HomeMy WebLinkAboutL 12635 P 713SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED' LIf~
~m~er of Pages: 8
Receipt ~,mher : 10-0100885
TRANS~R TAX NUMBER: 10-02077
District:
1000
Deed Amount:
Recorded:
At:
LIBER:
PAGE:
Section: Block:
118.00 01.00
EXAMINED AND CHARGED AS FOLLOWS
$2,990,000.00
08/27/2010
09:33:51 AM
D00012635
713
Lot:
004.001
Received the Following Fees For Above Instrument
Exempt
Page/Filing $40.00 NO Handling
COE $5.00 NO NYS SRCHG
EA-CTY $5.00 NO EA-STATE
TP-584 $5.00 NO Notation
Cert. Copies $0.00 NO RPT
Transfer tax $11,960.00 NO Mansion Tax
Comm. Pres $56,800.00 NO
Fees Paid
TRANSFER TAX NUMBER: 10-02077
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
Exempt
$20.00 NO
$15.00 NO
$125.00 NO
$0.00 NO
$30.00 NO
$29,900.00 NO
$98,905.00
JUDITH A. PASCALE
County Clerk, Suffolk County
Number of pages
This document will be public
record. Please remove all
SociarSecurity Numbers
prior to recordino.
Deed / Mortgage Instrument
Deed / Mortgage Tax Stamp
FEES
RECORDED
2010 Au9 27 09:33:51
JUDITH ~. PASC~LE
CLERK OF
SUFFOLK COUHTY
L D00012635
P 713
DT# 10-02077
Recording / Filing Stamps
Page / Filing Fee
Handling ~.O 00
TP-584
Notation
EA-52 17 (County)
Sub Total
EA-5217 (State)
R.P. TS.A.
Comm. of Ed.
Affidavit
Certified Copy
5. O0
NYS Surcharge
Other
15. 00
Sub Total
Grand Total
Real Property
Tax Service
Agency
Verification
10018376 sooo sseoo o~oo oo4oos
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 Il: q~0. i~ /l~
Mansion Tax ~
The property covered by this mortgage is
or will be improved by a one or two
family dwelling only.
YES or NO
see appropriate tax clause on
of thi.~instrum~ent.
Z-/D-/z)
~r~rnunity Preservation Fund
Consideration Amount $ ~,.
CPF Tax Due $ ~
Improved
Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD & RETURN TO:
DEBORAH DOTY, .ESQ.
P. O. BOX 1181
CUTCHOGUE, NY 11935
Vacant Land
TD
TD
TD
310 Center Drive, Riverhead, NY 11901 me q:h±cago Title
www. suffoIkcou ntyny, gov/clerk 3810-00292
Suffolk County Recording & Endorsement Page
This page forms part of the attached DEED (SPECI-FY ~YPE OF INSTRUMENT) made by:
l/ALTER E. SILBERNAGEL, .MILDRED K. SILBERNAGEL
' The premises here n is situated in
~:r.l.EU WIqI?E AND ELISE NELSON SUFFOLK COUNTY, NEW YORK.
TO In the TO'P/N of SOUTHOLD
WILLIAM D. MURPHY AND KIMBERLY L. REECE
In the VILLAGE CUTCHOGUE
or HAMLET of
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
BARGAIN AND SALE DEED WITH COVENANT AGAINST GRANToR'S ACTS
(INDIVIDUAL OR CORPORATION)
STANDARD NYBTU FORM 8007
CAUTION: THIS AGREEMENT SHOULD BE PREPARED BY AN ATI'ORNEY AND REVIEWED BY ATI~ORNEYS FOR SELLER AND
PURCHASER BEFORE SIGNING.
THIS INDENTURE, made the /,.,~'~.~6 day of ~t~a tt,5~' , 2010
between
MILDRED K. SILBERNAGEL, as a life tenant, residing at 16 Old Woods Rd., Saddle River, NJ
07458, ELLEN WHITE, residing at 66 Carlton Place, Ho Ho Kus, NJ 07423,.~.~IELSON, residing at
26 Old Woods Road, Saddle River, NJ 07458, and WALTER E. SILBERNAGEE,'~'~'-~"'re-si~Iing at 370
Glenwood Road, Ridgewood, NJ 07450 as TENANTS IN C(JMMON. ~/k]..
party of the first part, and
WILLIAM D. MURPHY and KIMBERLY L. REECE, being married to each other,
residing at 197 Prince St., Apt. 4, New York, NY 10012
party ofthe second part,
WITNESSETH, that the party of the first part, in consideration of Ten Dollars and other lawful
consideration, lawful money of the United States, paid by the party of the second part, does hereby grant and
release unto the party of the second part, the heirs or successors and assigns of the party of the second part
forever,
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected,
situate, lying and being at Cutchogue, Town of Southold, County of Suffolk and State of New York.
SEE SCHEDULE 'A' ATTACHED HERETO AND MADE A PART HEREOF
Being and intended to be the same premises conveyed to the party of the first part by deed dated 10/6/88
recorded 10/28/88 in Liber 10724 CP 68.
TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and roads
abutting the above described premises to the center lines thereof,
TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to
said premises,
TO HA VEAND TO HOLD the premises herein granted unto the party of the second part, the heirs or
successors and assigns of the party of the second part forever.
AND the party of the first part, covenants that the party of the first part has not done or suffered anything
whereby the said premises have been encumbered in any way whatever, except as aforesaid.
AND the party of the first part, in compliance with Section 13 of the Lien Law, covenants that the party
of the first part will receive the consideration for this conveyance and will hold the right to receive such
consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will
apply the same first to the payment of the cost of the improvement before using any part of the total of the same
for any other purpose.
The word "party" shall be construed as if it read "parties" whenever the sense of this indenture so
requires.
NYSBA Residential Real Estate Forms on HotDocs~ (9/00) Copyright Capsofl® Development
IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first
above written.
MILDRED K. SILBE/~NA{~EL
ELLE~N WHIT~'~ '~ '~ ~
ELISE N~NI D ~'~
STATE OF NEW JERSEY
COUNTY OF ~
On the I~ day of~
)
) SS.:
)
, in the year 2010, before me, the undersigned personally appeared
Mildred K. Silbernagel 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, that by her signature on the instrument, the individual, or the person upon behalf of which
the individual acted, executed the instrument, and that such individual made such appearance before the
undersigned in the
Notary Public
MICHAEL C ZEALE '
NOTARY PUBLIC "~ '1
STATE OF NEW JERSE'~' -
I
MYCOMMISSION EXPIRESAUG:8,'~20?O I . '~
I.D.#2180755 '" I _
STATE OF NEW JERSEY )
)SS:
COUNTY OF ~
)
On the ~ day of .~c~r- , in the year 2010, before me, the
undersigned
personally
appeared
Ellen White, 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, that by her signature on the instrument, the individual, or the person upon behalf of which the
individual acted, executed the instrument, and that such individual made such appearance before the undersigned
in the
I MICHAEL C ZEAI..E
I NOTARY PUBLIC
Notary Public ! STATE OF NEW JERSEY
I MY cowa SStON E mRES ^Ua' a' 0 /
l I,D,# 2180755 '.
NYSBA Residential Real Estate Forms on HotDocs~ (9/00) Copyright Capsofl~ Development
STATE OF NEW JERSEY )
COUNTY OF ~ )
~On the hi` day of jt~tL(~ , in the year 2010, before me, the undersigned personally appeared
Sq'~ee Nelson, personally known to me or proved to me on th~ basis of satisfacto~ evidence to be th~ individual
whos~ name is subscribed to the within instrument and ac~owledg~d to me that she ~xecuted the sine in her
capaci~, that by her si~ature on the instrument, the individual, or the person upon behalf of which the
individual acted, executed the instrument, and that such individual made such appellee before the undersized
in the
Notary Public
STATE OF NEW YORK
COUNTY OF SUFFOLK
)
)
MICHAEL C :ZEALE - -
NOTARY PUBUC ' .'
STATE OF NEW JERSEY
MY (~OMMISSION EXPIRES ~U~ #, 2010
I.D.# 2180755 · '
On the ~ day of/~ ~ ~' , in the year 2010, before me, the undersigned personally appeared
Walter E. Silbernagel, 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, that by her signature on the instrument, the individual, or the person upon behalf&which
the individual acted, executed the instrument, and that such individual made such appearance before the
undersigned in the
LORRAINE KLOPFER
Nota~ Pubtic, State o! New York
No. 4828373
Qualified in Suffolk County
Commissior~ E~ires Nov. 30. ~0/~
DEED
Title No.
Silbemagel and Others
To
Murphy
Section 118.00
Block 01.00
Lot 004.001
County or Town SUFFOLK
Return By Mail To:
Deborah Doty, Esq.
P. O. Box 706
Cutchogue, NY 11935
NYSBA Residential Real Estate Forms on HotDocs® (9/00) Copyright Capsof~® Development
.3.
CHICAGO TITLE INSURANCE COMPANY
Title No.: 3810-00292
LEGAL DESCRIPTION
ALL TI{AT CERTAIN PLOT, PIECE, OR PARCEL OF LAND, SITUATE, LYING, AND BEING AT
NASSAU POINT, IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK AND STATE OF NEW YORK
BEING PART OF THE LOT KNOWN AND DESIGNATED AS AS LOT NO. 115 AS SHOWN ON A
CERTAIN MAP ENTITLED "AMENDED MAP A OF NASSAU POINT, OWNED BY NASSAU POINT CLUB
PROPERTIES INC." AND FILED IN THE OFFICE OF THE CLERK OF THE COUNTY OF SUFFOLK
ON AUGUST 16, 1922 AS MAP NUMBER 156, WHICH PART OF SAID LOT BEING MORE
PARTICULARLY BOUNDED AND DESCRIBED AS FOLLOWS:
BEGINNING AT A MONUMENT AT THE SOUTHWESTERLY CORNER OF LOT NO. 114 ON THE ABOVE
MENTIONED MAP;
RUNNING THENCE ALONG THE EASTERLY SIDE AND ALONG THE EXTENSION SOUTHERLY OF THE
EASTERLY SIDE OF SAID LOT NO. 115 ON THE ABOVE MENTIONED MAP THE FOLLOWING TIE
LINE COURSE AND DISTANCE:
1. SOUTH 15 DEGREES 37 MINUTES 30 SECONDS EAST 122.53 FEET TO THE PRESENT HIGH
WATER MARK (AS OF MARCH 28, 1978) OF WUNNEWETA POND;
THENCE ALONG THE PRESENT HIGH WATER MARK (AS OF MARCH 28, 1978) OF W~ETA
POND THE FOLLOWING 8 TIE LINE COURSES AND DISTANCES:
1. SOUTH 62 DEGREES 31 MINUTES 30 SECONDS WEST 112~71 FEET TO A POINT;
2. NORTH 86 DEGREES 49 MINUTES 10 SECONDS WEST 72.11 FEET TO A POINT;
3. NORTH 55 DEGREES 55 MINUTES 20 SECONDS WEST 41.05 FEET TO A POINT;
4. NORTH 12 DEGREES 25 MINUTES 00 S~CONDS WEST 111.61 FEET TO A POINT;
5. NORTH 28 DEGREES 23 MINUTES 30 SECONDS WEST 84.12 FEET TO A POINT;
6. NORTH 32 DEGREES 54 MINUTES 20 SECONDS EAST 40.50 FEET TO A POINT;
7. SOUTH 55 DEGREES 16 MINUTES 30 SECONDS EAST 122.89 FEET TO A POINT;
8. NORTH 55 DEGREES 40 MINUTES 50 SECONDS EAST 54.98 FEET TO THE EXTENSION
NORTHWESTERLY OF THE SOUTHWESTERLY SIDE OF LAND NOW OR FORMERLY OF HENRY G.
KUNKEL AND BETTY KUNKEL;
THENCE SOUTH 62 DEGREES 58 MINUTES 00 SECONDS EAST ALONG THE EXTENSION
NORTHWESTERLY OF THE SOUTHWESTERLY SIDE OF SAID LAST MENTIONED LAND AND ALONG
THE SOUTHWESTERLY SIDE OF SAID LAST MENTIONED LAND,. PASSING THROUGH A MONUMENT,
77.00 FEET TO THE POINT OR PLACE OF BEGINNING.
AND ALSO, ALL TEAT CERTAIN PLOT, PIECE, OR PARCEL OF LAND, SITUATE, LYING, AND
BEING AT NASSAU POINT, IN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK AND STATE OF
NEW YORK BEING MORE PARTICULARLY BOUNDED AND DESCRIBED AS FOLLOWS:
- -CONTINUED--
- LEGAL DESCRIPTION-
" CHICAGO TITLE INSURANCE COMPANY
Title No.: 3810-00292
LEGAL DESCRIPTION
BEGINNING AT A POINT ON THE PRESENT HIGH WATER MARK (AS OF MARCH 28, 1978) OF
GREAT PECONIC BAY, WHERE THE SAME IS INTERSECTED BY THE NORTHWESTERLY SIDE OF
BRIDGE LANE;
RUNNING THENCE ALONG THE SAID HIGH WATER MARK OF GRBAT PECONIC BAY, A TIE LINE
COURSE ~ DISTANCE OF NORTH 50 DEGREES 21 MINLVI'ES 20 SECONDS WEST 249.70 FEET
TO LJ%ND NOW OR FORHERLY OF RICHARD LAITINEN AND SIGRID C. LAITINET, HIS WIFE;
THENCE NORTH 43 DEGREES 07 MINUTES 20 SECONDS EAST ALONG SAID LAST MENTIONED
LANq) 175.00 FEET TO THE PRESENT HIGH WATER MARK (AS OF MARCH 28, 1978) OF
WUNNBS~ETA POND;
THENCE ALONG THE PRESENT HIGH WATER MARK (AS OF MARCH 28, 1978) OF WENNEWETA
POND THE FOLLOWING 3 TIE LINE COURSES AND DISTANCES:
1. SOUTH 22 DEGREES 21 MINUTES 50 SECONDS EAST 122.36 FEET TO A POINT;
2. SOUTH 55 DEGREES 43 MINIJTES 40 SECONDS BAST 136.74 FEET TO A POINT;
3. NORTH 72 DEGREES 45 MINUTES 30 SECONDS EAST 30.36 FEET TO THE NORTHWESTERLY
SIDE OF BRIDGE LANE;
THENCE ALONG THE NORTHWESTERLY SIDE OF BRIDGE LANE A TIE LINE COURSE ;L,ND
DISTANCE OF SOUTH 47 DEGREES 35 MINUTES 10 SECONDS WEST 157.00 FEET TO THE POINT
OR PLACE OF BEGINNING.
TOGETHER WITH ALL THE 'RIGHT, TITLE A/9'D INTEREST OF WHICH ONE JOHN B. SLEE DIED
SEIZED, IN AND TO ANY GORES OF SLIVERS OF LAND LYING IN FRONT OF AND /%DJACENT TO
EITHER OF THE ABOVE DESCRIBED PARCELS OF LARq) ~ BETWEEN SAID PARCEL AND THE
PRESENT OR FORMER HIGH WATER MARKS OF W~ETA POND AND GREAT PECONIC BAY, AND
ALSO OF, IN AND TO A PARCEL OF.LAND ADJOINING SAID LOT 115 ON THE NORTH BAST
BOUNDED NORTHEASTERLY BY THE BASTWA/~D PROLONGATION OF THE NORTHBASTERLY LINE OF
SAID LOT NO. 115 SOUTHWESTERLY BY BRIDGE LAND AND SOUTHWESTERLY BY WUNNEWETA
POND ;%ND SAID LOT NO. 115.
/%LSO TOGETHER WITH A RIGHT OF WAY TO ~ FROM THE SAID LANDS ABOVE DESCRIBED
FROM /~ND TO THE BRIDGE BY WHICH BRIDGE LANE PASSES OVER THE WATERWAY OR CREEK
LEADING FROM WUNNEWETA POND TO THE LAGOON, OVER BRIDGE LANE AND THE ROAD LE.~ING
FROM BRIDGE LANE TO SAID LOT NO. 115 AS SHOWN ON SAID MAP OVER THE PRESENT
TRAVELED ROADS AS NOW LAID OUT AND IN USE TO THE EXTENT THAT THE PARTY OF THE
FIRST PART HAS TEE RIGHT TO GRANT SUCH RIGHT OF WAY.
FOR INFORMATION ONLY: DISTRICT 1000 SECTION 118.00 BLOCK 01.00 LOT 004.001
-LECJ%L DESCRIPTION CONTIN~]ED-
PolicyNo.: 38~10-00292 '
SCHEDULE A DESCRIPTION
AND ALSO, A~L THAT CERTAIN PLOT, PIECE, OR PARCEL OF LAND, SITUATE, LYING, AND
BEING AT NASSAU POINT, TOWN OF SOUTHOLD, COUNTy OF SUFFOLK AND STATE OF NEW
YORK BEING MORE PARTICULARLY BOUNDED AND DESCRIBED AS FOLLOWS:
BEGINNING AT A POINT ON THE PRESENT HIGH WATER MARK OF GREAT PECONIC BAY,
WHERE THE SAME IS INTERSECTED BY THE NORTHWESTERLY SIDE OF BRIDGE LANE;
RUNNING THENCE ALONG THE HIGH WATER MARK OF GREAT PECONIC BAY THE FOLLOWING
THREE (3) TIE LINE COURSES AND DISTANCES:
1. NORTH 47 DEGREES 43 MINUTES 27 SECONDs WEST 84.53 FEET;
2. NORTH <52 DEGREES 15 MINUTES 59 SECONDS WEST 85.10 FEET;
3. NORTH 56 DEGREES 26 MINUTES 55 SECONDS WEST 82.78 FEET TO LAND NOW OR
FORMERLY OF ALAN CARDINALE;
RUNNING THENCE ALONG SAID LANDS NOW OR FORMERLY OF CARDINALE NORTH 43 DEGREES
07 MINUTES 20 SECONDS EAST 132. 75 FEET TO WUNNEWETA POND;
RUNNING THENCE ALONG WUNNEWETA POND AS IT WINDS AND TURNs THE FOLLOWING NINE
(9) TIE LINE COURSES AND DISTANCES:
1.. SOUTH 26 DEGREES 21 MINUTES 52 SECONDS EAST 36.96 FEET;
2. NORTH 68 DEGREES 17 MI ,N33TES 24 SECONDS EAST 38.48 FEET;
3. SOUTH 50 DEGREES 34 MINUTES 12 SECONDS EAST 8.63 FEET;
4. SOUTH 31 DEGREES 06 MINUTES 22 SECONDS WEST 34.48 FEET;
5. SOUTH 39 DEGREES 56 MINUTES 11 SECONDS EAST 56.12 FEET;
6. SOUTH 49 DEGREES 19 MINUTES 24 SECONDS EAST 80.76 FEET;
7. SOUTH 65 DEGREES 05 MINUTES 01 SECONDs EAST 47.08 FEET;
8. NORTH 61 DEGREES 05 MIAK3TES 06 SECONDS EAST 32.93 FEET;
9. NORTH 58 DEGREES 47 MINUTES 32 SECONDs EAST 53.63 FEET TO THE
NORTHWESTERLY SIDE OF BRIDGE LANE;
RUNNING THENCE ALONG THE NORTHWESTERLY SIDE OF BRIDGE LANE THE FOLLOWING TWO
(2) COURSES AND DISTANCES:
1. SOUTH 54 DEGREES 05 MINUTES 21 SECONDS WEST 58.34 FEET;
2. SOUTH 47 DEGREES 35 MINUTES 10 SECONDs WEST 135.92 FEET TO THE HIGH WATER
Fu~RK OF GREAT PECONIC BAY AT THE PPOB.
PLEGCONR
Cost Center: 70020074
Policy No.: 3810-00292
SCHEDULE A DESCR PTION
TOGETHER WITH THE RIGHT OF WAY TO AND FROM THE SAID LANDS ABOVE DESCRIBED FROM
AND TO THE BRIDGE BY WHICH BRIDGE LANE PASSES OVER THE WATERWAY OR CREEK
LEADING FROM WUNNEWETA POND TO THE LAGOON, OVER BRIDGE LANE AND THE ROAD
LEADING FROM BRIDGE LA~E TO SAID LOT NO. 115 AS SHOWN ON SAID MAp OVER THE
PRESENT TRAVELED ROADS AS NOW LAID OUT AND IN USE THE EXTENT THAT THE PARTY OF
THE FIRST PART HAS THE RIGHT TO GRANT SUCH RIGHT OF WAY.
PLEGCONR
Cost Center: 70020074
4
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS: http:l/www.orps.state.ny.us or PHONE (518} 474-6450
IFOR~COU~JTY' USE ONLY . ,,, I :,
'Cl. SW,~ Code I L~,'7 ,~,','~ ,~ ,~ ~ I I . ~ REAL PROPER~ T~NSFER REPORT
. m -~ R~t7 R~ ~
1.~ 1652 [ Bridge Lane
I Rnllt'hfll d I Cutchosue
[ Reece I K~berly L.
11935
S. Tax Indicate whine futura Tax Bills am lo be
Billing if uther then buyer address (at bMtom of form)
I
FIRST
RF~T NAME
I , I
4. Indicate the numbM of AeMecment ~ lOaF/if Prat of a Pa~) Che(~ a~ they apply:
Rollparoel~trar, stmTedonthadoed [ ~, ~, [ J #of Parcels OR PartofaParcol 4& Plannmng Board with Subdivision Authority Exists
S. Deed 4~ Subdivision Approval was Required for Transfer
Pro,,.y I I x I ] OR I I E~ 01 ~c Parcel Approved lot Sutxlivision with Map Provided
e. Sdl.r I Silbernaael [ tttldced K. and othecs (see attached)
I
7. Check the box below which most accurately deco,bec the use of the pmpm~y at the time of ~ala:
iOne Family Residential
2 or 3 Famdy Residential
Rasidontial Vacant Land
Non-Resideotml Vacant Lend
I SALE INFORMATION I
iAgricuBuml I [] Community Service
· Commorcial J ~ Industrial
Apartment K]~ Public Service
Eota~tainmant/Amusement [.[~ Forest
2 0
Io;/ ;5/;o I
8. Ownership Type is Condominium []
9. New Constmcdon on Vacant Land []
lS. Full,selepric~ I , ,2 ,9 ,9 , 0,0 ,0 ,0 , 0 , O I
· ~ ~ ·
(Full .~E(a Price is the total amount paid for the property including personal properly. J
This payment may pa in the fon~ of cash, other properly or goads, or the assumption of J
mortge~ges or other obligeqons.) Pfeaseroundottheneamstwhofedol(aramounL
14. ind[r, st~ the value of gemon.l I . , , "~ ~) 0 0 ~-'
~ induded in the sale ; ~ ; '
ASSESSMENT INFORMATION - Data should roflect tho, latest Final Assossment Roll and Tax Bill
18. YMr of AMe~ment RoB f~N~ oqllo
which iofon~st on token -- 17. Total Aue~ed Velds Id ell parmb in l~.Mhrl I
Significam Change in Pmpedy Between Ta~ab(a Status and Sale Dates
Sale of Busineaa is Included in Sale Price
Other Unusual Factors Affecting selo Price (Specify Below)
None
.,t. 5t. q.o. Ol
~ ½ ,
1000-118.00~1.00-004.001
L J I I
I CERTIFICATION I
I ctrtify that ail d' tl~ ileum d' infmmadoa eatemJ o~ thL,~ roma am tree and em. Tact itoe the bGt at' oty knov~k-df~f ami Iwlk, l~ ami I underdaml that the makJnR
M' alTy ~iBful raise ~lainmml of' matedal fad hernia ~ subjeet me to the ixo*f.dop.1 ~* Ute uemd law mlalhe
BUYER'S AI'rORNEY
NEW YORK STATE
COPY