HomeMy WebLinkAboutL 12815 P 353SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED
Recorded:
04/29/2015
Number of Pages:
5
At:
03:33:02 PM
Receipt Number :
15-0057502
Handling
$20.00
TRANSFER TAX NUMBER: 14-24119
LIBER:
D00012815
NO
NYS SRCHG
PAGE:
353
District:
Section:
Block: Lot:
EA -STATE
1000
125.00
04.00 006.000
$5.00
EXAMINED AND
CHARGED AS FOLLOWS
$0.00
Deed Amount:
$387,500.00
$0.00
NO
Received the Following Fees For Above Instrument
JUDITH A. PASCALE
County Clerk, Suffolk County
Exempt
Exempt
Page/Filing
$25.00
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
$260.00
TRANSFER TAX NUMBER:
14-24119
THIS PAGE
IS A PART
OF THE INSTRUMENT
THIS IS NOT
A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
Number of
This document will be
public record. Please remove
all
Social Security Numbers
prior to recording.
RECORDED
2015 ADr 29 03:33:02 P19
JUDITH A. PASCALE
CLERK OF
SUFFOLK COUNTY
L D00012815
F 353
DT# 14-24119
Deed / Mortgage Instrument I Deed / Mortgage Tax Stamp I Recording / Filing Stamps
FEES
Page / Filing Fee.
Mortgage Amt.
1. Basic Tax::... • :._ :. _
Handling 20. 00
2. Additional Tax _
TP -58
Sub Total
Spec. /Assit.
Notation _
EA -52 17 (County) _ Sub Total
or
Spec./Add. J
EA -5217 (State)
TOT. MTG. TAX _
®�
Dual Town Dual County
R.P.T.S.A._
Held for Appointment
m
Comm. of Ed. 5. 0rr�
Transfer TaxJ_
4
Affidavit
Mansion Tax
Certified Copy _ _�
The property covered by this
mortgage is or will be improved by a
NYS Surcharge 15. 00 Sub Total
one or two family dwelling only.
Other _ Grand Total
YES or NO
a(�p� If NO, see appropriate tax clause
on page # of this
instrument.
15010326 1000 12500 0400 006000 0
5 Community Preservation Fund
Rea( P c R pL A IIIIIIIIIIIIIIII I I I
II[II II I�III III I�IIIIII Il�j
Consideration Amount $c a� �
Tax Sen 24 -APR -1 tt[ !
Agenc
CPF Tax Due $►
Verification --- '
h
Satisfactions/Discharges/Releases List Property Owners Mailing
Improved
Address
_
RECORD Et RETURN TO:
lip
Vacant Land
D
Oco)
D 1O
t8w�4/� 'n I I d1TD
-
Mail to: Judith A. Pascale, Suffolk County Clerk
71
Title -Company Information
310 Center Drive, Riverhead,
Co. Name
NY11901
www.suffo[kcountyny.gov/clerk
Title #
8
Suffolk County Recording Et
Endorsement Page
This page forms part of the
attached DEED made
by: (SPECIFY TYPE OF INSTRUMENT)
Theodore J. li Kathy Maher
/LI
TO
VICTOR Et LEONORA SPITALIERI
The premises herein is situated in
SUFFOLK COUNTY, NEW YORK.
In the TOWN
of SOUTHOLD
In the VILLAGE
Or HAMLET of LAUREL
4 b 7y S
NY 005 - Bargain and Sale Deed with Covenant against Grantor's Acts individual or Corporation (Single Sheet) (NYBTU 8002)
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT -THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
THIS INDENTURE, made the 2y day of HQt-dN in the year 2015
BETWEEN
Theodore J. Maher and Kathy Maher, his wife, both residing at 3365 Delmar Drive, Laurel, New York 11948
parry of the first part, and /
Victor Spitalieri and Leonora Spitalieri, his wife, both residing at
party of the second part,
WITNESSETH, that the party of the first part, in consideration of Ten Dollars and other valuable consideration paid by
the party of the second part, noes 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 in the Hamlet of Laurel, Town of Southold, County of Suffolk and State of New York, known as Sufoflk County
Tax Map number 1000-125.00-04.00-006.000, more particularly bounded and described as follows:
ALL that certain plot, piece or parcel of lind, with the buildings and improvements thereon
erected, situate, lying and being in the Town of Southold, at Laurel, County of Suffolk and
State of New York, known and designated as Lot No. 24 on a certain map entitled, "Map of
Laurel Country Estatgs", and filed in the Suffolk County Clerk's Office on June 22, 1970 as
Map Number 5486, which is more particularly bounded and described as follows:
BEGINNING at a point on the westerly side of Delmar Drive the fOhowing two courses and
distances northerly from the northerly end of a curve which connects the we4terly side of
Delmar Drive with the northerly side of Gina Street: (1) North 13 degrees 38 4floutes 10
seconds West, 5.49 feet; and (2) along the are of a curve having a radius of 2,304.68 feet a
distance of 99.87 feet to the point of beginning;
RUNNING THENCE South 71 degrees 23 minutes 40 seconds West a distance of 187.83 feet
to lands now or formerly of Henry Romanowski;'
THENCE North 18 degrees 36 minutes 20 seconds West along said last mentioned lands, 130 .
feet to a point;
THENCE North 71 degrees 23 minutes 40 seconds East a distance of 190.00 feet to the
westerly side of Delmar Drive;
THENCE southerly along the westerly side of Delmar Drive the following two courses and
distances: (1) South 18 degrees 36 minutes 20 seconds East, 30 feet; and (2) along the are of a
curve having a radius of 2,304.68 feet a distance of 100.02 feet to the point or place of .
BEGINNING.
BEING and intended to be the same premises conveyed to Grantors herein by Deed dated January 30, 1996 and recorded
May 9, 1996 in Liber 11773 page 381 in the Office of the Suffolk County Clerk.
TOGETHER with all right, title and interest, if any, of the parry of the first part of, 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 ofthe party ofthe 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 ofthe 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 incumbered in any way whatever, except as aforesaid.
AND the party ofthe first part, in compliance with Section 13 ofthe Lien Law, covenants that the party ofthe 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 ofthe improvement and will apply the same first to the payment ofthe
cost ofthe improvement before using any part ofthe total ofthe 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 ofthe first part has duly executed this deed the day and year first above written.
IN PRESENCE OF:
a ly
4l�:uyy,/oC1 I J
ELIZABETH OLIVO
= Notary Putiltc • State 01 Fj"Wa
My Comm. Explroa Aug 21, 2015
COmmisal0n'F EE 124877 l r
USEACKNOWLEDGMENTFORMBEL OWWITHINNEWYORKSTATEONL Y:
State of New York, County of Suffolk ) ss.:
On the day of in the year 2015
before me, the undersigned, personally appeared Theodore J. Maher
and Kathy Maher, 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/shellhey 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.
ACKNOWLEDGMENTFORM FORUSEWITHINNEWYORK STA TEONLY:
(Nets, York Subscribing Witness Acknowledgment Cerrificaiel
State of New York, County of ) ss.:
On the day of in the year
before me, the undersigned, personally appeared
the subscribing witness to the foregoing instrument, with whom I
am personally acquainted, who, being by me duly sworn, did
depose and say that he/she/they reside(s) in
(f the place ofresidence is in a city, include the street and street number, tf
anv, thereoj); that he/she/they know(s) to be the individual described
in and who executed the foregoing instrument; that said subscribing
witness was present and saw said
execute the same; and that said witness at the same time subscribed
his/her/their name(s) as a witness thereto.
BARGAIN & SALE DEED
WITH COVENANTS AGArNST GRANTOR'S ACTS
TITLE NO.
Theodore J. Maher and Kathy Maher
TO
Victor and Leonora Spitalieri
FIDELITY NATIONAL TITLE
INSURANCE COMPANY
nvcoeroxATFD 1928
Fidelity �'"
M-baNm Ymk Slaw LadnrraAsraet Wn
USEACKNOWLEDGMENTFORMBELOWWITH/NNEW YORKSTATEONI. Y:
State of New York, 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 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.
ACKNOWLEDGAfENTFORM FOR USEOUTSIDENEWYORK STATEONL Y.'
(Out of State or Foreign General Acknowledgment Certificate/
- - ) ss.:
-----------------------------
(Complere 6'enue ,vilh .Srnle, Cnurrrry, Province or MunicipnlityJ
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/her/their capacity(ies), 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.
DISTRICT 1000
SECTION 125
BLOCK 4
IAT 6
COUid'fYORTOWN Suffolk County
RECORDED ATREQUFSPOF
Fidelity National Title Insurance Company
RETURN BY MAIL TO
0V116nt311ASW
Stool" In at6ti, • ai!Gu'i vtc,taN
�•_
'
trot euA :ettcX3 .mrnL.a VM
^'
.t•S
mw 33 nei??imroJ
�?.•� r
USEACKNOWLEDGMENTFORMBELOWWITH/NNEW YORKSTATEONI. Y:
State of New York, 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 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.
ACKNOWLEDGAfENTFORM FOR USEOUTSIDENEWYORK STATEONL Y.'
(Out of State or Foreign General Acknowledgment Certificate/
- - ) ss.:
-----------------------------
(Complere 6'enue ,vilh .Srnle, Cnurrrry, Province or MunicipnlityJ
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/her/their capacity(ies), 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.
DISTRICT 1000
SECTION 125
BLOCK 4
IAT 6
COUid'fYORTOWN Suffolk County
RECORDED ATREQUFSPOF
Fidelity National Title Insurance Company
RETURN BY MAIL TO
CXHiari
�►07US
VX
NY 005 -Bargain and Sale Deed with Covenant against Grantor's Acts Individual or Corporation (Single Sheet) (NYBTU 8002) . : r
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT -THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
THIS INDENTURE, made the 2_ { day of ru.tfGVin the year 2015
BETWEEN -
Theodore J. Maher and Kathy Maher, his wife, both residing at 3365 Delmar Drive, Laurel, New York 11948
patty of the first part, and
Victor Spitalieri and Leonora Spitalieri, his wife, both residing at
party of the second part,
WITNESSETH, that the party ofthe first part, in consideration of Ten Dollars and other valuable consideration 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 parry 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 in the Hamlet of Laurel, Town of Southold, County of Suffolk and State of New York, known as Sufoflk County
Tax Map number 1000-125.00-04.00-006.000, more particularly bounded and described as follows:
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, at Laurel, County of Suffolk and
State of New York, known and designated as Lot No. 24 on a certain map entitled, "Map of
Laurel Country Estatgs", and filed in the Suffolk County Clerk's Office on June 22, 1970 as
Map Number 5486, which is more particularly bounded and described as follows:
Wil t m
2Iris ll Q
C` . ;r
a� a.Itr,,lot the westerly side of Delmar Drive the following two courses and
0fft%20 nor-�he,��y�ipin he norther) end ofa curve which connects the westerly side of
If arldu� IF211 T; f f� Y S y
IjhrRar, rry> herly side of Gina Street: (1) North 13 degrees 38 minutes 10
segoiadsnWest, 5`.y4f�et; d (2) along the arc of a curve having a radius of 2,304.68 feet a
distance.of99.87-feet•to the point of beginning;
RUNNING THENCE South 71 degrees 23 minutes 40 seconds West a distance of 187.83 feet
to lands now or formerly of Henry Romanowski;
THENCE North 18 degrees 36 minutes 20 seconds West along said last mentioned lands, 130
feet to a point;
THENCE North 71 degrees 23 minutes 40 seconds East a distance of 190.00 feet to the
westerly side of Delmar Drive;
THENCE southerly along the westerly side of Delmar Drive the following two courses and
distances: (1) South 18 degrees 36 minutes 20 seconds East, 30 feet; and (2) along the are of a
curve having a radius of 2,304.68 feet a distance of 100.02 feet to the point or place of
BEGINNING.
BEING and intended to be the same premises conveyed to Grantors herein by Deed dated January 30, 1996 and recorded
May 9, 1996 in Liber 11773 page 381 in the Office of the Suffolk County Clerk.
TOGETHER with all right, title and interest, if any, of the party of the first part of, 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 parry 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 incumbered 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.
IN PRESENCE OF:�
eod,o)e J. Maher
;W'210
% ELIZABETH OLIVO
g. : Notary Public - State or Florida
210 MY Comm, Expires Au 24.2015 /�
COmmisslen t EE 124077 l Y J
USEACKNOWLEDGMENTFORMBELOWWITHINNEWYORKSTATEONL Y.
State of Nrw York, County of Suffolk ) ss.:
On the day bf in the year 2015
before me, the itndersigned, personally appeared Theodore J. Maher
and Kathy Mater, 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/shelthey 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.
ACKNOWLEDGMENTFORM FORUSEWITHINNEWYORKSTATEONLY.
(Nese York Subscribing Witness Acknowledgment Certificate)
State of New York, County of ) ss.:
On the day of in the year
before me, the undersigned, personally appeared
the subscribing witness to the foregoing instrument, with whom I
am personally acquainted, who, being by me duly sworn, did
depose and say that he/she/they reside(s) in
(if the pace of residence is in a city, include the street and street number, if
any, thereqfi; that he/she/they know(s) to be the individual described
in and who executed the foregoing instrument; that said subscribing
witness was present and saw said
execute the same; and that said witness at the same time subscribed
his/her/their name(s) as a witness thereto.
BARGAIN & SALE DEED
WITH COVENANTS AGAINST GRANTOR'S ACTS
TITLE NO,
Theodore J. Maher and Kathy Maher
TO
Victorand Leonora Spitalieri
FIDELITY NATIONAL TITLE
0 INSURANCE COMPANY
lncloRPoRATFD 1928
"Gate -Y- Fidelity
Mem&. New York store r—d naeAnaeiad-
.1
USEACKNOWL EDGMENTFORMBELOWWITHINNEW YORKSTATEONLY.
State of New York, 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 to the
within instrument and acknowledged to me that he/site/they
executed the same in his/her/their capacity(ies), and that by
his/her/their signatures) on the instrument, the individual(s), or the
person upon behalf of which the individual(s) acted, -executed the
instrument.
ACKNOWLEDGMENTFORM FORUSEOUTmDENEWYORK STATEONL Y:
/Ou! gjStare or Forei* Gerre�nI Acknaw edgment Cerlificcue)
{a of F�qr'-dq--fl-�1-7-1n-`-1- Ritter } ss.:
(Complete h'emte with State, Cawurv. Province or Municipality)
On the 2 H "'day of Nojci n the year
before me, the undersigned, personally appeared
personally known to me or proved to me on the basis of SEsfacto y
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), 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.
ELOBEM OLIVO
Notary Pu00e - State of Rem&
My Comm. Expires Avg 24, 2015
Men Copimissim 0 EE 124877
DISTRICT 1000 (:�;v
SECTION 125
BLOCK 4
LOT 6
COUNTYORTOWN Suffolk County
RECORDEDATREQUFS7'OF
Fidelity National Title Insurance Company
RETURN BY MAIL TO
Vafrhle 7,
qq-77
FOR•COUNTY USE ONLY INSTTRRUCnONS(RP-5217-POF-INS): www.olps.state.ny.us
C1. SWIS Code / 3 2S Lal 7 I New York State Department of
Roll paresb tnnsfared on Um deed hP of Parcels OR ❑ Ped of a Parcal (Only N part arm Parcoq Check as they apply;
Taxation and Finance
/ n
C2 Dace Dead �eeOrded Li 9 I
Lq
Office
c9. BDOk 1ca..P �e VMr
PROPERTY INFORMATION
of Real Property Tax Services
RP- 5217 -PDF
Real Properly Transfer Report (BH 0)
1. Properly 3365
❑
Location Delmar. Drive
4C. Parcel Approved for Subdivision milh Map provided
•araEETgWIaFA _
Maher
G. Saler •IAarNav:IcamAex
•81gEETNAEE
Southold
�a.wn --- +,a Lire L
own
vanAOt —
7. Buyer Spitalieri
11940
•m000e
Nor"IAerNIaX0WAgy Leonora
LAST xArFx.•OIpAN••
FlRCT NOA6 -
rvrarNUB
SDitalieri
'7. Select the dsaerlpBal which most accurately describe, the
use of the propnly at the time of gab:
Victor
IAeTNRMIFCaEPANr
a. Owncrenip 7 ype IS Condominium
3. Tax r.RaT,yMO:
Billing Indicate whew Pollee Tax 8109 are to be Wt Spi to l ierJ
If other Olen buyer address(al betlom of form
Address )
V' C L c.
IAST NsuseeoraAN•
:1365 Delmar Drive
r1Rel KA e
=aural
�_„
�MUBERA —NAME CRYORTOWN
NY
11948
4. Indicateneo number et Aeasasmant 1
STATE 2PCCCE
Roll paresb tnnsfared on Um deed hP of Parcels OR ❑ Ped of a Parcal (Only N part arm Parcoq Check as they apply;
5. Deed
4A. Planning Board with SubdrAsion Authority FJxsls
Property Size ':Naar neer , .OEnTR OR 0.57
_ 4B. Subdivision Approval was Required for Transfer
❑
4C. Parcel Approved for Subdivision milh Map provided
❑
Maher
G. Saler •IAarNav:IcamAex
'_Lhecdore a
NamsYRarNME
.Naber
Kathy
LAST xArFx.•OIpAN••
FlRCT NOA6 -
'7. Select the dsaerlpBal which most accurately describe, the
use of the propnly at the time of gab:
Check the boxes below as they apply:
One Family Residential
a. Owncrenip 7 ype IS Condominium
El
9. New Congtnldion ion a Vacant Land
11111A.
111A. Property Located wdnin an Agdaaturel X dad
0
108. Buyer recbiwad a disclosure notice indicating that the property ie in an
SALE INFORMATION
Agricultural lxasict
❑
15.
Check Or or mom afIhaae coldldona tis gpplluble fo trangrer:
71. Ssla Contract Data 10/24/2014
A. Sole Between Relatives Or Form Relarms
.
B. Sale between Related Companbg or partners in SuginOsa.
12. Deb of Satdfrensfer 0 4 / 02 / 2 015
n. e otthd Buyers is also a Seller
Buyer or Seller is Governmwt Agency Lending
or Insctution
E. Dead Type not Warranty or Bargain and Sale (Speclj Be"
Full Sole Price 38 i r 5 00 a)
Sale M Frnctoral or Less then Fee Imereat (Spedy Belo et
•F.
'Full Sala Price b tho total amount paid for the property Incluclina personal ro
p
G. Signibcant Change In Property Between Taxable Statue and Sale Dates
N. 3810 Of 8111811111153 IS Included in Sale Price
rhls payment may be Ir. Ina form nt dash, Other goods, or the assure
ORM Of Other Property P� o,
obiipations.) Please round to the
1. Other Unusual FacbB Atreming Sa:e Pnce (SPO
WY
J Nona (� � ��
a
nearest whole doaaramounf
COMMORt(a) on Candllfon:
14. Indicate the value Of pgmongl
Property Included In Ow aab 0 •00
ASSESSMENT INFORMATION - Data should reflect the Iateat Final Assessment Roll and Tax BIII
16. Year of Aasassmera ROTI from whish InIOMMAW MMn(YY) 15 •17. Total Assessed Value 4,300
'10. Property Class 210 p
'19.School District Name Laurelax0. Tax seep IOsrlBflort*yRall Identtear(e) of mon thea four, attach sheet With additional IdemBbr(s)j
1000-125.00-06.00-004.000
CERTIFICATION
Certify that all of the Roan of Information entered On this form ars true and Correct (to the but of my knowledge and ballef) and I understand that the making of any willful
alae slatemam of material hct herein subject me to the RMVJW g oilltgnlael NMErONVO to the making and Hung of false Instruments.
SEL X"rINA.TURF. M® i/y//J� I
BIJY9RJCPNFAUJNFORNIATIQN
/ 1v rci par,, M malrvl M o huya NCe lr e.7or to — U nisy. as omfon. WfFerftmw >on. Nissgrk oo,Tomry. e,ab a
J party wM wnanswerpuOMllma� a MIIrgmNrY- err u Irma Ind anted Type w Prim W N •N'NAIaAaapwrLr
ra0atliq rlw:•matm ml.rr be elaerad. Type a prim clerrlY 1
SPitalieri Victor
---W — AigT gMl
vWFACd1E TELniYYJra;reurdEa �+ Tonere,
'MROU rMNE
cff '—* -
WAR W CODE
�Irs aIIQNN�Y '
Ferrier Raymond
Wt tWY VINeI NSM!
4iAfxYJE neFfNCrIEMpre9teixmaar0