HomeMy WebLinkAboutSCWA- Laurel Lake Preserve - PRELIMINARYBoard Meeting of October 20, 2009
Southold Town Board - Letter
RESOLUTION 2009-862
ADOPTED
Item # 5.33
DOC ID: 5388
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2009-862 WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
OCTOBER 20, 2009:
RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs
Supervisor Scott A. Russell to execute License Agreements between the Town of Southold
and the Suffolk County Water Authority in connection with the relocation of the proposed
subsurface pipelines within the Laurel Lake Preserve and access across the Suffolk County
Water Authority property adjacent to the Laurel Lake Preserve for use within the Town's trail
system, subject to the approval of the Town Attorney.
Elizabeth A. Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: Louisa P. Evans, Justice
SECONDER: Vincent Orlando, Councilman
AYES: Ruland, Orlando, Krupski Jr., Wickham, Evans, Russell
Generated October 26, 2009 Page 35
ABANDONMENT AND EXTINGUISHMENT
OF EASEMENT AND RELEASE
AGREEMENT made this !{_~ctt~ day of~lLLe~c:~d~_, 2009, by and between
the Town of Southold, a municipal corporation, with its principal place of business at P.O.
Box 1179, 53095 Main Road, Southold, New York 11971 (hereinafter the "Town") and the
Suffolk County Water Authority, with offices at P.O. Box 38, 4060 Sunrise Highway,
Oakdale, New York 11769 (hereinafter "SCWA').
WHEREAS, the Town granted the SCWA an easement dated September 22, 2006
which was recorded at Liber 12471 Page 45 in the Offices of the Suffolk County Clerk (the
"Easement") which affects certain property owned by the Town as more particularly
described in Schedule A attached hereto and made a part hereof, and
WHEREAS, the SCWA and the Town wish to abandon and extinguish the Easement,
NOW, THEREFORE, the parties hereto, intending to be legally bound do hereby
agree as follows:
1. SCWA hereby grants and conveys to the Town, its successors and assigns all of its
right, title and interest in and to the Easement without covenant, representation or
warranty of any kind.
2. SCWA hereby abandons and extinguishes the Easement and the Easement is of no
further force or effect.
3. The Town releases SCWA, its officers, employees, agents or assigns from any claims,
actions, damages, trespasses, judgments, and liens of any kind which the Town, its
successors and assigns may have by reason of the Easement.
IN WITNESS WHEREOF, the parties have executed this Release of Easement as of the day
and year first written above.
Town of Southold
By:~~
Scott A. Russell, Town Supervtsor
STATE OF NEW YORK )
COUNTY OF SUFFOLK ) ss.:
On the/~O day of ~4./~Y'~ in the year 2009
before me, the undersigned, personally appeared
Scott A. Russell, personally known to me or
proved to me on the basis of satisfacto~7
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 individual acted, executed
the instrument.
Notary ~ublic ! t
LINDA J coOPER
NOTARY PUBLIC, State of New York
NO. 01 CO4822563, S uffotk Cou.~.t~.
Term Expires December 31,
STATE OF NEW YORK )
COUNTY OF SUFFOLK ) ss.:
On the ~tay of ~'l~c~jin the year 2009
before me, the undersigned, personally
appeared Steohen M. Jones, 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 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
individual acted, executed the instrument.
\ J
KIMBERLY A. KENNEDY
Notary Public, State of New York
Qualified in Sufloik County
#01KE603100t
Commission Expires September 20,
2
Schedule A
All that certain piece or parcel of land lying and being in Laurel, Town of Southold, County
of Suffolk and State of New York, more particularly bounded and described as follows:
BEGINNING at a point on the northerly side of Main Road, New York State Route 25, being
the centerline of a twenty foot (20) wide easement herein described, said BEGINNING point
being the following four courses and distances from the interseetlon of the easterly property
line of lands of the Town of Southold where it intersects with the northerly line of the Long
Island Railroad.
2.
3.
4.
South 46 degrees 53 minutes 39 seconds West a distance of 196.04 feet,
South 78 degrees 03 minutes 40 seconds West a distance of 139.84 feet,
South 72 degrees 51 minutes 10 seconds West a distance of 215.63 feet,
South 85 degrees 44 minutes 00 seconds West a distance of 233.66 feet, to the true
place or point of BEGINNING.
Running the following twenty-five (25) courses and distances:
2.
3.
4.
5.
6.
7.
8.
9.
10.
ll.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
Thence, North 00 degrees 27 minutes 32 seconds East, 39.18 feet,
Thence North 09 degrees 06 minutes 58 seconds East, 39.57 feet,
Thence North 38 degrees 57 minutes 21 seconds East, 34.26 feet,
Thence North 47 degrees 17 minutes 44 seconds East, I I 1.96 feet,
Thence North 39 degrees 07 minutes 14 seconds East, 26.18 feet,
Thence North 14 degrees 39 minutes 51 seconds East, 33.60 feet,
Thence North 07 degrees 52 minutes. 16 seconds West, 171.74 feet,
Thence North 13 degrees 48 minutes 31
Thence North 23 degrees 34 minutes 01
Thence North 31 degrees 04 minutes 46
Thence North 22 degrees 01 minutes 55
Thence North 09 degrees 43 minutes 16
Thence North 18 degrees 08 minutes 30
Thence North 45 degrees 03 minutes 44
Thence North 67 degrees 29 minutes 29
Thence North 56 degrees 57 minutes 17
Thence North
Thence South
Thence South
Thence South
Thence South
Thence South
Thence South
Thence North
72 degrees 55 minutes 16
89 degrees 33 minutes 58
70 degrees 29 minutes 59
58 degrees 52 minutes 00
62 degrees 36 minutes 46
71 degrees 19 minutes 44
82 degrees 03 minutes 31
86 degrees 29 minutes 27
3
seconds West, 31.24 feet,
seconds West, 46.50 feet,
seconds West, 106.43 feet,
seconds West, 129.45 feet,
seconds West, 34.60 feet.
seconds East, 26.53 feet,
seconds East, 24.46 feet,
seconds East, 47.47 feet,
seconds East, 95.29 feet,
seconds East, 30.51 feet,
seconds East, 36.17 feet,
seconds East, 43.63 feet,
seconds East, 95.63 feet,
seconds East, 46.96 feet,
seconds East, 121.43 feet,
seconds East, 28.68 feet,
seconds East, 27.37 feet,
25. Thence North 73 degrees 06 minutes 15 seconds East, 33.50 feet,
to a point on the westerly property line of the Suffolk County Water Authority said point also
being North 35 degrees 01 minutes 10 seconds West 302.74 feet from a monument set on the
northeast corner of property of the Town of Southold.
SCTM # 1000-125 - 1 - 14 (p/o).
4
LICENSE
This Agreement made this l/.~.day of ~0LI[~,~,e_r 2009 between the Town of
Southold, a municipal corporation, with its principal place of business at 53095 Main Road,
Southold, New York, I 197 I, (hereinat~er "Southold" or "Town") and the Suffolk County Water
Authority, a public benefit corporation, with its principal place of business at P.O. Box 311, 4060
Sunrise Highway, Oakdale, New York, 11769, (hereinat~er "SCWA').
Whereas, the Town owns lands in the vicinity of Laurel Lake in the Town of Southold,
and
Whereas, the SCWA owns property adjoining the Town Property which is used by the
SCWA for public water supply purposes, (the "SCWA Property"), and
Whereas, the SCWA seeks to install water mains and appurtenances in the portion of the
Town Property set forth in Schedule A, attached hereto and made a part hereof(the "Schedule A
Property"), and
Whereas, the SCWA seeks permission to cross the portion of the Town Property set forth
in Schedule B, attached hereto and made a part hereof(the "Schedule B Property"), and
Whereas, the Town wishes to grant a license to the SCWA to permit the SCWA to install
water main and appurtenances and cross the Town Property as set forth below,
Now therefore, in consideration of the premises and the mutual covenants and conditions
herein contained, it is agreed by the parties hereto, as follows:
1. The above recitals are incorporated herein and made a part hereof.
2. Interest Conveyed:
This instrument shall be deemed to be a revocable license from the Town to the SCWA
for the purposes set forth herein. The license shall not be construed to convey any
interest in real property and it shall not be deemed to be a license coupled with an
interest.
3. Term:
The Term of this License shall be for thirty (30) years from the date first written above.
The License may be renewed for additional thirty (30) year terms upon the written
request of the SCWA. Such notice shall be provided to the Town prior to the expiration
of the then current term.
4. Insurance:
Southold to SCWA License 1
Prior to undertaking any activities contemplated by this Agreement, the SCWA shall, at
its own cost and expense, provide and keep in full force and effect following insurance
coverages. Insurance coverage shall be provided by an insurance company licensed as an
"admitted carrier" by the New York State Insurance Department and rated by "Bests" at
"A-" or better, or as otherwise deemed acceptable by the Town.
Insurance coverage shall be evidenced by a Certificate of Insurance submitted in a form
acceptable to the Town. "Acord" or other blank certificates may not be acceptable. The
Town may request a letter of transmittal from the insurance company providing coverage
indicating that the certificate is issued correctly and pursuant to their authorization.
Thirty (30) days notice of cancellation, non-renewal or reduction of coverage is required.
The insuring company shall not be released from liability or obligation for its failure to
notify the Town.
Contractual Liability Insurance as specified in paragraph B to follow, shall be provided to
insure this agreement.
The interest of the Town, as additional insured and as primary insurance with no
responsibility for payment of premium shall be added to all policies other than Workers'
Compensation.
Coverage shall be obtained, and maintained throughout the life of the Contract as
follows:
~ (if any vehicles are used by the Licensee in performance of
this AgreemenO
$1,000,000 Combined Single Limit for Bodily Injury and Property Damage
Liability, New York State Personal Injury Protection.
B. General Liability:
Form:
Limit;
Comprehensive General Liability
$1,000,000 per occurrence/S2,000,000 general aggregate.
$1,000,000 for Products/Completed Operations
$ 1,000,000 for Personal Injury
C. Workers' Comoensation:
As required by the Workers' Compensation Law of the State of New York
Southold to SCWA License 2
D. Excess Liability:
Excess Liability Limits of $5,000,000 on a form, which follows the underlying
coverage.
The Town must be notified of any impairment of any of the above limits at the inception
of or during the contract.
Subcontractors shall adhere to the above.
All ertlficates of insurance shall contain the following provisions:
(I) Nature of work described on certificate (in case of liability or compensation
certificates) shall be inclusive of work provided for under this project.
(2) Location of work described shall be inclusive of the location of the work provided
under this project.
(3) The period of certificates shall cover the period of the work or a new certificate
shall be furnished before the current certificate expires.
If the SCWA has a self-insurance program under which it acts as a self-insurer for any of
such required coverage, it may provide self-funded coverage and certificates or other
evidence of such self-insurance in lieu of insurance issued by insurance companies,
subject to approval of the Town, which approval shall not be unreasonably withheld or
conditioned.
The Town shall be the sole judge in determining the acceptability of insurance
requirements. The Town retains the right to reasonably adjust the coverages required
herein from time to time.
5. Indemnification:
The SCWA shall defend, indemnify, and save harmless, to the extent permitted by law,
the Town its officers, agents, servants, and employees against and fi.om all suits, losses,
demands, actions, recoveries, judgments, and costs of every kind and description and
from all damages to which the Town, or any of its officers, agents, servants, employees
may be subjected by reason of injury to person or property of others resulting from the
SCWA's use of this License, or through any act or omission on the part of the SCWA, of
its agents, employees, or servants.
6. Permitted SCWA Activities:
A. Pursuant to this Agreement, the SCWA may install, operate, maintain, repair and
Southold to SCWA License 3
replace water mains and/or appurtenances and ancillary facilities, without
limitation for the purposes of supplying, delivering, and transmitting water for
public water supply purposes from, through, or within the Schedule A Property,
including the right to operate machinery, without limitation, to effect the same.
The right of vehicular, equipment, machinery and pedestrian ingress and egress
over the Schedule B Property, attached hereto and made a part hereofi Said right
shall be exercised by the SCWA upon the Town's approval which shall not be
unreasonably withheld or conditioned and only to the extent that the SCWA, in its
sole discretion, determines that the SCWA's ingress and egress through the Long
Island Rail Road trestle to the SCWA Property is impracticable. The SCWA shall
provide the Town reasonable advance notice of its intent to cross the Schedule B
Property for such access purposes. Notwithstanding the foregoing, in the event of
an emergency related to the SCWA's operations, the SCWA not need provide
pr!or notice to the Town of the SCWA's intent to cross the Schedule B Property
prior to crossing the Schedule B Property but shall to the extent practicable
provide notice after the emergency condition has ceased.
The right to clear and disturb, in any reasonable manner, form or way, without
limitation, the Schedule A Property and the Schedule B Property a width of
fifteen (I 5) feet to effect the terms of these Agreement.
7. SCWA espons~btht~es
Restoration: The SCWA agrees, to the extent possible, to restore any areas
disturbed by the SCWA to a condition similar to that which existed prior to the
disturbance.
Maintenance of the SCWA Facilities: The SCWA shall maintain, at its own cost
and expense, all of the facilities installed by the SCWA in the Town Property in a
clean and safe manner at all times.
Regulatory Compliance: The SCWA shall comply with all applicable Federal,
State and local laws, rules and regulations and shall indemnify the Town pursuant
to Section 5 for failure to do so.
8. Termination:
This Agreement may be terminated by either party upon sixty (60) days written notice. If
the Town terminates the Agreement, the Town shall pay to the SCWA, within thirty (30)
days of the termination date, the net book value of the SCWA water mains and
appurtenances installed within the Town Property. In determining the net book value of
the water mains and appurtenances the useful life of such facilities shall be deemed to be
one hundred (100) years. In addition, on the termination date, the Town shall pay
Southold to SCWA License 4
o
11.
12.
13.
14.
15.
I0.
$24,000.00 to the SCWA. The Termination date shall be defined to be the sixtieth (60's)
day after notice is given pursuant to this Section. Obligations under this Section shall
survive the termination of this Agreement.
Default:
Failure to perform any requirement under this Agreement shall constitute a default.
Contact Information
All notices under this agreement shall be directed by first class mail as follows:
If to the Town:
Town of Southold
Supervisor's Office
53095 Main Road
Southold, New York 11971
(631 ) 765 - 1800
If to SCWA:
Suffolk County Water Authority
Legal Department
4060 Sunrise Highway
Oakdale, NY 11769
(63 !) 589-5200
This Agreement shall be governed by the substantive and procedural laws of the State of
New York.
Both parties acknowledge that they have had the opportunity to have counsel of their
choosing review this Agreement. Regardless of any contrary rule of construction, no
provision or alleged ambiguity of this Agreement shall be construed in favor of one of the
parties because it was drained by the other party or their attorney.
This Agreement may only be changed in writing signed by both parties.
This Agreement is not assignable without written approval of the proposed assignment by
the non-assigning party.
This Agreement and the exhibits attached hereto contain the entire agreement of the
parties with respect to the subject matter of this Agreement, and supersede all prior
negotiations, agreements, and understandings with respect thereto including the parties'
September 22, 2006 Easement.
Southold to SCWA License 5
IN WITNESS WHEREOF, the parties have interchangeably set their seals (or caused
these presents to be signed by their proper corporate officers and caused their proper corporate
seals to be hereto affixed) on the day and year first written above.
WITNESS
Town of Southold
· Russell, Supervisor
State of New York )
County of Suf'folk ) ss.:
On the ~_ day of A/~'in the year 2009 before
me, the undersigned, a Notary Public personally
appeared Scott A. Russell. 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 he executed the same in
his capacity, and that by his signature on the
instrument, the individual, or the person upon
?ehalfofwhich the individual acted, executed the
mstrument.
LINDA J COOPER
NOTARY pUBLIC, State of New York
NO, 01 CO4822563, Suffolk Cou~tv
Term Expires December 31, 20
State of New York )
County of Suffolk ) ss.:
On the J~day of I",[. Ot~. in the year 2009 before
me, the undersigned, a Notary Public personally
appeared Stet)hen M. Jones, 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 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 individual acted,
executed the instrument.
KIMBERLY A. KENNEDY
Notary Public, Stata of New York
Qualified in Suffolk County
#01KE8031001
Commission Expires September 20, 20/
Southold to SCWA License 6
Laurel Lake Water Main Project
200 0 200 400 600 800 1000 Feet
P-584 (3/07)
New York Slale Department of Taxation and Finance
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 type.
Schedule A -- h~ui motion relating to conveyance
Grantor/Transferor Name (if individual; last. hYst, middle initial)
[] Individual Town of Southold
[] Corporation Mailing address
[] Partnership P.O. Box 1179, 53095 Main Road
[] Estate/Trust City State ZIP code
[] Other
Grantee/Transferee
[] Individual
~--~ Corporation
[] Partnership
[] Estate/Trust
[] Other
Southold NY
Name (~f tndividual: last, first, middle ~nitial)
11971
Social secudty number
Social security number
Suffolk County Water Authority
Mailing address Social security number
P.O. Box 37, 4060 Sunrise Highway
City State ZIP code Federal employer ident, number
Oakdale, NY 11769 11-6002552
Location and description of property conveyed
Federal employer ident, number ._~
I
Social security number
Tax map designation Address City/village Town County
Section Block Lot
Main Road, Laurel Southold Suffolk
125 1 14 (p/
o)
Type yed (check applicable box)
I [] One- to three-family house 5 [] Commemial/Industrial
2 [] Residenlial cooperative 6 [] Apartment building
3 [] Residential condominium 7 [] Office building
4 [] Vacant land 8 [] Other easement
Date of conveyance
2009I
Percentage of real property
conveyed which is residential
real property %
(see instructions)
Condition of conveyance (chec~ all that apply)
a. [] Conveyance of fee interest
b. [] Acguisition of a controlling interest (state
percentage acquired %)
c. [] Transfer of a controlling interest (state
percentage transferred %)
d. [] Conveyance to cooperative housing
corporation
f. [] Conveyance which consists of a
mere change of identify or form of
ownership or organization (attach
Form TP-584. I, Schedule F)
g. i"'l Conveyance for which credit for tax
previously paid will be claimed (a~ach
Form TP-584. t, Schedule G)
h. [] Conveyance of cooperative apartment(s)
i. [] Syndication
e. [] Conveyance pursuant to or in lieu of j. [] Conveyance of air rights or
foreclosure or enforcement of security development rights
interest (a~ach Form TP-584. I, Schedule E) k. [] Contract assignment
For recording officer's use ScheduleSCheduleAm°unt receivedB.,B., PartPart III $$Date received
L [] Option assignment or surrender
m. [] Leasehold assignment or surrender
n, [] Leasehold grant
o. [] Conveyance of an easement
p. [] Conveyance for which exemption
from transfer tax claimed (complete
Schedule B, Part///)
q, [] Conveyance of property partly within
and partly outside the state
r, [] Other (describe) Easement Abandon
Page 2 of 4 TP-584 (3/07)
Schedule B -- Real estate transfer tax return (Tax Law, Article 31)
Part 1 - Computation of tax due
I Enter amount of consideration for the conveyance (if you am claiming a total exemption from tax, check the
exemption claimed box, enter consideration and proceed m Partlll) .............................. [] Exemption claimed
2 Continuing lien deduction (see instructions if property is taken subject to mortgage or flen) ......................................... I 2. J
3 Taxable considemtioo (subtract line 2 from line 1) ...................................................................................................
4 Tax: $2 for each $500, or fractional part thereof, of consideration on line 3 ......................................................... 4.
5 Amount of credit claimed (see instructions and attach Form TP-584.1, Schedule G) ..............................................
6 Total tax due* (subtract line 5 from ina 4) ...............................................................
Part II - Computation of additional tax due on the conveyance of residential mai property for $1 million or mom
I Enter amount of consideration for conveyance (from Part f, line t) ........................................................................
2 Taxab~ec~nsiderat~n(rnu~tip~ytine1bythepercentage~fthepremiseswhichisresidentia~rea~pr~per~assh~wninschedueA)
3 Total additional transfer tax due* (multiply line 2 by 1% (01)) .....................................................
Part 111 - Explanation of exemption claimed on Part t, line 1 (check any boxes that apply)
The conveyance of mai property is exempt from the real estate transfer tax for the following mason:
a. Conveyance is to the United Nations, the United States of Amedca, the state of New York, or any of their instrumentalities,
agencies, or political subdivisions (or any public corporation, including a public corpemtion created pursuant 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 real property is without consideration and not in connection with a sale, including conveyances conveying
realty as bona fide gifts ....................................................................................................................................................................... d
f- Conveyance is a mere change of identity or farm ct ownership or organization where them is no change in beneficial
owne~hip. {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 Acl ............................................................................................................. h
L 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 of an option or contract to purchase real property with the use or occupancy of such property where the
consideration is ~ess than $200,000 and such properly was used solely by the grantor as the grantors 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 ct 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) (a~sch 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.
Schedule C -- Credit Line Mortgage Certificate (Tax Law, Article 11)
Page 3 of 4 TP-584 (3/07)
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 sold 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 cimumstances. 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 counO/ clerk where deed will be recorded or, if the recording is to take place in
New York Ci~ make chect~ 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 effecting the conveyance.
,/ ~'~. ~' ~Grantor~ignaturej~ -- i / ~ Title Granlee signalure Tit~e
Reminder: Did'you (:o'n~plett~ all of'Re 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 wilt 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 tee simple interest or a cooperative unit is being transferred by an individual or estate or trust.
Part I - New York State residents
If you are 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 transferors/sellem.
Certification of resident transferor(s)/eeller(s)
This is to certify that at the time of the sale or transfer of the real property or cooperative unit, the trensferer(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.
Signature Prinl tull name Date
Signature Print full name Date
Signalure Print full 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 t! - 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 transferer(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 as many schedules as necessary to accommodate all nonresident transferors/sellers.
If none of these exemption statements apply, you must complete Form IT-2663, Nonresident Real Property Estimated income Tax Payment
Form, or Form IT-2664, Nonresident Cooperative Unit Estimated income Tax Payment Form. For more information, see Payment of estimated
personalincome tax, on page I of Form TP-584-1.
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 transferer(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 transferer's/seller's principal residence
(within the meaning of Internal Revenue Code, section 121) from to (see instructions).
Date Date
[~The 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 Asseciation, the Federal Home Loan Mortgage Corporation, the Government National
Mortgage Association, or a private mortgage insurance company.
Signalum Print lull name Date
Signalure Print lull name Date
Signature Print full name Date
Signalure Print lull name Date
Peconic Bay Region
Community Preservation Fund
Proceeds of this transfer tax are dlsbur~ed to the
Townships in which the transaction takes place for
ils acquisition of land, development r~h1~, and
other inter~ta in property for conservation
Schedule A Information Relating to Conveyance
Townships:
East Ham pton 03
Riverhead 06
Shelter Island 07
Southampton 09
Southold 10
Dlndividual Town of Southold
~ean~h~, P.O. BOX 1179,s,at~53095 Main Road
~ (~her Southold. NY 1 I q71 -~qqq
~lndlvidual Suffolk County Wmt~r A~]~hmr~y
~PaRne,ship P.O. BOX 37. 4060 S~nr~ gwv
Oakdale, NY 11769
~, S~ur~
I 1 160fl2552
000 125 1 14 Main Road, Laurel Southol
p/o
[~ Vacant land I I I
Schedule B - Community Preservation Fund
Part I - Computation of Tax Due
1. Enter amount of consideration for the conveyance (imm llne I TP584 Schedule B) t
2. Allowance (see below)
3. Taxable consideration (subtract line 2 fi.om line D
4. 2% Communiiy Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK
5. Proper;y not subject to CPF Tax (See Schedule C)
Allowance:
East Hampton
Shelter island
Southampton
$2S0,000.00 Improved
S250,000.00 Improved
$250.000.00 Improved
$100J)O0.O0 Vacant Land (Unimproved)
$100,000.00 Vacant Land (Unimproved)
$100,000.00 Vacant Land (Unimproved)
Riverhead $1SO~O0.o0 Improved S 75,000.00 Vacant Land (Unimproved)
Southold $1SO,O00.O0 Improved $ 75,000.00 Vacant Land (Unimproved)
Schedule C (continued)
Part II - Explanation of Exemption Claimed in Par~ I, line 1 (check any boxes that apply)
The conveyance of real property is exempt from the real estate transfer tax for the fol~owin g 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, Induding 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
i. Conveyance con sists 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 purcha se real property with out the use or occupancy of such property
j. Conveyance or real property which Is subject to restriction s which prohibit th e use of the entire property for a ny 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 oben 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. The conveyance is approved for an exemption from the Community Preservation Transfer Ta~ under Section 144g~e of
Article 31-O of the Tax law. (See j in Schedule C)
Town Attorney 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 requirL~d~
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).
~11e undersigned certify that the above return, including any certification, schedule or attachment, Is to the best of his/her
Grantor Grantee