of air rights or development rights k. [] Contract assignment Amount received Date received Schedule B., Part [ $ Schedule B., Part I[ $ I. [] Option assignment or surrender m. [] Leasehold assignment or surrender n. [] Leasehold grant o. r-~ conveyance of an easement p. [] conveyance for which exemption from transfer tax claimed (complete Schedule B, Part lll) q, [] Conveyance of property partly within and partly outside the state r. [] Other (describe) · Page 2 of 4 TP-584 (3/07) Schedule B -- Real estate transfer tax return (Tax Law, Article 31) Part ][ - Computation of tax due I Enter amount of consideration for the conveyance (if you are claiming a total exemption from tax, check the exemption claimed box, enter consideration and proceed to Part/ii) .............................. [] Exemption claimed 2 Continuing lien deduction (see instructions if property is taken subject to mortgage or lien) ......................................... 3 Taxable consideration (subtract line 2 from line 1) ................................................................................................... 4 Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ......................................................... 5 Amount of credit claimed (see instructions and attach Form TP-584.1, Schedule G) ................................................... 6 Tota tax due* (subtract line 5 from line 4) ................................................................................................................ 0.00 0.00 0.00 0.00 0.00 0.00 0 0 0 Part [! - Computation of additional tax due on the conveyance of residential mar property for $1 million or more I Enter amount of consideration for conveyance (from Part [, line 1) ........................................................................ 1. 2 Taxab~ec~n~iderati~n(mu~tip~y~ine~bythepercentage~fthepremi$eswhichisre$identia~rea~pr~perty~assh~wninSchedu~eA)~~~ :: 3 Totaladditionaltransfertaxdue*(mutiplyine2by1%(.Ol)) ........................................................................... Part [I[ - Explanation of exemption claimed on Part I, line 1 (check any boxes that apply) The conveyance of real property is exempt from the mai estate transfer tax for the following mason: a. Conveyance is to the United Nations, the United States of America, the state of New York, or any of their instrumentalities, agencies, or political subdivisions (or any public corporation, including a public corporation created pumuant to agreement or compact with another state or Canada) .............................................................................................................................................. a b. Conveyance is to secure a debt or other obligation ............................................................................................................................ b [] c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................... c [] d. Conveyance of mai property is without consideration and not in connection with a sale, including conveyances conveying malty as bona fide gifts ....................................................................................................................................................................... d [] Conveyance is given in connection with a tax sale ............................................................................................................................. e [] f. Conveyance is a mere change of identity or form of ownership or organization where there is no change in beneficial ownership. (This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) Attach Form TP-584.1, Schedule F .................................................................... f g. Conveyance consists of deed of partition ........................................................................................................................................... g h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................. h L Conveyance consists of the execution of a contract to sell mai property, without the use or occupancy of such property, or the granting of an option to pumhase real property, without the use or occupancy of such property ................................................. j. Conveyance of an option or contract to purchase real properly with the use or occupancy of such property where the consideration is less than $200,000 and such property was used solely by the grantor as the grantor's personal residence and consists of a one-, two-, or three-family house, an individual residential condominium unit, or the sale of stock in a cooperative housing corporation in connection with the grant or transfer of a proprietary leasehold covering an individual residential cooperative apartment ....................................................................................................................................... k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401 (e) (attach documents supporting such claim) ........................................................................................................................................................................... k L Other (attach explanation) ..................................................................................................................................................................... I *Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in New York City. make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. Page 3 of 4 TP-584 (3/07) Schedule C w Credit Line Mortgage Certificate (Tax Law, Article 11 ) Complete the following only if the Interest being transferred is a fee simple interest. I (we) certify that: (check the appropriate box) 1. [] The real property being sold or transferred is not subject to an outstanding credit line mortgage. 2. [] The real property being so~d or transferred is subject to an outstanding credit line mortgage. However, an exemption from the tax is claimed for the following reason: [] The transfer of real property is a transfer of a fee simple interest to a person or persons who held a fee simple interest in the real property (whether as a joint tenant, a tenant in common or otherwise) immediately before the transfer. [] The transfer of real property is (A) to a person or persons related by blood, marriage or adoption to the original obligor or to one or more of the original obligors or (B) to a person or entity where 50% or more of the beneficial interest in such real property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for the benefit of a minor or the transfer to a trust for the benefit of the transferor). [] The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court. [] The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and the real property being sold or transferred is not principally improved nor will it be improved by a one- to six-family owner-occupied residence or dwelling. Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circumstances. See TSB-M-96(6)-R for more information regarding these aggregation requirements. [] Other (attach detailed explanation). 3. [] The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the following reason: [] A certificate of discharge of the credit line mortgage is being offered at the time of recording the deed. [] A check has been drawn payable for transmission to the credit line mortgagee or his agent for the balance due, and a satisfaction of such mortgage will be recorded as soon as it is available. 4. [] The real property being transferred is subject to an outstanding credit line mortgage recorded in (insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured by the mortgage is No exemption from tax is claimed and the tax of is being paid herewith. (Make check payable to county clerk where deed will be recorded or, if the recording is to take place in New York City, make check payable to the NYC Department of Finance.) Signature (both the grantor(s) and grantee(s) must sign) The undersigned certify that the above information contained in schedules A, B, and C, including any return, certification, schedule, or attachment, is to the best of his/her knowledge, true and complete, and authorize the person(s) submitting such form on their behalf to receive a copy for purposes of recording the deed or other instrument affecting the conveyance. ~,~.~;~ signature~ .~&l~_..)~.~. TitJe J'.~ ~ sign~,~ /~ ~.~.~ Lf(, T~ Grantor signature Title Grantee signature Title Reminder: Did you complete all of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you checked e, f, or g in Schedule A, did you complete Form TP-584,17 Have you attached your check(s) made payable to the county clerk where recording will take place or, if the recording is in New York City, to the NYC Department of Finance? If no recording is required, send your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045, Albany NY 12205-5045. · Page 4 of 4 TP-584 (3/07) Schedule D - Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit Is being transferred by an individual or estate or trust. Part ! - New York State residents If you am a New York State resident transferor(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must sign the certification below. If one or more transferors/sellers of the real property or cooperative unit is a resident of New York State, each resident transferor/seller must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to accommodate all resident transferers/sellers. Certification of resident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) as signed below was a resident of New York State, and therefore is not required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of this real property or cooperative unit, Date Signature Print full name Date Signature Print full name Date Signature Print lull name Date Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording a deed. Part I! - Nonresidents of New York State If you are a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but are not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the appropriate exemption below· If any one of the exemptions below applies to the transfemr(s)/seller(s), that transferor(s)/seller(s) is not required to pay estimated personal income tax to New York State under Tax Law, section 663. Each nonresident transferor/seller who · qualifies under one of the exemptions below must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit es many schedules as necessary to accommodate all nonresident transferals/sellers. if none of these exemption statements apply, you must complete Form IT-2663, Nonresident Rea/Property Estimated Income Tax Payment Form, or Form IT-2664, Nonresident Cooperative Unit Estimated/ncome Tax Payment Form. For more information, see Payment of estimated persona/income tax, on page 1 of Form TP-584-l. Exemption for nonresident transferor(s)/seller(s) This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the transferor(s)/seller(s) (grantor) of this real property or cooperative unit was a nonresident of New York State, but is not required to pay estimated personal income tax under Tax Law, section 663 due to one of the following exemptions: [] The real property or cooperative unit being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of Internal Revenue Code, section 121) from to (see instructions). Date Date [-'-] '~he transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with no additional consideration, [] The transferor or transferee is an agency or authority of the United States of America, an agency or authority of the state of New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National Mortgage Association, or a private mortgage insurance company. Signature Print full name Date Signature Print tull name Date Signature Print 1Mil name Date Signature Print full name Date Peconic Bay Region Community Preservation Fund Proceeds of this transfer tax are disbursed to the Townships in which the transaction takes place for its acquisition of land, development rights, and other interests in property for conservation purposes. Townships: East Hampton 03 Riverhead 06 Shelter Island 07 Southampton 09 Southoid 10 Please print or type. Schedule A Information Relating to Conveyance Grantor Name (individual; last, first, middle Initial) [] Individual [] Corporation [] Partnership [] Other brantee [] Individual [] Corporation [] Partnership [] Other TRUST U/A PAUL L. MITCHELL Mailing address C/OMITCHELL 1630 TOWN HARBOR LANE C~YOUTHOLD StatN~ ZIP code 1197! Name (individual; last, first, middle initial) TOWN OF $OUTHOLD Mailinq address PO B-OX 1179 C~t~ UTHOLD State zip code NY 11971 Social Security Number Socia Security Number I I Federal employer idenl, number Social Security Number Social Security Number I Pedera emp oyer idenl, number Location and description of property conveyed t Tax map designation Address Village Town Dist Section Block Lot 1000 65 i 2 1630 TOWN HARBOR LANE SOUTHOLD SOUTHOLD Type of property conveyed (check applicable box) Date of conveyance [] Improved []Vacant,and [ I I month day year Dual Towns: Condition of conveyance (check all thai apply) a. - Conveyance of fee interest b. - Acquisition of a controlling interest (state percentage acquired c. - Transfer of a controlling Interest (state percentage transferred %) d. - Conveyance to cooperative housing , corporation e. - Conveyance pursuant to or in lieu of foreclosure or enforcement of security interest L - Conveyance which consists of a mere change of identity or form of ownership or organization g. - Conveyance for which credit (or tax previously paid will be claimed h. - Conveyance of cooperative apartment(s) L - ~ynalcatlon J. - Conveyance of air rights or development rights k. - Contract assignment J. - Option assignment or surrender m. - Leasehold assignment or surrender n. - Leasehold grant o. - Conveyance of an easement p. - Conveyance for which exemption is claimed (complete Schedule B. Part II) q. - Conveyance of property partly within and partly without the state r. - Other (describe) Sch'edule B - Community Preservation Fund Part I - Computation of Tax Due 1. Enter amount of consideration for thc conveyance (from line I TP584 Schedule B) 2. Allowance (see below) 3. Taxable consideration (subtract line 2 from line 1) 4, 2% Community Preservation Fund (of line 3) make certified cheek payable to SUFFOLK COUNTY CLERK 5, Property not subject to CPF Tax (See Schedule C) 1 0.00 2 0.00 3 0.00 4 0.00 For recording officer's use Datereceived Allowance: East Hampton Shelter Island Southampton $250,000.00 Improved $250,000.00 Improved $250,000.00 Improved $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) $100,000.00 Vacant Land (Unimproved) Rlverhead $150,000.00 improved $ 75,000.00 Vacant Land (Unimproved) Southold $150,000.00 Improved $ 75,000.00 Vacant Land (Unimproved) 12*0213.09/01 cg Schedule C (continued) Part 11 - Explanation of Exemption Claimed in Part I, line 1 (check any boxes that apply) The conveyance of real properb/is exempt from the real estate transfer tax for the following reason: a. Conveyance is to the United Nations, the United States of America, the state of New York or any of their Instrumentalities, agencies or political subdivisions (or any public corporation, Including a public corporation created pursuant to agreement or compact with another state or Canada) b. Conveyance is to secure a debt or other obligation c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying realty as bona fide gifts e. Conveyance is given in connection with a tax sale f. Conveyance is mere change of identity or form of ownership or organization where there is no change in beneficial ownership. (This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the cooperative dwelling or dwellings.) g. Conveyance consists of deed of partition h. Conveyance is given pursuant to the federal bankruptcy act Conveyance consists of the execution of a contract to sell real property without the use or occupancy of such property or the granting of an option to purchase real property without the use or occupancy of such property j. Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) (j) or (k) of Article 31-D of the Tax Law. (See required Town approval, below) k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt corporation operated for conservation, environmental, or historic preservation purposes. I. Other list explanations in space below (Grandfather/Contract) m. Conveyance of real property as a primary residence where the grantee is a first-time homebuyer (attached approved application) n. Conveyance of real property to a tax exempt, not-for-profit corporation for the purpose of providing affordable housing. o. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of Article 31-D of the Tax law. (Seej in Schedule C) Town Ar[orney or other designated official Penalties and Interest Penalties Interest Any grantor or grantee failing to file a return or to pay any tax within Daily compounded interest will be charged on the amount of the the time required shall be subject to a penalty of 10% of the amount tax due not paid within the time required. of tax due plus an interest penalty of 2% of such amount of each month of delay or fraction thereof after the expiration of the first month after such return was required to be filed or the tax became due. However, the interest penalty shall not exceed 25% in the aggregate. Signature (both the grantor(s) and grantee(s) must sign). The undersigned certif~ that the above return, including any certification, schedule or al/~chment, is to the Best ~f~s/her Grantee Fr Number of pages TORRENS Serial # Certificate # Prior Cfi. # Deed. Mortgage Instrument Page / Filing Fee Handling TP-584 Notation EA-5217 (County) EA-5217 (State) R.P.T.S.A. Comm. of Ed. Affidavit Certified Copy Reg. Copy Other [1000 1 065.o0 4 [District [ ~ectton Real Property Tax Service Agency Verification s. 00 5. O0 Deed / Mortgage Tax Stamp FEES Sub Total Sub Total Grand Total I t)o OO IfiF.ooo Safisfacfion/Dis~ges/Release ~st~opertyOwn~s M~lingAd~s RECORD&RETURNTO: Martin D. Finnegant Town Attorney TOWN OF SOUTHOLD P.O. Box 1179 Southold, NY 11971-0959 Recording / Filing Stmnps Mortgage AJnt. 1. Basic Tax 2. Additional Tax Sub Total Spec. / Assit. or Spec. / Add. TOT. lvlTG TAX Dual Town Dual County Held for Appointment Transfer Tax Mansion Tax ' The property covered by this motgage is or will be improved by a one or two family dwelling only. YES or NO If NO, see appropriate tax clause on ,age ~ of this instrument 5 Commtmit~ Preservation Fund Consideration Amount $ O CPF Tax Due $ 0 Improved Vacant Land Title Company Int'omafion Co. Name Title # s Suffolk County Recording & Endorsement Page This page fomas part of the atteched Grant of Draina~ ~qt~man.t madeby: (SPEcm~r TYPE OF INSTRUMF_2qT) Trust U/A Paul L. Mitchell TO The premisis herein is situated in SUffOLK COUNTY, NEW YORK. h ~eTowns~pof Southold In ~e %r~ j Town of Southold or HAi~iLETof Southold BOXES 6 THROUGH 8 MIJST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR (nvar~