HomeMy WebLinkAboutL 12742 P 766 11111111 IIII full IIIII IIIII 11111 IIIII IIIII IIIII IIII IIII
1111111 I 1111111111111
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 09/03/2013
Number of Pages: 6 At: 02:26:06 PM
Receipt Nuiaber 13-0110373
TRANSFER TAX NUMBER: 13-03121 LIBER: D00012742
PAGE: 766
District: Section: Block: Lot:
1000 007.00 01.00 003.000
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $2,025,000.00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $30.00 NO Handling $20.00 NO
COE $5.00 NO NYS SRCHG $15.00 NO
EA-CTY $5.00 NO EA-STATE $125.00 NO
TP-584 $5.00 NO Notation $0.00 NO
Cert.Copies $0.00 NO RPT $120.00 NO
Transfer tax $8,100.00 NO Mansion Tax $20,250.00 NO
Comm.Pres $37,500.00 NO
Fees Paid $66,175.00
TRANSFER TAX NUMBER: 13-03121
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Cierk, Suffolk County
0
Number of pages ~ - ~ -
REGORC~EC~
2013 'ep O3 U2:26:03 PPi
This document will be ublic JULIITM A. PASCALE
p CLERY. OF
record. Please remOVe all S~
IFFOLK COUNTY ,
Social Security Numbers L pOOOt2742
priorto recording. P 7~5
OT# i3-O~121
Deed /Mortgage Instrument Deed /Mortgage Tax Stamp ~ Recording /Filing Stamps
3 FEES
Mortgage Amt. ~ '
Page /Filing Fee
' 1. Basic Tax
Handling 20. 00
2. Additional Tax
TP-584 ~ ~ Sub Total
Notation SpecJAssit.
or
EA-52 17 (County} _ ~ ~ ~ Sub Total ~ Spec. /Add.
TOT. MTG. TAX
EA-5217 (State) _1
~ ~~n= ~,l Dual Town Dual County
R.P.T.S.A. Held for Appointment
Comm. of Ed. 5.'00 ~ ~ Transfer Tex -
+ Mansion Tax ~-0, ~.5
t7,
Affidavit
~ The property covered by this mortgage is
Certified Copy ~ or will be improved by a one or two
NYS Surcharge 15. 00 ' family dwelling only,
Sub Total ~f~S YES or NO
Other
Grand Total 3~ ~ ~ If N0, see appropriate tax clause on
page # of this instrument.
/3/ ZZ -
000 007. UO O I . GO 00 . UOO
4 Dist. 1000 Section 007.00 Block 02.00 Lot®- 5 Community Preservation Fund
Real Property 13023525 ~p ~ Consideration Amount $ 2,025,000,
T Age cYe pg T S lll~llll~llllllll~l~ll~l CPF Tax Due $ 37,50Q
Verification R ~ G A llll~lll~l~llllll Improved ~ ~ !~S
6 Satisfact,..,.~,~.---~--~---- - - _ ~ Iress
RECORD & RETURN TO: J Vacant Land
TD
DAVID WORTHINGTON OLSEN, ESQ.
OLSEN & OLSEN, L.L.P. Tp
P.O. BOX 706
CUTCHOGUE, NY 11935 TD
Maif to: Judith A. Pascale, Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 Co. Name Fidelity National Title Insurance Co.
www.suffolkcountyny.govlclerk Title # F13-7404-91586
g Suffolk Count Recordin & Endorsement Pa e
This page forms part of the attached DEED made
by: (SPECIFY TYPE OF INSTRUMENT)
ALBERT L. LINGELEBACH & CHRISTOPHER The premises herein is situated in
L. RAFFERTY, AS SUCCESSOR CO-TRUSTEES SUFFOLK COUNTY, NEW YORK.
CHRISTOPHER L. RAFFERTY and KATHLEEN R. LAMBORN
TO In the TOWN of SOUTNOLD ~ -
WILLIAM d. DOTSON. JR. and In the VILLAGE ~
hL-.ONq THEODORA DOTSON or HAMLET of FISHERS ISLAND
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
over
pT ~
DvcID: 13023525 ~ DTY ~
9-AUG-13
Tax Maps '
District Sector Black Lot School District Sub Division Name
1000 00700 0100 003000
1000 00700 0200 D05002
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' CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
' 1
'1.
- THIS INDENTURE, made the ~.3 I day of August, two thousand thirteen,
BETWEEN
ALBERT L. LINGELBACH and CHRISTOPHER L. RAFFERTY, as Successor Co-Trustees of the Natalie R.
Rafferty Personal ResidenceTrustcreatedunderDeclaration dated August 28, 1999,1359 Broadway-Suite
600, New York, New York 10018, CHRISTOPHER L. RAFFERTY, 1163 Reservoir Road, No. 393, Fishers Island,
New York 06390, and KATHLEEN R. LAMBORN, 311 East 72n0 Street - 17E, New York, New York 10021,
party~of the first part, and ryus64,,,ct' i` W i-r'Q
WILLIAM J. DOTSON, JR. and ILONA THEODORA DOTSON, 258 Broadway -Apt. 7A, New York, New York
10007,
party of the second part,
~ ~ 1 -
WITNESSETH, that the party of the frst part, in consideration of Two Million Twenty-Five Thousand Dollars
($2,025,000) paid by3he party of the second part, does hereby grarit and~reiease unto the party of the second part;
the heirs or successors and assigns of the party of the second part forever, - ~ _
ALL those certain plots, pieces or parcels of land, with the buildings and improvements thereon erected, situate,
lying and being at Fishers Island, Town of Southold, County of Suffolk and State of New York, being more
particularly bounded and described as set forth on Schedule A hereto.
BEING AND INTENDED TO BE a portion of the same premises conveyed to Natalie R. Rafferty, as Trustee of the
Natalie R. Rafferty Personal Residence Trust created under Declaration dated August 28, 1999, in the deed dated
August 28, 1999 and recorded in the Office of the Suffolk County Clerk on November 4, 9999 in Liber 11998 page
878. -
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 HAVE AND TO HOLD the premises herein
granted unto the party of the sewnd 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 parry 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 wilE hold the right fo 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.
IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written.
IN PRESENCE Of:
Albert L. Ling Ib ch, a Co-Trustee
~~:._.4.n...;..•_*.. Christopher .Rafferty, indivi -
and as Co-Trustee
Kathleen R. Lamborn
Standard N.Y.B.T.U. Fonn 8002 -Bargain and Sale Deed, with Covenant against Grantor's Acts - Un'rform Adcnowledgmanl
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YORK STATE
State of New York, County of New York ss.: State of New York, County of Suffolk ss.:
On the ~ day of August in the year 2013 before me, On the 13~`day of August in the year 2013
the undersigned, personally appeared before me, the undersigned, personally appeared
Albert L. Lingelbach and Kathleen R. Lamborn Christopher L. Rafferty
personally known to me or proved to me on the basis of personally known to me or proved to me on the basis of '
satisfactory evidence to be the individuals whose names are satisfactory evidence to be the individual whose name is
subscribed to the within instrument and acknowledged to me that subscribed to the within instrument and acknowledged to me that
they executed the same in their capacities, and that by their he executed the same in his capacities, and that by his signature
signatures on the instrument, the individuals, or the persons upon on the instrument, the individual, or the person upon behalf of
behalf~of/which/the indivinduals acted, executed the instrument. which the individual attend, a led t e instrument.
Notary Public Notary Public
(signature and office of individual taking acknowledgment) (signature and office of individual taking ac edgment)
EDWARD W. OREASON MARY 8 PANKIEWICZ
Notary Public, State of New York Notary Pu6~c Sate of New York
No. 02GR6243996 d?~ •8267850
- Quetliied in New York Courrririyy COhImiS5i0rl F~frBS ~901sor
.f;,ommissionExpireaJune27,~01s Qvolf~rta ?w IK~wa{tr
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE
State of ;County of ss.:
On the day of in the year before me, the undersigned, personally appeared
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed
Eo the within instrument and acknowledged to me that he/shefthey executed the same in his/herRheir capacity(ies), and that by
hisRter/iheir signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the
instrument, and that such individual made such appearance before the undersigned -
in the in the
(insert the City or other political subdivision) (insert the State or Gauntry or other place the acknowledgment was taken)
(signature and office of individual taking acknowledgment)
My Commission Expires On:
BARGAIN AND SALE DEED DISTRICT tooo
WITH COVENANT AGAINST GRANTOR'S ACTS SECTIONS 007.00 & 007.00
BLOCKS 01.00 & 02.00
Title No. F13-7404-91688SUFF LOTS 003.000 8 p/o 005.000
COUNTY OR TOWN Suffolk -Southold
STREET ApDRESS Barlow Pond Road
ALBERT L. LINGELBACH and CHRISTOPHER L. RAFFERTY, Fishers Island, NY 06390
as Successor Co-Trustees,
CHRISTOPHER L. RAFFERTY, and KATHLEEN R. LAMBORN
TO
RETURN BY MAIL TO:
WILLIAM J. DOTSON, JR. and ILONA THEODORA DOTSON -
STANDARD FORM OF NEW YORK BOARD OF TITLE UNDERWRITERS
Distributed by
RESERVE THIS SPACE FOR USE OF RECORDING OFFICE
_ Fidelity National Title Insurance Company _
TITLE NO. F13-7404-916$6-BUFF
SCHEDULE A-1 (DescriptiaT) '
• AMENDED $114113
ALL that certain plot, piece or parcel of land, situate, lying and being in the Town of Southold, County of Suffolk and
State of New York, bounded and described as follows:
As to Part of Tax Lot 005.000:
BEGINNING at a stone monument set on the Easterly and Southeasterly side of a road 40 feet wide known as Clay Point
Road, said monument being eighty-three hundred and eight and eighty-five hundredths feet West of a point which is
twenty-six hundred and sixty-two and fifty-four hundredths feet South of another monument marking the U.S. Coast and
Geodetic Survey Triangulation Station "Chocomount 2" (which said "Chocomount 2" monument is located on the summit
of the highest hill on Fishers Island, N.Y. about two and one-quarter miles West of the Eastern end of Fishers Island and
lies South 79 degrees 29 minutes 46 seconds bast of North Dumpling Light in Fishers Island Sound};
Said point also being at the Southwesterly corner of the premises about to be described and the Northwesterly corner of
land now or formerly of V irginia F. Thors;
THENCE the following 4 courses and distances along the Easterly and Southeasterly side of Clay Point Road:
1. North 20 degrees 58 minutes 10 seconds East, 109.38 feet to a point marking a point of curve bearing to the right whose
radius is 433.14 feet and the direction of whose radius at that point is South 69 degrees O 1 minutes 50 seconds East;
2. Northeasterly and following the arc of said curve, 188.15 feet;
3. North 45 degrees 51 minutes 30 seconds East, 598.92 to a point of curve bearing to the left whose radius is 274.$2 feet
and the direction of whose radius at that point is North 44 deb
ees 08 minutes 30 seconds West;
4. Northerly and following the arc of said curve, 89.69 feet to land now or formerly of Fishers Island Development Corp.;
THENCE Southeasterly and Southerly along land now or formerly of Fishers Island Development Corp., the following 2
courses and distances:
i. South 37 degrees 20 minutes 40 seconds East, 432.91 feet;
2. South 04 degrees 41 minutes 00 seconds East, 150.07 feet to the Northerly side of Barlow Pond Lane;
THENCE Westerly along the Northerly 'side of Barlow Pond Lane and Following the arc of a curve bearing to the left r
whose radius is 183.53 feet and the direction of whose radius at that paint is South 00 degrees 51 minutes 30 seconds
West, 219.62 feet;
THENCE Southerly along the Westerly side of Barlow Pond Lane and following the arc of a curve bearing to the left
whose radius is 1157.55 feet and the direction of whose radius at that point is South 67 degrees 42 minutes 10 seconds
East, i 80.19 feet to a drill hole in a rock situated on the Northerly side of a road 40 feet wide known as Barlow Pong Lane
said drill hole being seventy-six hundred and thirty-six and eighty-hundredths feet West of a point which is twenty-six and
ninety-four and sixty-four hundredths feet South of monument marking the U.S. Coast and Geodetic Survey Triangulation
Station "Chocomount 2" (which said "Chocomount 2" monument is located on the summit of the highest hill on Fishers
Island, N.Y. about two and one-quarter miles West of the Eastern end of Fishers Island and lies South 79 degrees 29
THE POLICY TO BE ISSUED under this commitment will insure the title to such buildings and improvements on the premises which
b}~ law constitute real property.
FOR CONYEY.4NCING ONLY: Together with all the right, title and interest of the party of the first part, of in and to the land lying
in the street in front of and adjoining said premises.
SCHEDULE A-1 (Description)
Rcv. (03104)
• ' . ~ ~ _ Fidelity National Title Insurance Company _
TITLE N4. F13-7404-91686-SUFF
SCHEDULE A-1 (Description)
(Continued)
minutes and 45 seconds East of North Dumpling Light in Fishers Island Sound;
THENCE North 85 degrees 38 minutes 10 seconds West, along land now or formerly of Estate of Natalie R. Rafferty,
147.84 feet;
THENCE North 85 degrees 44 minutes 10 seconds West, still along land now or formerly of Estate of Natalie R. Rafferty,
151.99 feet;
THENCE South 33 degrees 52 minutes 30 seconds West, still along last mentioned land, 178.84 feet to land now or
formerly of Virginia F. Thors;
THENCE Westerly along land now or formerly of Thors, the following 2 courses and distances:
1. North 44 degrees 46 minutes 50 seconds West, 154.88 feet;
2. Noah 73 degrees 41 minutes 00 seconds West, 171.20 feet to the point or place of BEGINNING.
As to Tax Lot 003.000:
BEGINNING at a stone monument set on the Northwesterly side of a road 40 feet wide known as Clay Point Road, said
monument being seventy-eight hundred and seventy-nine and twenty-hundredths feet West of a point which is two
thousand and sixty-nine and fifty-nine hundredths feet South of another monument marking the U.S. Coast and Geodetic
Survey Triangulation Station "Chocomount 2" (which said "Chocomount 2" monument is located an the summit of the
highest hill on Fishers Island, N.Y. about two and one-quarter miles West of the Eastern end of Fishers Island and lies
South 79 degrees 29 minutes 46 seconds East of North Dumpling Light in Fishers Island Sound);
Said point also being at the Northeasterly corner of the premises about to he described and the Southeasterly comer of
land now or formerly of Burton G. Tremaine Jr. Irrevocable Qualified PE;
THENCE Southwesterly along the Northwesterly side of Clay Point Road, South 45 degrees 51 minutes 30 seconds West,
439.74 feet to a point of curve to the left whose radius is 473.14 feet and the direction of whose radius at that point is
South 44 degrees 08 minutes 30 seconds East;
THENCE Southwesterly and still along the Northwesterly side of Clay Point Road and fallowing the arc of said curve,
25.00 feet;
THENCE Southerly and following the arc of a curve to the left whose radius is 473.14 feet and the direction of whose
radius at that point is South 47 degrees 10 minutes 10 seconds East;
THENCE still Southerly and following the arc of said curve 180.53 feet;
THENCE South 20 degrees 58 minutes 10 seconds West, along the Westerly side of Clay Point Road, 109.38 feet to land
now or formerly of Virginia F. Thors;
THE POLICY TO BE ISSt/ED under this commitment will insure the title to such buildings and improvements on the premises which
by law constitute real property.
FOR CONVEYANCING ONLY: Together with all the right, title and interest of the part of the ftrst part, of in and to the land lying
in the street in front ojand adjoining said premises.
SCHEDULER-1 (Description)
Rev. (03!04}
• ' . ' Fidelity National Title Insurance Company _ _
TITLE NO. F13-7404-91686-BUFF
SCHEDULE A-1 (Description)
(Continued)
THENCE North 69 degrees O1 minutes 50 seconds West, along last mentioned land, 43.00 feet to shores of West Harbor)
Fishers Island Sound;
THENCE Northerly along the shores of West Harbor/ Fishers Island Sound, the following 3 courses and distances:
1. North 21 degrees 28 minutes 30 seconds East, 347.65 feet;
2. North i 1 degrees O1 minutes 30 seconds East, 100.44 feet;
3. North 03 degrees 38 minutes 20 seconds West, 202.68 feet to land now or formerly of Burton G. Tremaine Jr.
Irrevocable Qualified PE;
THENCE South 86 degrees 48 minutes 40 seconds East, along last mentioned land, 257.51 feet to a point;
THENCE South 68 degrees OS minutes 20 seconds East, still along Iast mentioned land, 125.4$ feet to the point or place
of BEGINNING.
THE POLICY TO BE ISSUED under this commitment will insure the title to such buildings and improvements on the premises which
by lativ constitute real property.
FOR CONVEYANCING ONLY: Together with all the right, title and interest of the part of the f rst part, of in and to the land lying
in the street in front of and adjoining said premises.
SCHEDULE A-1 (Description)
Rcv. (03104)
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS (RP-5217-INS?: www.orps.state.ny.uS
FOR COUNTY USE ONLY
Ct. StMB Code ~ ~ NotN York State Department of
/ Taxation and Finance
C2. Date Daed Rttwrdad ) y / e~ / / ~ I O((iC9 Of Real PrOpBAy T8x ServICeS
n i y Isar
cs. Book o~ C4. Page I ~ ~ ~,0 I RP- 5217
5 Real Property Transfer Report (8N0)
PROPERTY INFORMATION
pLo
ed~en l 1478 1 Barlow Pond Road I
~TiEE
Town of Southold I Fishers Island 106390 I
cirv oR rowN veUCE arcooE
z.etryar I Dotson I William J., Jr. I
Name twtr xre,ErcoLwN+r rarer raNE
I Dotson I Ilona Theodora I
~TAR,1 F1er1
3. Tax Indicate where future Tax Bilb are to be sent
Bllling it other than Wyar address (at lroaom of form) I .>al~aafl-ea~x~ I Cyst I
Address
I I I I I
$rtiEET NeIalF,1 Ma REST GTY IM TOMa1 eTwrE ~p
4. fndtrab Ma numhor of Aesassmanl (Only N Part of a Parcel) Cheek u they apply:
Roll lwala nanafartad en the dead I 2 I p of Paroels OR Pert of a Parch ?
4A Planning Board with Subdivision Aulhodry Exists
A Dsed 2 1 4 4B. Subdivision Appoval was Required ter Transfer
Proporgr I ~1 FEED X `~smlr~ OR I-~L~t 1
1~J 4C. Pareal Appeared for Subdivision wish AAap Provided ?
SILe Natalie R. Rafferty Personal Residence Trust UTD dated August 28, 2013
B.Sellsr I Raffe~ I Christopher L. I
•Nams rxrwErtxwrwr n r r
I Lamborn (Kathleen R. I
. --naTlamFrett~m~- ttta:raaaE
7. Cheek the btn bNorr rrltleh most aeeuretory daserlbes Ms ues oT mo property K Ihs tlms of salr. Cheek Iho bozos below i• tltay apply:
B.Owneaship Type is Condominium ?
A One Family Residential E AgrlCTllWref I Cpnmuniry Service g. New ConsWetion m Vaeam Land ?
B 2 ar 3 Family Residential F Cemmwdal 1 Intlustiial 10A property Legated within en Agdgulwral Diehid ?
C ResideMlal Vacent Land G Apartinare k Public Service 108. Buyer received a dixbwre notlea Intliceting ?
D Non•Resldantlal Vacant Land H Entarlainment t Amusement L Forest that the properly is in an Agrleulwrel DIsWa
SALE INFORMATION 15. Cheek otw or more of arose dondlUone es applleable to Vanahr:
11. sale Contract Dab 107 / 25 / 13 I A Sale Between Relatives or Fomtor Relatives
omit
r may ~f m B Sale Between Related Companies or PaMere In Susinass
C Ono d the Buyers is also a Seller
12. Deto of Selo 1 Trenahr I D8 / t~OZ / 13 1 D Buyer or Seller is GOVemment Agenq or Lending InsGwtion
-Nonni Der w'- Dead type not Warranty or Bargain and Sale (Spetay Below )
I: Sale of Frectienal a Less than Fea Interest (Speciry Sabw )
G Significant Change in Properly Between Texabla Staves and Sob Dates
T9. Full Sale Prlea L 2 0 2 5 0 0 0 x 0 0 I t1 Sale of Buwnesa is Indudetl in Sale Price
( Full Salo Prrce is the tool anwunl pad for Iho properly Includmg personal propsrry. I $ Other Unuwal Factors Affecting Sale Prlce (Spedfy Below l
This payment may ha in Iha forth of cash, other property or goods, or the aswmption of ~ NOfe
mortgages tx othor ebllgetiona.) Please round Po the nearest whop doyen errrounf.
separate buildable vacant lot included in
14. Indkeb the veltw of pereonal I D - 1
property trtetudadmths sale - assessment for tax lot 5~~intluded_in
ASSESSMENT INFORMATION -Data shouts reflect the latest Final Assessment RDII and Tax Bill sale
18. Year oT Assaesmank Roll from 11 2. 13 I +7 Total Assessed Velus (of ell parcels In uansfar)I 3 7 i 7 0 0
whkh lnformatlon Lkan -
3 1 2 *includea entire assessment
2 5 0 - Fishers Island for tax lot 5
1B. Properly Close IJ 1g, School Dlsldct Nama I _ I
20. Tax Map IdenllBar(s) I Roll khnllRor(s) (Il more Than lour, stlseh shoat vetch addNlonal idantlNar(s) )
I 1000 - 007.00 - 01.00 - 003.000 I X000 - 007~9D.0=02.-O.O-p/_o_005...000-J
I I L- _ _ I
CERTIFICATION
1 eMlTy fkat ell eT tM Ibrtre M In/amellan enbred m 0b Tartu ere t>w ant correct tb Me Me! of my knewbdae ant IwIbQ wN 1 nrrexrebM Nn1 lire renalna at any r,rlrlhe
Tahe etebment of mebrlal Tact herein vent wlyeet ere b dte provlerone o1 Me deml law relatlw to tke maklrra end sane of lnlw Instruewnb.
SELLER SIGNATURE BUYER CONTACT INFORMATION
NATALI FF RTY PERS IDENCE TRUST (t:r.:Lr lntomcwm'or molxryor.Ndo.ahY,wrl,LLC, sadoq. astoda•.ion. eorperaaac ieim clock
08~ ~ 13 Lamperry, slaw a envy dlel is na en rrdmdua apmt a Ilduoery, Vwn a ~wme and W n:od Inramadgrr
B ~ L,_/~~I man Indedua'hEeparnldo carry wro ren arewarqueaiona eytrrdng ma transfer moat ae wnwea.
Ctli~'ff'~'tit7~iher L. Raffe Co-Truarrtee '''p'erprkd~..ry.t
BUYER/SI~GNATURE DOtSOn i Ilona Theodora
~hre. /JY/~/~ 108 ~13 wrNnLa nNSrNiuc
If`S'n$"~`tieodoit~t~i~iL~YBRNEr wrL 1
wNEwgOnF IELEPNCNE NULBEX
Olsen ~ David Worthingtoa
wrNwNE FitLSrNwvE I 258 I Broadway -Apt. 7A
a1Nk61 YJYe1:R STREE-NN/E
(f~31) X734-7666
rwEwcooc TELEPNdr1E•aR.wER New York I NY I 10021
NEW YORK STATE envnRrowx suTE arcdx
COPY