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SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 09/10/2015
Number of Pages : 4 At: 11:07 :22 AM
Receipt Number : 15-0122202
TRANSFER TAX NUMBER: 15-03990 LIBER: D00012831
PAGE: 539
District: Section: Block: Lot:
1000 115 .00 16 .00 001 .000
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 $255.00
TRANSFER TAX NUMBER: 15-03990
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
1 2
• RECORDED
2015 Sep 10 11:07:22 Rig
Number of pages JUDICL R. FSCaLE
O
CLERK OF
SUFFOLK COUNTY
This document will be public L D00P 5 519831
39
record.Please remove all DT# 15-03990
Social Security Numbers
prior to recording.
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
3 I FEES
Mortgage Amt.
Page/Filing Fee
1.Basic Tax
Handling 20. 00 2. Additional Tax
TP 584 Sub Total
Spec.Assit.
Notation
or
EA 52 17(County) Sub Total 'v Spec,/Add.
401
EA-5217(State) TOT.MTG.TAX
Dual Town Dual County
R.P.T.S.A. •••, Held for Appointment
5. 00 JV'4 Transfer Tax
Comm.of Ed. T
� 1 ,; Mansion Tax
Affidavit i ._,.' •
The property covered by this mortgage is
Certified Copy - or will be improved by a one or two
NYS Surcharge 15. 00 family dwelling only.
Sub Total YES or NO
Other
Grand Total 7,53—‘6„) If NO, see appropriate tax clause on
CCS' page# of this
5171 tru ent.
It
4 Dist. 1 15025340 1000 11500 1600 001000 5 Community Preservation Fund
Real Property ` 18111I111111111111111111111111111111 1111IIIII III Consideration Amount$ O
Tax Service R SMI R 1 1II I� 111 E11IIIA il11111 X11111111 11111111 CPF Tax Due $
Agency 09-SEP-15
Verification
- --- - - - --- - -J Improved
6 Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD&RETURN TO: Vacant Land
TD
Davidow,Davidow,Siegel&Stern,LLP
1050 Old Nichols Road-Suite 100 TD
Islandia,New York 11749 TD
Mail to:Judith A.Pascale,Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name a_),,v4
www.suffolkcountyny.gov/clerk Title# •
�gl S
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached Deed made
by: (SPECIFY TYPE OF INSTRUMENT)
Donald Kirby and Doreen R.Kirby,his wife The premises herein is situated in
SUFFOLK COUNTY,NEW YORK.
TO In the TOWN of Southold
Dawnmarie Moffitt.as Trustee of the Donald and In the VILLAGE
Doreen R.Kirby Family Trust dated TLA- 4 7, b r HAMLET of Mattituck
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
(over)
•
• tsps
• NY 014- Full Covenant&Warranty Deed Individual or Corporation(Single Sheet)(NYBTU 8003)
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
THIS INDENTURE,made the -1 day of in the year 2015
BETWEEN
DONALD KIRBY and DOREEN R.KIRBY,his wife,both residing at'75 Donna Drive,
Mattituck,New York 11952
party of the first part,and
DAWNMARIE MOFFITT,residing at 8702 Maywood Avenue,Silver Spring,Maryland 20910,as
Trustee of the DONALD AND DOREEN R.KIRBY FAMILY TRUST dated ttio - 1 , 2 of 5
party of the second part, •
WITNESSETH,that the party of the first part,in consideration often 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 party of
the second part forever,
Od O
ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected,situate,lying and being in the
115.-16-1
See Schedule"A"Attached
SAID premises being known as 75 Donna Drive,Mattituck,New York 11952.
BEING AND INTENDED TO BE THE same premises conveyed to the party of the first part by
deed dated April 22,1975,recorded in Liber 7829 Page 565 on April 24,1975,in the Office of the
Clerk of the County of Suffolk.
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,in compliance with Section 13 of the Lien Law,covenants that the party of the first part w ill 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.
AND the party of the first part covenants as follows:that said party of the first part is seized of the said premises in fee simple,and
has good right to convey the same;that the party of the second part shall quietly enjoy the said premises;that the said premises are
free from incumbrances,except as aforesaid;that the party of the first part will execute or procure any further necessary assurance
of the title to said premises;and that said party of the first part will forever warrant the title to said premises.
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 exe.. .i this deed the lday and year first above written.
IN PRESENCE OF: /
• DonaR?
. /
r. .4117
Doreen R.Kirby
USE ACKNOWLEDGMENTFORMBELOW WTFHINNEW YORK STATE ONLY: USEACKNOWLEDGMENI'FORMBELOW WITHIN NEW YORK STATE ONLY.:,
State of New York,County of Suffolk I ss.: State of New York,County of }ss.:
4
On the?day of 441 c.IS r Lin the year 2015 On the day of in the year
before me,the undersign personally appeared before me,the undersigned,personally appeared
Donald Kirby and Doreen R.Kirby
personally known to me or proved to me on the basis of satisfactory 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 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 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 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 signature(s)on the instrument,the individual(s),or the person upon
behalf of hick the indivi (s)acted executed the instrument. behalf of which the individual(s)acted,executed the instrument
__ .
ANTHONY VINCENT FALCONE
Notary Public,state of New York
No.02FA6141300
Cootilied in Suffolk County
Commission Expires Feb.21,20
ACKNOWLEDGMENT FORM FOR USE WITHIN NEW YORK STATE ONLY: ACKNOWLEDGMENTFORMFOR USE OUTSIDE NEW YORK STATE ONLY:
/New York Subscribing Witness Acknowledgment Certificate( (Out of State or Foreign General Acknowledgment Certificate). .
State of New York,County of }ss.: }ss.:
(Complete Venue with State,Country,Province or Municipality)
On the day of in the year
before me,the undersigned,personally appeared 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 personally known to me or proved to me on the basis of satisfactory
say that he/she/they reside(s)in 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
(if the place of residence is in a city,include the street and street number, the same in his/her/their capacity(ies),that by his/her/their signature(s)
if any,thereof);that he/she/they'know(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
to be the individual described in and who executed the foregoing made such appearance before the undersigned in the
instrument;that said subscribing witness was present and saw said
execute the same;and that said witness at the same time subscribed (Insert the city or other political subdivision and the state or country or
his/her/their name(s)as a witness thereto. other place the acknowledgment was taken).
WARRANTY DEED
(Wmi FULL COVENANTS)
TITLE NO. DISTRICT
SECTION
BLOCK
LOT
COUNTY OR TOWN Suffolk
TO
RECORDED AT REQUEST OF
Fidelity National Title Insurance Company
RETURN BY MAIL TO
FIDELITY NATIONAL TITLEDavidow Davidow Siegel&Stern,LLP
INSURANCE COMPANY 1050 Old Nichols Road-Suite 100
FINCORPORATED 1923 Islandia,New York 11749
as
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Schedule "A"
District 1000 Section 115 Block 16 Lot 1
ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon
erected,situate,lying and being at Mattituck,Town of Southold,County of Suffolk and State of New
York,known and designated as Lot 45 on a certain map entitled"Map of Deep Hole Creek Estates"
and filed in the Suffolk County Clerk's Office on January 28, 1965, as Map No. 4256.
INSTRUCTIONS(RP-5217-PDF-INS):www.erps.state.ny.us
FOR COUNTY USE ONLY New Volt State Department of
Cl.SWIS Code 14-7
r t7 t 3 i g r g 9 I Taxation and Finance
C2.Date Deed Recorded I CD 9/ IL)/ IS i Office of Real Property Tax Services
ibe' lee Yes RP-5217-PDF '
C�
C3.Book I I , A, t�,3 J los.Page i , 5 9 1I Roal Property Transfer Report(8110)
PROPERTY INFORMATION I
1.Prop•ny 75 Donna Drive
Location
.5TREEI HUMBER •STREET rine
Southold Mattituck 11952
• •are OR Tem VLUsE •OP CODE
x.Buyer Moffitt, Trustee Dawnmario
Name
•,Air ryt,,EEm.PNIY FIRST met
•
LAST NIWEICOMMSN FIRST NNE
7.TaaIndicate where ferre Tex BlRsaetobesent Kirby Donald and Doreen S.
Billing -
dother than buyer addrcss(at bosom of form) LAST h.Arycauwwr FIRST NATE
Address
75 Donna Drive Mattituck NY 11952
STREET MMNRNINNE CrtYOR TOMi STATE names
4.Indicate the number of ASSasement 1Part of a Parcel (Only If Part of a Purcell Check an they appy:
Roll parcels transferred on the deed 8 ❑
of Parcels OR 4A.Panning Board with Subdivision Authority Exists I]
6.Deed x OR 0•S3 4B.Subdivision Approval was Required for Transfer ❑
Property "•FRONT FEET •OFPTN •Acres
Size 4C.Parcel Approved for Subdasalon with Map Provided 0
Kirby Donald
8.Seller •LASHIPMEMORPNM FIRST MME
Name Kirby Doreen R.
LAST NRYE,rdWwY FIRST WE
•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: B.Ownership Type a Condanlnium 0
A.One Family Itesidcntial B.New Construction one Vacant Land 0
10A.Property Located wlthm en Agricultural District El
10B.Buyer received a disclosure notice indicating that the property Is in an 0
Agricultural District
(SALE INFORMATION' 15.Check one or more of these conditions as applicable to transfer.
N A.Side Fanner le Between Relatives or Relatives
1 L Sale Contract Dale B.Sale between Related Compendia a Partners in Business.
//((�T C.One of the Buyers a also a Sailer
12.ata of SHMrenefer Oil 1 I S" D.Buyer or Seller Is Government Agency or Landed Institution
• 1 E.Deed Type not Warranty or Bargain and Sale(Specify Below)
F.Sale of Fredcnal or Less than Fee Interest(Specify Below)
•13.Full Sale Price .00 G.Significant Change in Properly Between Taxable Stabs and Sale Dates
N.Sale of Ruaeless Is Included in Sale Price
(Fut Sale Price Is the toter amount paid far the properly including personal progeny. I I.Other Unusual Factors Affecting Sale Price(Specify Below)
ThIe payment may be in the form of cash,other popery or goods,or the assumption of _j J.None
metopes or other obligations.)Pleue round to the neurit whole dollar amount.
'Commends)on Condition:
14.Indicate the value of peraonet
property Included In the sue .00 conveyance to trust
ASSESSMENT INFORMATION-Data should reflect the latest Final Assessment Roll and Tax Bill I
15.Year of Assessment Roll from which Information teken(YY) 15 97.Total Assessed Value 4,600
•711.Property Crass 210 — •1e.School District Nam* Mattituck
10.Tax Map Identllher(sliR011 Identlllege)(If more than four,attach sheet with additional Identmerle))
1000 115.-16-1
'CERTIFICATION'
I Certify that all of the Some of Information entered on this form are true and correct(to the best of my knowledge and beltof)and I understand that the making of any willful
false stats. -nt of material fact herein subject me to the.proylslen6.af.Ihe.penallaw_relative to the making and filing of false Insaumenta.
ELLER SIGNATURE BUYER CONTACT INFORMATION
Mier inhume:merle buyer.Note ll tonsil LLC,saaaty,aeeaasm.carp:moan.Idle sock company.estate or/• entry 6w isnot at indmduel ages a e:Leary.awn a nen,and meta seamaNn hen Irgn iedsompaeno
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SELLER.Mei -ii a
Moffitt, TrLstee Dawnmarie
DMYE6 MONAIUHE
n •WT RMF mid wee
L'r'p ' a_� !-F (301)AREAcaDE 495-9239
y�llll....(((( .TELEPHola mosiERIEs.effete
aNERSIONIIT�-eDATE
87.02 Maywood Avenue
•sT1EEr RAISER •STREET PAVE
1, J 1 ' Silver Spring MD 20910
�' 1�1 li'll,�ki 11 ` 5,,.r j' (i ClivORTOYYN ...STATE, •OP coca
�h 1(I I1. �11'+5 =•1+ t llyl l��' �1 BUYER'S ATTORNEY
i'1,l. 11i'' 1, 6;11+f ;f I�I,i,1 Il+�,i' Falcone Anthony V.
�'IIL14 I '}1 j111''I,}'�l'll +ll {'1� Y r usTxsuE
FIRST ERIE
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1116111%,'I
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