HomeMy WebLinkAboutL 12743 P 932
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SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 09/12/2013
Number of Pages: 7 At: 08:44:02 AM
Receipt Number : 13-0115186
TRANSFER TAX NUMBER: 13-04064 LIBER: D00012743
PAGE: 932
District: Section: Block: Lot:
1000 038.00 01.00 001.008
EXAMINED AND CHARGED.AS FOLLOWS
Deed Amount: $0.00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $35.00 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 $0.00 NO Comm.Pres
$0.00 NO
Fees Paid $330.00
TRANSFER TAX NUMBER: 13-04064
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
rys . F110
RECORDED
Number of pages 2013 Sep 12 08:44:02 AM
JUDITH A. PASCALE
CLERK OF
This document will be public SUFFOLK COUNTY
record. Please remove all L D00012743
P 932
Social Security Numbers DT# 13-04064
prior to recording.
Deed / Mortgage Instrument Deed / Mortgage Tax Stamp Recording / Filing Stamps
3 FEES
Page/ Filing Fee ~2- Mortgage Amt.
1. Basic Tax
Handling 20. 00 2. Additional Tax
TP-584 Sub Total '
Spec./Assit.
Notation
or
EA-52 17 (County) Sub Total Spec. /Add.
~EA-5217 (State) .01 TOT. MTG. TAX
Dual Town Dual County
R.P.T.S.A. (1 1 Held for Appointment
Comrh. of Ed. •5. 00 ~ lOrj Transfer Tax - Q
• a Mansion Tax
Affidavit
R~ The property covered by this mortgage is
r. Certified Copy or will be improved by a one or two
NYS Surcharge Is. 00 family dwelling only.
SubTotal_ YES or NO
Other O
w Grand Total 3 ~ If NO, see appropriate tax clause on
page # of this instr me t.
1 13008275 5 Community Preservation Fund
~ 4 Dist. 100
Real Property CW I ~ll~`~~~~IIIIIIII 1fill~llll~llll~ll~ll~lll~ Consideration Amount $
Tax Service / ~!O
Agency cy ~ ~ CPF Tax Due S
Verification 11 Improved
6 Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD & RETURN TO: I Vacant Land
SCOLARO SHULMAN COHEN FETTER & BURSTEIN, P.C. TD Y) 01
507 PLUM STREET, SUITE 300
SYRACUSE, NY 13204 TD
TD
Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name N/A
www.suffolkcountyny.gov/clerk Title # N/A
g Suffolk County Recording & Endorsement Page
This page forms part of the attached TRUSTEE:"S DEED made
by: (SPECIFY TYPE OF INSTRUMENT)
The Helen A. Polak Irrevocable Income The premises herein is situated in
only Trust SUFFOLK COUNTY,NEWYORK.
TO In the TOWN of Southold
The Kevin T. Polak Trust In the VILLAGE
The Gie or P. Polak Trust or HAMLET of
The am o a rust
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
over
iJ
` pT S
Doc ID: 13008275 P SMI A
O~JN-13~
Tax Maps
District Secton Block Lot School District Sub Division Name
1000 03800 0100 001008
1000 03800 0100 001013
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TRUSTEE'S DEED
THIS INDENTURE, made the 4`h day of April, 2012.
BETWEEN: WILLIAM J. POLAK III, of 565 West Lane, Riverhead, New
York 11901, KEVIN T. POLAK, of 55 Fanning Boulevard,
Riverhead, New York 11901; GREGORY P. POLAK, of 159
Hubbard Avenue, Riverhead, New York 11901, as Trustees of
The Helen A. Polak Irrevocable Income Only- Trust,
conveying an undivided one-third (1/3) interest,
Grantor,
AND: KEVIN T. POLAK, of 55 Fanning Boulevard, Riverhead, New
York 11901, and GREGORY P. POLAK, of 159 Hubbard
Avenue, Riverhead, New York 11901, as Trustees of The Kevin
T. Polak Trust under Agreement dated January 1, 2008, and
GREGORY P. POLAK, of 159 Hubbard Avenue, Riverhead,
New York 11901, and WILLIAM J. POLAK III, of 565 West
Lane, Riverhead, New York 11901, as Trustees of The Gregory
P. Polak Trust under Agreement dated January 1, 2008, and
WILLIAM J. POLAK III, of 565 West Lane, Riverhead, New
York 11901, and KEVIN T. POLAK, of 55 Fanning Boulevard,
Riverhead, New York 11901, as Trustees of The William J.
Polak III Trust under Agreement dated January 1, 2008,
Grantee:
WITNESSETH, that the Grantor, by virtue of the power and authority give in and by the said Trust
Instrument and inconsideration of Ten and 001100 Dollars ($10.00), and other good and valuable consideration
paid by the Grantee, grants, conveys and releases unto the Grantee, the heirs or successors and assigns of the
Grantee forever,
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected,
situate, lying and being in the Town of Southold, County of Suffolk and State of New York, bounded and
described as follows on Schedule "A" attached hereto and made a part hereof.
FOR REFERENCE ONLY: Property Address: 6500 Route 25, Southold, NY
Tax May Nos.: 1000-38-1-1.8 and 1000-38-1-1.13
BEING the same premises described in the Deed to The Helen A. Polak Irrevocable Income Only Trust
by Deed dated January 30, 2008 and recorded in the Suffolk County Clerk's Office on February 11, 2009 in
Book D00012580 of Deeds at Page 413.
William J. Polak III, Kevin T. Polak and Gregory P. Polak are the Trustees of The Helen A. Polak
Irrevocable Income Only Trust, which Trust was created on January 30, 2008 and which Trust has not been
amended. The Trust contains no restrictions on the power of the Trustees to convey the real property described
in this Deed.
TOGETHER with the appurtenances and all the estate and rights which the Grantor Trustee have in and
io'the above-described property, by virtue of the Trust or otherwise.
TO HAVE AND TO HOLD the premises herein granted'unto the Grantee, the heirs or successors.and
assigns of the Grantee forever.
AND the Grantor covenants that Grantor has not done or suffered anything whereby the said premises
have been encumbered in any way whatsoever.
THIS Deed is subject to the trust provisions of Section 13 of the Lien Law.
The words "Grantor" and "Grantee" shall be construed to read in the plural whenever the sense of this
Deed so requires.
IN WITNESS WHEREOF, the Grantor has duly executed this deed the day and year first above
written.
THE HELEN A. POLAK IRREVOCABLE
INCOME ONLY TRUST
By:
4
William J. lak III, Trustee
By: r 641 t - -
Kevin T. Polak, Trustee
By:
Gre olak, Trustee
STATE OF NEW YORK )
COUNTY OF SUFFOLK ) ss.:
On this~day of A&L , 2012, before me, the undersigned, a Notary Public in and for
said State, personally appeared William J. Polak III, 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 to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their
signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument.
NADtACHARAMONTE
L ~
Now York
NataryPubic, Swe Slaw of New Yak
W 4012H Notary Public
Oea>fdied In swi W"
Cm=Wm EVkw 4d ZT,>~1a
,STATE OF NEW YORK
COUNTY OF SUFFOLK ) ss.:
On this day of ~2012, before me, the undersigned, a Notary Public in and for
said State, personally appeared Kevin T. Polak, 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 to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their
signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument.
w4M224 K~*L
pu~ned>h a-0( Notary Public
Canmhon Expires App 27,
STATE OF NEW YORK }
COUNTY OF SUFFOLK } ss.:
On this_qt day of 2012, before me, the undersigned, a Notary Public in and for
said State, personally appeared Gregory P. Polak, 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 to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their
signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted,
executed the instrument.
Nrf otlc CL~ y1u (,Lt~~1
Notary Public
dqA% coumy
Comlrilssion Dow Apra 27, TaU
Record & Retum To:
Scolaro, Shulman, Cohen, Fetter & Burstein, P.C.
507 Plum Street, Suite 300
Syracuse, New York 13204
580060.1
SCHEDULE "A"
LEGAL DESCRIPTION
ALL THAT CERTAIN PLOT, PIECE OR PARCEL OF LAND, with the buildings and
improvements thereon erected, situate, lying and being in East Marion, Town of Southold, County of Suffolk
and State of New York, beginning at a point in the easterly line of Union Avenue or Shipyard Lane where the
easterly line of Union Avenue or Shipyard Lane is intersected by the northerly line of land now or formerly of
Blue Points Co., Inc.; running thence in a general northerly direction along the easterly line of Union Avenue
or Shipyard Lane a distance of about 180 feet to the southwest corner of land now or formerly of Thomas
Jackson; running thence along land of Thomas Jackson, North 73" 53' 10" East 170.25 feet to a locust post;
running thence along land now or formerly of Thomas Jackson, Fish Estate and Caulkins, North 23 ° 9'20" West
1190 feet to the northeasterly corner of land of Fish Estate; running thence along land of Fish Estate, South 09 °
31' 40" West 167.19 feet to the easterly line of Union Avenue or Shipyard Lane; running thence along the
easterly line of Union Avenue or Shipyard Lane a distance of 90.37 feet to a granite monument; running thence
further along the easterly line of Union Avenue or Shipyard Lane North 24° 33' 40" West 829.91 feet to a
granite monument at the intersection of the easterly line of Union Avenue or Shipyard Lane with the Southerly
line of Kings Highway; running thence along said Kings Highway or Main Road, North 57° 48'l 0" East 457.68
feet to a granite monument; running thence further along the southerly line of Kings Highway or Main Road,
North 55 ° 52'50" East 515.34 feet to a granite monument and land formerly of William Gillette; running thence
along land formerly of William Gillette, South 25° 8' 50" East 853.95 feet to a granite monument; running
thence South 25 ° 8' 50" East 2454.13 feet to the northerly line of land conveyed to Blue Points Co., Inc.;
running thence in a general westerly direction along the northerly line and last mentioned 860 feet to the point
or place of beginning.
The Grantor hereby quit claims the following more modern description, the intention of the parties is
to convey the remaining property owned by The Helen A. Polak Irrevocable Income Only Trust:
ALL THAT TRACT OR PARCEL OF LAND, situate in the Town of Southhold, County of Suffolk,
and State of New York, bounded and described as follows: BEGINNING at a point at the southeast corner of
land now or formerly owned by Richard J. Rossetti and Susan N. Rossetti, by deed dated January 8, 1999 and
recorded February 5, 1999 at Book 11944 of Deeds at Page 77, said point being located North 60° 37'21 " East
170 feet more or less from the easterly boundary of Shipyard Lane; running thence North 37° 2'38" West a
distance of 94.96 feet to a point; thence North 37 ° 2'27" West a distance of 81.627 feet to a point; thence North
37° 2' 38" West a distance of 68.789 feet to a point; thence North 37° 2' 39" West a distance of 52.697 feet to
a point; thence North 37° 2' 39" West a distance of 83.552 feet to a point; thence North 37° 2' 35 West a
distance of 53.163 feet to a point; thence North 37° 2' 39" West a distance of 88.946 feet to a point; thence
North 37° 239" West a distance of 99.533 feet to a point; thence North 37° 2'39" West a distance of 99.98 feet
to a point; thence North 37° 2' 38" West a distance of 103.182 feet to a point; thence North 37° 2'38" West a
distance of 99.224 feet to a point; thence North 37° 2' 39" West a distance of 98.681 feet to a point; thence
North 37° 2'37" West a distance of 68.184 feet to a point; thence North 37° 2'37" West a distance of 96.578
feet to a point; thence South 52° 44' 50" West a distance of 17.399 feet to a point; thence North 37° 14' 18"
West a distance of 35.071 feet to a point; thence North 37° 14' 22" West a distance of 39.909 feet to a point;
thence North 37° 43'40" West a distance of 73.067 feet to a point; thence North 37° 43'41 " West a distance
of 73.081 feet to a point; thence North 37" 43'40" West a distance of 74.072 feet to a point; thence North 37°
43' 40" West a distance of 77.421 feet to a point; thence North 37° 43' 40" West a distance of 151.442 feet to
a point; thence North 37° 43'40" West a distance of 149.953 feet to a point; thence North 37° 43'44" West a
distance of 38.392 feet to a point; thence North 52° 16' 19" East a distance of 221.505 feet to a point; thence
-I-
Noah 52° 1635" East a distance of 3.495 feet to a point; thence North 37° 33'5" West a distance of 124.974
feet to a point; thence North 37 ° 33'5" West a distance of 131.201 feet to a point; thence North 44 ° 38'33" East
a distance of 3.717 feet to a point; thence North 44 ° 3 8' 9" East a distance of 21.503 feet to a point; thence North
44° 38'4" East a distance of 54.1 feet to a point; thence North 42° 39' 23" East a distance of 192.11 feet to a
point; thence South 40 ° 17' 20" East a distance of 262.473 feet to a point; thence North 55 ° 16' 2" East a
distance of 161.112 feet to a point; thence South 38° 22' 17" East a distance of 30.273 feet to a point; thence
South 38 ° 22' 16" East a distance of 101.006 feet to a point; thence South 38 ° 22' 18" East a distance of 99.039
feet to a point; thence South 38 ° 22' 18" East a distance of 98.162 feet to a point; thence South 38 ° 22' 17" East
a distance of 101.893 feet to a point; thence South 38" 22' 18" East a distance of 50.097 feet to a point; thence
South 38 ° 22' 18" East a distance of 97.931 feet to a point; thence South 38 ° 22' 18" East a distance of 99.958
feet to a point; thence South 38° 22' 18" East a distance of 102.885 feet to a point; thence South 38 ° 22' 16" East
a distance of 99.275 feet to,a point; thence South 38° 22' 18" East a distance of 99.837 feet to a point; thence
South 38 ° 22'17 East a distance of 101.503 feet to a point; thence South 38 ° 22' 17" East a distance of 100.245
feet to a point; thence South 38 ° 22' 16" East a distance of 98.818 feet to a point; thence South 38 ° 22' 17" East
a distance of 101.162 feet to a point; thence South 38° 22' 17" East a distance of 98.021 feet to a point; thence
South 38 ° 22' 17" East a distance of 52.519 feet to a point; thence South 38 ° 22' 17" East a distance of 104.612
feet to a point; thence South 38 ° 22' 17" East a distance of 105.014 feet to a point; thence South 38 ° 22' 17" East
a distance of 105.169 feet to a point; thence South 38 ° 22' 19" East a distance of 104.234 feet to a point; thence
South 38 ° 22' 18" East a distance of 105.361 feet to a point; thence South 38 ° 22' 16" East a distance of 66.794
feet to a point; thence South 54° 55' 34" West a distance of 118.041 feet to a point; thence North 38° 24' 27"
West a distance of 134.852 feet to a point; thence North 38 ° 22'55" West a distance of 49.999 feet to a point;
thence South 51 ° 35'30" West a distance of 502.298 feet to a point; thence South 60" 37'21 " West a distance
of 66.079 feet to the point and place of beginning.
ALSO ALL THAT CERTAIN PLOT, PIECE OR PARCEL OF LAND, with the buildings and
improvements thereon erected, situate, lying and being in East Marion, Town of Southold, County of Suffolk
and State of New York, beginning at a point on the southerly line of Kings Highway where the same is
intersected by the westerly line of land now or formerly of Ruth Hart Snyder; running thence along land last
mentioned two courses as follows, South 27 ° 20' 20" East 149.39 feet; running thence North 59" 25' 10" East
128.10 feet; running thence South 26° 39' 10" East, 513.06 feet to a locust stake; running thence North 68°
48'20" East 130.34 feet to a locust stake; running thence South 25 ° 22'20" East 247.32 feet to a locust stake;
running thence South 68° 40' West 427.38 feet to a granite monument and land formerly of William Gillette;
running thence North 25 ° 8' 50" West 860.78 feet to a granite monument on the southerly line of Kings
Highway; running thence along Kings Highway in an easterly or northeasterly direction 120 feet to the point or
place of beginning.
EXCEPTING the therefrom so much as was heretofore devised to Joseph Cherepowich by "THIRD"
paragraph of last Will and Testament of Martrona Czsrapowicz, also known as Martrona Cherepowich, dated
August 8, 1947 and probated in the Suffolk County Surrogate's Court on June 2, 1951, and more particularly
described as follows: ALL THAT TRACT OR PARCEL OF LAND situate at East Marion, in the Town of
Southold, County of Suffolk and State of New York:
PARCEL L BEGINNING at a point on the southerly line of Kings Highway where the same is
intersected by the westerly line of land now or formerly of Ruth Hart Snyder; running
thence along land last mentioned two courses as follows: South 27 ° 20'20" East 149.39
feet; running thence North 59° 25' 10" East 128.10 feet; running thence South 26° 39'
10" East 511.06 feet to a locust stake; running thence North 68 ° 48'20" East 130.34 feet
to a locust stake; running thence South 25 ° 22' 20" East 247.32 feet to a locust stake;
-2-
SCHEDULE "A" CONTINUED
LEGAL DESCRIPTION
running thence South 68 ° 40' West 427.38 feet to a granite monument and land formerly
of William Gillette; running thence North 25° 8' 50" West 860.78 feet to a granite
monument on the southerly line of Kings Highway,; running thence along Kings
Highway in an easterly or northeasterly direction, 120 feet to the point or place of
beginning;
PARCEL II: BEGINNING at a point on the southerly line of Kings Highway where the same is
intersected by the westerly line of the land or right of way now or formerly of William
Gillette and being approximately 30 feet westerly of the westerly line of Parcel I
hereinabove mentioned and described; running thence in a general southerly direction
along the said westerly side of the lands or right of way formerly of William Gillette
South 25 ° 8' 50" East about 854 feet to a concrete monument set on a line being the
extension of the southerly line of Parcel I hereinabove mentioned; thence westerly South
68 ° 40' West a distance sufficient to contain two (2) acres bounded on the east by the
said westerly line of lands or right of way now or formerly of William Gillette, southerly
by a line being the extension of the southerly line of Parcel I Westerly by lands
hereinafter devised to my son, Peter; Northerly by Kings Highway. TOGETHER with
a right of way twenty (20) feet in width connecting Parcel I and the parcel herein
described as Parcel 11 and more particularly described in deed of Philip Boyer to Joseph
Cheropowicz and wife dated February 16, 1937 and recorded in Suffolk County Clerk's
Office in Liber 1908 of deeds at page 541 on February 25, 1937.
PARCEL III: A parcel of arable farm land being eight (8) acres in area, more or less, bounded northerly
by Parcel II herein; Easterly by lands formerly of William Gillette; Southerly by the
Barnyard and unplowed grass plot; Westerly by the easterly side of the farm road leading
to the barnyard.
PARCEL IV: The easterly half of my woodland lying at the Northwest corner of my homestead farm
(It is my will that the said woodland be equally divided between my sons, Joseph and
Peter. Peter to get the westerly land which lies on Shipyard Lane and that Joseph shall
have the easterly half adjoining).
EXCEPTING so much of above premises as heretofore conveyed to Thomas Santacroce and Marion
Santacroce, his wife.
ALSO EXCEPTING the premises described in the Deed to Joseph A. Cherapowich and Susan G.
Cherepowich dated January 7, 1987 and recorded in the Suffolk County Clerk's Office in Book 10238 of Deeds
at Page 376.
-3-
PLEASE TYPE OR PRESS FIRMLY WHEN WRITING ON FORM
INSTRUCTIONS (RP-5217-INS): www.orps.state.ny.us
FOR COUNTY USE ONLY
C1. SWIS Code ~R New York State Departfnent of
Taxation and Finance
C2. Date Deed Recorded Office of Real Property Tax Services
ear RP- 5217
C9. Book C4. Page Real Property Transfer Report (8110)
PROPERTY INFORMATION
t. Property l ~ 6a q ROUTF. 75
I t SOUTHOLD I I
CITY OR TOM VLIWA zP mrE
2-Blryer I KEVIN T. POLAK AND GREGORY P. POLAK AS h'R1lrTRES O
Name T cadFSNr t F,TSrxs¦E F THR-LEV.IN .T...P.Oi.AM TRUST 1
IEGRY P. POLAK AND WILLIAM J. POLAK III, AS TRUSTEES OF THE GREGORY P. POLAK TRUST
I 1JT?.f TeM T ROLAK-7i1-AND-KEVIN T--ROLAK,LA$ UISTRES OF TH-J-.-POLAK TRUS•If
S. Tax Indicate where future Tax Bills are to be sent
assets if other then buyer address (at bottom of form) I~ I - nnsr ntur . - - I
Address
I 3l.F l NUbete MD S T I CIT Mai 3-a-9 - I I1 1 /S1CCDE 1
0. Indicate the number of Assessment (Only N Part at a Parcel) Check as they apply:
F Pan of a Parcel
Roll parcels transferred on the deed I 2 I a of Parcels OR
IA. Planning Board with Subdivision Authority Exists ?
5. Dsed ea. Subdivision Approval was Required for Transfer ?
Property I cwr ~ xI OR I „ . 3 . 1 e 7 8 I 4C, Parcel Approved for Subdivision with Map Provided ?
Sim
&Seller I WILLIAM J. POLAK III, KEVIN T. POLAK AND GREGORY P. POLAK,_AS TRUSTEES OF I
Noma THE HELEN A. POLAK IRREVOCABLE M ONLY TRUST
~al7me~eaem9,ir 1
7. Check the box below which most accurately describes the use of the property at the time of sate: Cheek the boxes below as they apply: ?
a. Ownership Type Is Condominium
A One Family Rdsidential E X'A9deullural I Community Service 9. Now construction on Vacant Land ?
I; 2 or 9 Family Residenti al F Commercial J Industrial 10A. Property located within an Agricultural District ?
C Residential Vacant Land G rAparlmenl K Pubic Service 10B. Buyer received a disclosure notice adirating ?
1) Non-Rowdonaal Vacant Land If Entertainmont / Amusomont L Forest that the property is in an Agricultural District
SALE INFORMATION 15. Check one or more of these conditions a$ appllcable W transfer:
11. Sale Contract Date I N 1A / I A X Sale Between Relatives or Farrow Relatives
.1, By B Sale Between Related Companies or Partners in Business
C One or the Buyers is also a Seller
12. Dore of Sale I transfer 104 / 04 / 2012 I D Buyer or Seller is Government Agency or Lending Institution
Monet sly ear 1: Deed Type not Warranty or Bargain and Sale (Spedly Below )
I: Sale of Fractional or Less than Fee Interest ( Spedly Below )
G Slgnikent Change in Property Between Taxable Status and Sale cases
17. Full Sale Price 0- 0.0 1 H Sale of Business is Included in Sale Price
( Full Sale Price Is the total amount paid for the property Including personal property. I Ober Unusual Factors AflDcling Sale Prim ( Specify Below)
This payment may be In the hum of cash, other property or goods, or the assumption of J None
mortgages or other obligations.) Ploaso round to tie nearest whote daaer emounf.
14. Indicate the value of personal I 0 0 1
propatty Included In the ilia
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tex Bill
16. Year I Assessment Roll from 1 1
which Information taken 1 17. Total Assessed Value (of all parcels In tri nsferl 4 5 0 0 1
,L~ 1 r ~/1L
1s. Property Class L.0 5 I-U 19. School District Name I -y y "~JI' -v Lg _
20. Tax Map ldentlfler(s) I Roll Identifler(s) (N more than four, attach shoot with additional IdmdNler(s) )
1 1000-38-1-1.8 I I _ I
1 1000-38-1-1.13
CERTIFICATION
I eonft ten ¦o of use hems of Irrrar"oloe entered an this form sra true and carvaet (to the Met of nq Immuledee and bidMQ and I understand that the making n ¦sy willful
false statemmd ¦t renewed feet herein was sable", me the provisions or the eel law relative to the making and filing of folse Instruments.
SELLER SIGNATURE BUYER CONTACT INFORMATION -G; "WRYf (
~mpry.W.IND roaq boar.Neta: IfbrywwW iu rot U.C. s0 fidu ly. wass elm a name and m , Lhan a in= and Cpintt in
mmP~Y. esmA mty, eul r. not an indridiAl apse ac oMad inkwmabdi
r of an kidlVlduTTwre6porweb part' who ran arnww qumborn Meaning the rms%r maul be ent w.
WIb PO7:A1C'TI~ -R EVEN-'lP PO yypn m print clsartir.l
BUYER SI NATUR
I _
UISI NAM Fawn NAME
RM POLAK I KEVIN T. PO C
BUYER'S ATTORNEY AnEACODh TMEP40NEF+adoral
SCOLARO.a-SHULMAN, COHEN, FETTER 6 BURSTEIN- P
ear wwF. FibST eAUa I
81eiE111LdeEN STaEET WNE
315 1471-8111
AREACODE TF.I13-exiEMINGE4
(NEWYLORKSTATE GUY Oa corm sTATF MP CODE
OPY