HomeMy WebLinkAboutL 12830 P 480 ......................
I II111111111 11111 1111111111 11111 DIII 1111111111 liii III
1111111 iiu urn liv IIII
SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 09/01/2015
Number of Pages: 6 At: 04 :51 : 05 PM
Receipt Number : 15-0118467
TRANSFER TAX NUMBER: 15-03167 LIBER: D00012830
PAGE : 480
District: Section: Block: Lot:
1000 117 .00 03.00 006.000
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $0 . 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 $60 . 00 NO
Transfer tax $0.00 NO Comm.Pres $0 . 00 NO
Fees Paid $265 . 00
TRANSFER TAX NUMBER: 15-03167
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
A
•
4.
1 2
Number of pages , 7 RECORDED
C
2015 Sep 01 04:51:05 PI1
JUDITH A. PASCALE
This document will be public CLERK OF
SUFFOLK COUNTYrecord.Please remove all L 0000128.30
Social Security Numbers F 480
prior to recording. Fit 15-0.316?
?
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
3 I FEES
Page/Filing Fee 3v Mortgage Amt.
1.Basic Tax
Handling 20. 00
2. Additional Tax
TP-584 5 – Sub Total
Notation Spec./Assit.
or
EA-52 17(County) - Sub Total (SO Spec./Add.
EA 5217(State) TOT.MTG.TAX
iiDual Dual Town Dual County
R.P.T.S.A. .: � Held for Appointmentl
Comm.of Ed. 5. 00 ;.:ii
. r Transfer Tax -V
Affidavit
;.;% .;i�J ,.,;'' Mansion Tax
Certified • The property covered by this mortgage is
Copy ---- or will be improved by a one or two
NYS Surcharge 15. 00 family dwelling only.
Sub Total 20J YES or NO
Other _
Grand Total Du J - If NO, see appropriate tax clause on
page# of this instrument.
: il't ato Cal Z(11701 c-
4
4 Dist. 10C 15021290 1000 11700 0300 006000 5 Community Preservation Fund
Real Property PTS I 1111111111111 III fi�IIIIII 1111cIuco
erat Due Amount$
Tax Service R DHO A
Agency 06-AUG-1 el-
Verification
--- —J Improved ✓
6 Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD&RETURN TO: Vacant Land
TD (1)
Munley&Meade PLLC
160 Middle Neck Road TD
Great Neck,NY 11021 TD
Mail to:Judith A.Pascale,Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name Philip O'Hara Nassau Assoc
wwwsuffolkcountyny.gov/clerk Title
Pohn-2015-172
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached DEED made
by: (SPECIFY TYPE OF INSTRUMENT)
Scott Romond,Mary Ellen Eye The premises herein is situated in
Frederick W.Koehler,Joan Pollina *.ii- E‘ SUFFOLK COUNTY,NEW YORK.
TO In the TOWN of Southold
The Koehler Family Limited Partnership In the VILLAGE
or HAMLET of New Suffolk
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
(over)
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
• PO NN— 00/ I'J�
THIS INDENTURE,made the 24th day of June ,2015
BETWEEN SCOTT ROMOND, residing at 600 Wading River Road, Manorville, New York 11949; MARY
ELLEN EYE, residing at 2903 Gull Avenue, Medford, NY 11763; FREDERICK W. KOEHLER, III, residing at
600 Fulton Street,#K1, Farmingdale, NY 11735;JOAN POLLINA, residing at 2060 Leeward Drive,Southold,
NY 11971; AGNES KOEHLER, residing at 113 Birs Avenue, Lindenhurst, NY 11757; JOHN KOEHLER,
residing at 22 Lily Drive, S. Setauket, New York 11720; ANN KOEHLER, a/k/a ANN WARD, residing at 104
Colonial Drive,East Northport, New York 11731;NORA O'CONNOR,residing at 55 Stratford Road,Plainview, t'3
New York 11803;JEAN CUTRONE, residing at 30 E. Bay Drive,West Islip, New York 11795;JANE RUMPF,
residing at 42 Miller Road, Farmingdale, New York 11735; and THOMAS KOEHLER,residing at 42 Hunting
Hill Drive, Dix Hills, New York 11746;and JOHN KOEHLER, residing at 22 Lily Drive, S. Setauket, New York
11720;and THOMAS KOEHLER,residing at 42 Hunting Hill Drive,Dix Hills,New York 11746,as Co-Trustees
of a Supplemental Needs Trust for the benefit of KATHLEEN KOEHLER-under Article Seventh of the Sharon
Koehler Qualified Personal Residence Trust dated May 26,1994,as tenants-in-common,party of the first part,
and
THE KOEHLER FAMILY LIMITED PARTNERSHIP,whose principal place of business is at 376 Fulton Street, tf
Farmingdale, New York 11735,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, does hereby remise, release and quitclaim unto the party of the second
part,the heirs or successors and assigns of the party of the second part forever,
RICT ALL that certain plot piece or parcel of land, with the buildings and improvements thereon erected, situate,
DISTRICT and being at New Suffolk, Town of Southold, County of Suffolk and State of New York, bounded and
1000 described as follows:
SECTION BEGINNING at an iron pipe'set on the Easterly line of Old Harbor Road at the Southwesterly corner of the
117.00 subject premises,being the Northwesterly corner of land of Flora Mason;
BLOCK RUNNING THENCE along said Easterly line of Old Harbor Road, North 28 degrees 15 minutes 20 seconds
03.00 West,203.06 feet to land of Benbow;
LOT THENCE along said land of Benbow,South 83 degrees 37 minutes 40 seconds East 101.80 feet to a concrete
006.000 monument;
THENCE along other land now or formerly of Benbow&Given,three(3)courses,as follows:
1. SOUTH 83 degrees 32 minutes 00 seconds East,270.68 feet to an iron pipe;
2. NORTH 78 degrees 39 minutes 30 seconds East, 100.00 feet to an iron pipe;
3. SOUTH 71 degrees 26 minutes 30 seconds East 315.00 feet to the ordinary High Water mark of
Cutchogue Harbor;
THENCE along said High Water Mark,South 18 degrees 58 minutes 10 seconds West, 198.04 feet to land of
Whelan;
THENCE along said land of Whelan,two(2)courses as follows:
1. NORTH 66 degrees 37 minutes 00 seconds West 325.00 feet to a concrete monument;
2. THENCE South 23 degrees 12 minutes 20 seconds West 64.80 feet to land of Flora Mason;
THENCE along said land of Flora Mason, North 77 degrees 44 minutes 30 seconds West,289.05 feet to the
point or place of BEGINNING.
SAID PREMISES being also known as and by 575 Old Harbor Road, New Suffolk, New York 11956, and
known on the Land and Tax Map of Suffolk County as District 1000,Section 117.00,Block 03.00, Lot 006.000.
BEING AND INTENDED TO BE the same premises described in a Deed to JOHN KOEHLER and RICHARD
MURCOTT, as Co-Trustees of THE SHARON KOEHLER QUALIFIED PERSONAL RESIDENCE TRUST
DATED MAY 26, 1994 dated May 26, 1994 and recorded in the Office of the Clerk of the County of Suffolk on
June 10, 1994 in Liber 11680, Page 682.
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.
r'in‘ r?
't•
Standard N.Y.B.T.U.Form 8004—Quitclaim Deed—Uniform Acknowledgment(single sheet)
Form 2216
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.
DISTRICT
1000 IN PRESENCE OF: f
SECTION /�j,E 1P 4 D iL
117.00 7"' SCOTT ROMON 1
BLOCK '
03.00if
MAR 1i
LOT ` ��/` L. I , c----=
006.000 REDERICK W.KOEHLER,III
A'& S A_ • II l..1,;.
, POLLINA /
rf�a.�' ♦ I/L L.A.
I S KOELE'
. � r
.
4ill OEw 1ER
„iii
ANN WARD
NORA O'CONNOR
050
J CUTRONE
y >;j,
NE RUMPF '
T • 1'. KOEH -17ffr
JOH, i- LER, -7 Co-Trustee of a Supplemental
Needs for the benefit of
KATHL k KOEHLER �l
7�.-n-tel/.... /
THOMAS KOEHLER,as Co-Trustee of a
Supplemental Needs Trust for the benefit of
KATHLEEN KOEHLER
STATE OF NEW YORK i )
C`
U OLIO. ) SS.: e.
COUNTY OF )
On the o.<7. day oQv Cl_ , in the year 2015,before me,the undersigned, a Notary Public in and for said
State, personally appeared SCOTT ROMOND, 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 he executed
the same in his capacity,and that by his signature on the instrument,the individual,or the person upon behalf of which the
individual acted,executed the instrument.
A4r
g pHANIE��atetotSNew York NOTAR' 7IC
NOTARY PoU 01lHA.6107120 lf(��
pualitied in hes March 22,201t{1J
Commission Exp
•
STATE OF NEW YORK )
llttfcOLk, ) SS.:
COUNTY OF N A�4SSOrtl )
d
On thec:52 ( day of!ILL ./ , in the year 2015,before me,the undersigned,a Notary Public in and for said
State, personally appeared MARY ELLEN EYE, 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,and that by her signature on the instrument,the individual,or the person upon behalf of which the
individual acted,executed the instrument. r,
STEPHANIE A.HANSON
4 61Lctizgails„,
NOTARY PUBLIC,State of New York OT RY PUBLIC
No.01 HA6107120
Qualified in Suffolk County
Commission Expires March 22,20!..
STATE OF NEW YORK )
Ltd ttr 1)L�c ) SS.:
COUNTY OFI )
On thery7 day ofij,(/1/a. , in the year 2015,before me,the undersigned,a Notary Public in and for said
State, personally appeared FREDERICK W. KOEHLER, Ill, 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 he
executed the same in his capacity,and that by his'signatureton'Ahe instrument,the individual,or the person upon behalf of
which the individual acted,executed the instruthent7..- 3'1112 n
•
STEPHANIE A.HANSON :4_1!/./ ^��Aa A at,
NOTARY PUBLIC,No.01H6 tate of New York NO ARY PUBLIC
Qualified in Suffolk County
Commission Expires March 22,20' j
STATE OF NEW )
4.
0 ) SS.:
COUNTY OF ICU )
On the 0/Y day of,ji l n1 E , in the year 2015,before me,the undersigned, a Notary Public in and for said
State,personally appeared JOAN POLLINA,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,and that by her signature on the instrument,the individual,or the person upon behalf of which the individual
acted,executed the instrument. r ,ilbG
STEPHANIE A.HANSON Y et//ti /IL/A,,,•.
NOTARY PUBLIC,State of New York app
ARY PUBLI
No.01HA6107120
'Qualified in Suffolk County
Commission Expires March 22,20
STATE OF NEW YORK )
ac F il( ) SS.:
COUNTY O{FN )
/
On the obi day of‘,..„V i J , in the year 2015,before me,the undersigned,a Notary Public in and for said
State, personally appeared AGNES KOEHLER, personally known to me or proved to me on the basis of satisfactory
evidence,to be the individual whose name issubscribed to the within instrument and acknowledged to me that she executed
the same in her capacity,and that by her signature on the instrument,the individual,or the person upon behalf of which the
individual acted,executed the instrument. r
STEPHANIE A.HANSON
NOTARY PUBLIC,State of New York NOTARY PUBLIC l
J. No.01 HA6107120
'Qualified in Suffolk County
Commission Expires March 22,20
11
STATE OF NEW YORK )
rrnLI� ) ss.:
COUNTY OFA/.4At1 )
On the 40.17 day ofj,4 AJE ,in the year 2015,before me,the undersigned,a Notary Public in and for said
State, personally appeared JOHN KOEHLER, 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 he executed
the same in his capacity,and that by his signature on the instrument,the individual,or the person upon behalf of which the
individual acted,executed the instrument.
.STEPHANIE-A.HANSON NOT RY PUBLIC ger
NOTARY PUBLIC,State of New York
No.01 HA6107120
Qualified in Suffolk County
Commission Expires March 22,20
STATE OF NEW YORK��C. )
�(C ) SS.:
COUNTY OF�! )
On the c 7 ' day of {Af E , in the year 2015,before me,the undersigned, a Notary Public in and for said
State,personally appeared ANN WARD,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,and that by her signature on the instrument,the individual,or the person upon behalf of which the individual acted,
executed the instrument.
STEPHANIE A.HANSON
NOTARY PUBLIC,State of New York, �� �e�i,✓�
No.01HA6107120 O"ARY PUBLIC
Qualified in SuffolkSuffolk County /f
111,
Commission Expires March 22,20-;–
• - s
STATE OF NEW YORK ) •
A ) SS.:—_t
COUNTY OF I)
On the 0/'/day of II,L/1J2 , in the year 2015,before me,the undersigned,a Notary Public in and for said
State, personally appeared NORA O'CONNOR, 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,and that by her signature on the instrument,the individual,or the person upon behalf of which the
individual acted,executed the instrument.
STEPHANIE A.HANSON Ai ��-�'�� At,
NOTARY
No.PUBLIC,
State
of
0New York 10T RY PUBLIC MI
Qualified in Suffolk County
Commission Expires March 22,20
•
STATE OF NEW
YORK )
�J�r�FDLIC ) ss.:.
COUNTY OF 11Atl )
On the C�7 day of JO/JE , in the year 2015,before me,the undersigned,a Notary Public in and for said
State,personally appeared JEAN CUTRONE,personally known to me or proved tome 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,and that by her signature on the instrument,the individual,or the person upon behalf of which the individual
acted,executed the instrument.
STEPHANIE A.HANSON /1G[.,!
NOTARY PUBLIC,State of New York
No.01HA6107120 NOTARY PUBLIC
Qualified in Suffolk County
Commission Expires March 22,20
'c JI'c i
STATE OF NEW YORK ) •
dU.MOLL' ) SS.:
COUNTY OF )
On the 0/. 7'day off./ E , in the year 2015,before me,the undersigned,a Notary Public in and for said
State,personally appeared JANE RUMPF,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,and that by her signature on the instrument,the individual,or the person upon behalf of which the individual
acted,executed the instrument.
STEPHANIE A.HANSON – fr a
NOTARY PUBLIC,State of New York NO ARY PUBLI
No.01 HA6107120 —�
Qualified in Suffolk County
Commission Expires March 22,20
STATE OF NEW YORK )
&rOLS ) SS.:
COUNTY OF Ab9TJ )
On theOLF day of\IL(AiE ,in the year 2015,before me,the undersigned, a Notary Public in and for said
State, personally appeared THOMAS KOEHLER,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 he executed
the same in his capacity,and that by his signature on the instrument,the individual,or the person upon behalf of which the
individual acted,executed the instrument.
STEPHANIE A.HANSON Of
R / 11.a/ ! �.
NOTARY PUBLIC,State of New Yorjc OTA Y PUBLIC
No.01HA6107120
"Qualified in Suffolk County
Commission Expires March 22,20 ,
•
i= .
a
• TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YORK STATE
•
State of New York,County of ss: State of New York,County of ss:
On the day of in the year 2015, On the day of in the year
before me,the undersigned,personally appeared before me,the undersigned,personally appeared
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 whose name is satisfactory evidence to be the individual(s)whose name(s) is
subscribed to the within instrument and acknowledged to me (are)subscribed to the within instrument and acknowledged to
that he executed the same in his capacity, and that by his me that he/she/they executed the same in his/her/their
signature on the instrument,the individual,or the person upon capacity(ies), and that by his/her/their signature(s) on the
behalf of which the individual acted,executed the instrument. instrument,the individual(s),or the person upon behalf of which
the individual(s)acted,executed the instrument.
(signature and office of individual taking acknowledgment)
(signature and office of individual taking acknowledgment)
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/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,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)
QUITCLAIM DEED
Title No.
SCOTT ROMOND,MARY ELLEN EYE, DISTRICT 1000
FREDERICK W.KOEHLER,III,JOAN POLLINA, SECTION 117.00
AGNES KOEHLER,JOHN KOEHLER,ANN KOEHLER BLOCK 03.00
a/k/a ANN WARD,NORA O'CONNOR,JEAN CUTRONE, LOT 006.000
JANE RUMPF,THOMAS KOEHLER and COUNTY OR TOWN SUFFOLK
JOHN KOEHLER and THOMAS KOEHLER,as Co-Trustees STREET ADDRESS 575 Old Harbor Road
of a Supplemental Needs Trust for the benefit of KATHLEEN New Suffolk,NY 11956
KOEHLER under Article Seventh of the Sharon Koehler
Qualified Personal Residence Trust
dated May 26, 1994
RETURN BY MAIL TO:
to
THE KOHELER FAMILY LIMITED PARTNERSHIP JAMES G.MEADE,ESQ.
MUNLEY&MEADE PLLC
160 MIDDLE NECK ROAD
GREAT NECK,NEW YORK 11021
•
rc
•
•
• INSTRUCTIONS(RP-5217-PDF-INS):www.orps.state.ny.us
•
• FOR COUNTY 1ISF,ONLY �/ 9. New York State Department of
Cl.SIMS Code I /t j�/1�041 U 1 / .............I
Taxation and Finance
C2.Date Deed Recorded 1 / ��/ /.�� - Office of Real Property Tax Services
• Mwy, a. "5 nY/h. RP-5217-PDF
. C3.Book L r 3 C4.Page 1 L I yaL-'I Real Property Transfer Report(MD)
PROPERTY INFORMATION I .
1.Property 575 Old Harbor Road
Location
•steal NUMBER •SIRED NAME
New Suffolk 11956
•OTT OR TMH Weiner •7P COOS
2.Buyer THE KOEHLER FAMILY LIMITED PARTNERSHIP •
Name
•LAST NAMFICOMFAN, RAST NAME
LAST'AMEJCpPANY FAST NAME
3.Tax Indicate where future Tax Bills meth besent TacK Development Company, Att: Thomas Koehler
Billing if other then buyer eddress(at bottom of form) •,Ass NAFECauPAA, FIRST NAME
Address
108 Allen Boulevard, Farmingdale, NY 11735
STREET MAZER ARO MAIC CRYOR Tram STATE 7P COW
4.Irdleato the number atAssessment ] Pan of a Parcel ((Only WPM of■Parcel)Check es they apply:
Roll parcels transferred on the deed . a ot Percaleaox ❑ With 4A.Planning Board Subdivision Authority Exists
5.Deed _ X OR 2.00 4B.Subdrewon Approval was Respired for Trenalar ❑
Property •FRONT FEET •DEP III ...CMS
Size 4C.Parcel Approved for Subdivision with Map Provided ❑
. ROMOND SCOTT
S.Seller • •LAST NSAEFotlANY FIRST NAME
Name EYE MARY ELLEN
LAST NA EICOMPATY FIRST NAME
'7.Select the description which most accurately describes the Check the boxes below as they apply:
use of the property at the time of sale: 0.Owne a11p Type is Condominium 0
A.One Family Residential
0.New Constmaion one Valero Land 0
10A.Property Located within an Agricultural District ❑
MOB.Buyer received a disclosure notice indicating that the property is in an ❑
Agricultural District
ISALE INFORMATION' 15.Check one or mom of these conditions es applicable to transfer:
A See Between Relatives or Farmer Relatives
11.Sale Contract Date N/A _ B.Sale between Related Companies or Partnere in Burin's.
_ C.One of the Buyers is aeo a Seen
•12.Date of salerrranefer 6/24/2015 _ X E Deed Type not eller NarrantGovernment
or oBargain end ncy or
(Specify y g Below)
_ F Sale of Fractional or Lees than Fee Interest(Spedy Below)
•13.Full Sale Price 0.00 _G.Significant Change In Property Between Taxable Status and Sale Dales
_ H.Safe of Business is inducted ed in Sale Price
(Full Sale Price is the total amount pad for the plbpedy including personal properly. _ I Other Unusual Factors Affecting Sate Price(Speak Below)
This payment may be in the form d cosh.other properly ar goods,or the aasumpbcn d J.None
mortgages or other obligmlona.)Freese round to the nearest"Mole dollar amount.
•Commest(s)on Condition:
14.Indicate the value of personel - 6 a
property Included In the sale .00 QUITCLAIM DEED
IASSESSMENT INFORMATION-Data should reflect the latest Final Assessment Roll and Tax Bill I
10.Year of Assessment Roll from which information taken(YY) 1 4 '17.Total Assessed Value 26,400
-1e.Property Class 210 - 1 •1e.School District Name 429 - New Suffolk School
'20.Tax Nap Idendfler(s)Ralf Identified')(If more than four,attach sheet with additional Identmer(s))
DIST. 1000,SECTION 117.00.BLOCK 03.00,LOT 006.000 •
I CERTIFICATION I
I Certify that all of the Items of information entered on this form ere true end correct(to the best of my knowledge and belief)and I understand that the making of any willful
false statement of material fact herein subleat me to thsyrayialem of th`pensl law relative to the making and filing of false Instruments.
SELLER SJSENATURE BUYER CONTACT) EQMIAIIQN
1 Meter xdormatlon he the buyer.sols.If buyer is LI C.sodey.mmdmon.mlpasbo,.Lore clock=Rpey,cwt or
6J.../".
9 say SIM w M an kwMNaal ago a wy
ian .then■none coCRAW Nm
aekon of al i deiduaYnpmsiee
V/l i why who can enemy gentians reputing the MAW must be entered Type orpdm slowly.)
SCOTT ROMOND
BUYERSIGNATURt KOEHLER -_ THOMAS
THE KOEI•ILER FAMILY LIMITED PARTNERSHIP •LAST eAML FIRST RALE
By: Hun REALTY,GENERAL PAR" FR 631 694-4720
•AaFACOOF. •TELEFACME RIMIER MEA SSaerel
•
By: _ f
Fltla)ERIC411.I
W.h-R .:R.JR.,Partes r )air 108 Allen Boulevard
Buyer's Signature SIMEErw.uVSEN •a MEET muE
r �, r, it 1�,E , • `,,,, • Farmingdale NY 11735 _
(' !/,','' I - fl 1 II Ly�`u ' l �I xnYalTORN •OTArE •7PCOOF., I �.iiI �3{ti �i.jili11�i�ii1'M 'Hal ,'1%,,i �,11,'i ',I BUYER'S ATTORNEY
I 1 11( 1RIf '' Al . lt 11y11�1 !lli i'Ii, I
�n 1 MI , "� I �. ��' 1�, Meade James G.
I,t. )Ta 9';
i11 r 11 I I��� 1 �h M,�II ��f WINATE - FAST NUM
iI i, M■ � 11, ) ,;i 41, 1 1104 I!
11( �I��I il,� llf JJ55}� �1,'} �l 1 1J', ,LSi �, IMM) I; (516) A 487-6500 _ .
._
II �t.0}'i I,I'} 1' t
-1i l { �t 1 e 1y ll, ,il l ANF coot TELEMgr1E MASER TEA MLerN1
dl y'n I r , r1 III T IIIY1 15i��[r 1,l',l r)n f} I I�
�I Me 1114 11 111 1r 11 M,1 T #1rf '
. L
• Additional Sellers: t
bGlK.: 0011 O 112.015
KOEHLER, FREDERICK W., Illpavi I g()
POLLINA, JOAN I Ni i ,, 1 2_230
KOEHLER, AGNES D
KOEHLER, JOHN
KOEHLER, ANN a/k/a WARD, ANN
O'CONNOR, NORA
CUTRONE,JEAN
RUMPF, JANE
KOEHLER, THOMAS
KOEHLER, JOHN, as Co-Trustee of a
Supplemental Needs Trust for the
benefit of KATHLEEN KOEHLER
KOEHLER, THOMAS, as Co-Trustee of a
Supplemental Needs Trust for the benefit
of KATHLEEN KOEHLER
SELLER'S SIGNATURE:
1 ( 4ii1-ir
SCOTT ROMOND Date
BUYERS SIGNATURE:
THE KOEHLER FAMILY LIMITED PARTNERSHIP
By: BUD REALTY, General Partner
By:• 41,141.1,SideiscoliiG I a fFREDERICK W. KEHLERPartner Date