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L 12783 P 303
----------- IIIIIIIIIIIIVIIIVIIIVIIIVIIIVIIIVIIIVIIIIIIIIIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEED Recorded: 08/01/2014 Number of Pages: 4 At: 12 :41 :16 PM Receipt Number : 14-0100465 TRANSFER TAX NUMBER: 14-00100 LIBER: D00012783 PAGE : 303 District: Section: Block: Lot: 1000 079.00 04.00 004.001 EXAMINED AND CHARGED AS FOLLOWS Deed Amount: $0.00 Received the Following Fees For Above Instrument Exempt Exempt Page/Filing $20.00 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 $60 .00 NO Transfer tax $0 .00 NO Comm.Pres $0 .00 NO Fees Paid $255.00 TRANSFER TAX NUMBER: 14-00100 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County ' . RECORDED 2014 Aug 01 12:41:16 PM Number of pages JUDITH A. PASCALE CLERK OF SUFFOLK COUNTY This document will be public L D00012783 P 303 record.Please remove all DT# 14-00100 Social Security Numbers prior to recording. Deed/Mortgage Instrument Deed Mortgage Tax Stamp Recording Filing Stamps 3 1 FEES Mortgage Amt. Page/Filing Fee 41�0 1.Basic Tax Handling 20. 00 2. Additional Tax /,-584 11`5 SubTotal Notation SpecdAssit. EA-52 17(County) Sub Total or EA-5217(State) TOT.MTG,TAX Dual Town Dual County R.P.T.S.A. Pill Held for Appointment— Comm,of Ed. 5. 00 Transfer Tax —0— Affidavit Mansion Tax 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 OL) YES or NO Other Grand Total 1�qz�_ If NO, see appropriate tax clause on - page It—of this instrument. "A nA nn | ProperReal_ _ Tax Service improved R:e_-_sl RECORD&RETURN TO: Vacant Land CHRISTOPHER PETILLO, ESQ. TO )n 330 VANDERBILT MOTOR PARKWAY HAUPPAUGE, NY 11788 TO ` Mail to:Judith A.Pascale,Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 Co.Name TITLEWORKS ABSTRACT, INC 8 Suffolk Counq Recording & Endorsement Page This page forms part of the attached DBD made by: (SPECIFY TYPE opINSTRUMENT) The premises herein|ssituated in as co trustees of the Forosich Fam Irrev Trust SUFFOLK COUNTY,NEW YORK. TO mt»eTOwwof SOUTHOLD |nthe VILLAGE HIS WIFE o,HAMLET of BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY No consideration THIS INDENTURE,made the 7 I day of MAI ,WIy deed BETWEEN Nadalene Sirmons and Rodney Sirmons, as Co-Trustees of the Forosich Family Irrevocable Trust u/a/d April 26,2012,residing at 12 Beekman Place,New York,New York party of the first part,and Anthony Forosich and Lina Forosich,his wife,residing at 1405 Anchor Lane,Southold,New York 11971, DISTRICT party of the second part, 1on0 WITNESSETH, that the party of the first part, in consideration of TEN dollars and other good and valuable SECTION consideration paid by the party of the second part,does hereby grant and release unto the party of the second + 079.00 part,the heirs or successors and assigns of the party of the second part forever, BLOCK ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, 04.00 lying and being at LOT SEE ATTACHED DESCRIPTION 004.001 Subject to all covenants,restrictions,agreements and easements of record,if any. Said premises known as 1405 Anchor Lane,Southold, New York 11971 Being and intended to be the same premises as conveyed to the party of the first part by deed dated recorded 5/30/12 in Liber D00012694 page 719 in the Suffolk County Clerk's Office. 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 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. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written. Nadalene Sir ofis,Co-Trustee- Rodney Sir ons.Co-Trustee— Standard N.Y.B.T.U.Form 8002-Bargain and Sale Deed,with Covenant against Grantor's Acts—Uniform Acknowledgment Form 1000-7 TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YORK STATE State of New York,County of SLzPk�-\1G ss: State of New York,County of POO � ss: On the 3IS}day of Oa j in the year fly On the 3 i Sr dlayof 1_'G'A in the year Loiy before me,the undersigned,personally appeared before me,the undersigned,personally appeared Nadelene Sirmons Rodney Sirmons 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 individual(s)whose name(s) is satisfactory evidence to be the individual(s)whose name(s) is (are)subscribed to the within instrument and acknowledged to (are)subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the capacity(ies), and that by his/her/their signature($) on the instrument,the individual(s),or the person upon behalf of which instrument,the individual(s),or the person upon behalf of which the individual(s)acted,executed the instrument. the individual s}acted,executed the instrument. (sig an office ofividual taking acknowledgment) (signature and office of individual taking acknowledgment) irSTEVEN KRAMER Notary Public,State Of New York RIAZ ALI No.02KR6170141 Notary Public,State of New Yak Qualified In Suffolk County r No.01AL6016239 Commission Expires June 27,20 I y Cuatifled in Bronx County 'firm Expires November 16,3014 TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE State(or District of Columbia,Territory,or Foreign Country)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 to the within instrument and acknowledged to me that he/she/they executed the same in his/heritheir 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,and that such individual made such appearance before the undersigned in the in (insert the City or other political subdivision) (and insert the State or Country or other place the acknowledgment was taken) (signature and office of individual taking acknowledgment) FOROSICH FAMILY IRREVOCABLE TRUST Dl 7T'bc.�: 1060 SECTION 079.00 TO BLOCK 04.00 LOT 004.001 ANTHONY FOROSICH AND COUNTY OR TOWN Suffolk LINA FOROSICH,HIS WIFE STREET ADDRESS 1405 Anchor Lane Southold,New York 111971 BARGAIN AND SALE GEED WITH COVENANT AGAINST GRANTOR'S ACTS RETURN BY MAIL TO: Title No. — Christopher Petillo,Esq. Feldman,Kramer&Monaco,P.C. 330 Vanderbilt Motor Parkway Hauppauge,NY 11788 7 Schedule A ALL that certain plot, piece or parcel of land,with the buildings and improvements thereon crated,situate,lying and being in the Town of Southold, County of Suffolk and Stats of New Yozc; known and"read as Lot 15 on a certain map entitled, "Map of Harbor Lights Estates,Section 1",and filed in the Office of the Clerk of the County of Suffolk on June 8, 1965 as Map No.4362. ALL that certain plot,piece or parcel of land,situate,lying and being in the Town of Sowhold, County of Suffolk and State of New York, bounded and described as follows: BEGI 4MG at a point on the easterly side of Lot No.2 as shown on Map of-Harbor Lights Estates, Section 1, Map No. 4362, distant 25 feet northerly from the southeasterly comer of said Lot 2; running thence North.25 degrees 54 minims 50 seconds East along the easterly side of said Lot 2,25 feet; thence South 64 degrees 05 minutes 10 seconds East 31.28 feet; thence South 16 degrees dl minutes 00 soconds West 25.37 feet; and North 64 degrees 05 minutes 10 seconds Wast 35.64 feet to the point or place of BEGINNING. SUBJECT TO an easement for passage and repassage over the westerly five(5)fleet of said pmnises and together with an easerdent for pOsagie and repassage over an easement five(5)feet in width from said premises to the northerly side of Lot 15 on said map adjacent to said Lot 2. TOGETHER WITH an easement over the streets or roads shown on said fled map. SUBJECT TO an easement over the southerly 2 feet(approximate)of Lot 15 on said : map in favor of the Town of Southold for highway purposes. ; i TOGETHER WITH an easement for boating purposes,in common with od=-over a strip of land S0 feet in width, extending from the northerly line of Lot lel in a north/northeasterly direction to Southold Bay(Peeonic Bay on subdivision map)for ingress and egress to said bay. TOGETHER WITH the use, in common with others, of the beach area and parking arts adjacent thereto;said bemb area leaving a depth of approximately 50 fact fmm the average high water,mark an Peeonie Bay,and having a length of 900 feu,more or teas,measured along the ordinary high water manic,and said parking area having a , frontage on the northerly side of Harbor Lights Drive of approximately 150'feet, j running westerly along said stroet from Lot No. 7, and having a depth, of not less (: i INSTRUCTIONS(RP•5217-PDF-INS):vrww.orps.state.ny.us FOR•COl1NTY USE ONLY DeNew York State Department of ci.31101110 code i S'/© /Y! Taxation and Finance C2.Date ad Recorded (V I Office of Rea(Property Tax Services Y0e1 °" Y" Lq RP-5217-PDF C3.Book / 1S r) 3011.Page O Real Property Transfer Report($/10) PROPERTY INFORMATION 1.Property 1405 Anchor Lane tacedsn •BISLT NIIatFA •BIER W WE Southold 11971 -CITYM TOFM NtLACE 'ZPCOOE 2.Buyer Forosich Anthony Name 'LAST NAiMeCOMPYn FAST NAPE Forosich Lina LAw vAYEIeoaPMY ♦W Nwe 7.Tax Indafterhlarsfuturs Tax Bills eralobeeam Forosich Lina BBung M other then buyer ack ran(at bottom of farm) LAS:N wLjwYFANY FRET IoNE Address 1405 Anchor Lane Southold NY 11971 STREE MMMAMMME CINORTOM STM-E opcom 4.Indkafo the number of Assessment 1 act Parcels OR E]Pan Of a parol (Only If Part of a ParcaO Chock as they,apply: Roll parcels bamTened on the dead M.Planning Board with SuDdiNaon ANheey Exists El e.Dead Property 'FRONT FEET X OR 0• 4&SunWuon Approval was Requirrid for TransferEl$im 'DEPTH 'ACPEB 4C.Penal Approved for Sutdiuislen with Map provided ❑ Forosich Family Irrevocable Trust a.Sell" rABl xAu caPAra FIRST NAME Name LAST"AIE OMIU4 r FRST NAME '7.select the description which most acemialy describes the Check Use bona below n they apply: use of the property at the ams of foto: 6.ownership Type Is C x omineum El A.One Family RLsidential 6.Now Construction on a vacant Land ❑ 114A.Property Located within an Agricultural District El 1a8.Buyer received a disclosure notice Indicating that the property is in an O Agricultural District SALE INFORMATION1 16.Check one or more of dress conditions as applicable to tra widen A Sala Between Ralaeves or Former Relatives 11.$W COntreat Dab B.Sale between Related Companies or Paltasrs in BuW ns, C.One of the Buyers is also a Seller 05/211/2014 0.Buyer or Seller is Govemgm Agency or Landing Institution 'tS.Dam of SeJYTrsmfar nE.Deed Type not venality or Baryain end Sale(SM*Bows) F.Sale d Fractional of Less Own Fee Interest(Specify Below) 113.Full Sale Rice 0.00 G.Slpnl6ram Charge in Property Between Tandes Status and Sale Dates N.Sale of Business Is Included in Sale price 1 Full Sale Pita if the total amount paid for the property inducing Personal property. 1.Other Unusual Factors Allecang Sale Price(Spm*Below) This Payment soy be in the fern of ash,other property,or goods,or the anumpbon of J.None mongeges or other oMigaticoa)Ream round mare neela n Whole dollar amount. Commem(a)on Condition: 14.Initiate the value of personal �k properly Included In the Sale D.00 ASSESSMENT INFORMATION-Data should reed the latest Final Assessment Roll and Tax Bill 16.Year of Assessment Rall from which Information taken(YY) 14 117.Total Amerced Value 13,100 '11.Property Clem 210 _ '16.School OBtrict Name Southold '26.Tax Map Id9ntMGrpyRol1 IdnNINr(s)(If more then four,aaach Ghost with addabml ldentBlar(e)) 079.00-04.00-004.(joi CERTIFICATION I can"that a0 of use Rens of Information 0 to on a"form are hue and correct(lo the ben of my knowledge and bellep and I understand that am making of any wlMul Isles atatemam of metadd fact hanin subject me to flreJrrovls1606.aLiM.ptllWNtLreletiea to the making and Ming of take bwtruments. NS SELLER SIGNATURIF BUYER CONTACT INFORMATION X _ __ (EyR kdomuaon for to Buyer.NOW.if Myer is LLC.@Kkq,wsachd^ealpaatlaM,ipyy aleft mnpwly�M:ae w 3i aaRyWR11��aWSVWUl seed a Sooner.SON a IWIIB and Wmad Wit hen at YI nit-rA&Aft% lebN ptla� ,��w , l94 Pay owetanr aewana we OWWWMun be WOW.Type or lives manly) SELLER SIN A:WE �V/C A41/ 411194 1 p@ Forosich Lina Ay L..i/E� 4iY / LAST AAWT RRSS NAYS y��t1�b (631) 765-2579 /9%XXrr�� 'AnEACOOE 'iEIEPNCeE MYKN mu.Wien% BYY6R WNAi1dE DAZE 1405 Anchor Lane 'STRUT NUMBER 'STREET NAYS 1 Southold NY 11788 -Co.our TOWN 'STATE WCODE BUYER•B ATTORNEY Petiilo Christopher LASTIMW FmT NA II, Car a3I- 1 Urso MEACON 7ELEPN EMANERLE,teewt