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1111111 111111111 IIIII IIIII HIII 111111111111111110 IIII
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SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 10/13/2015
Number of Pages : 4 At: 01 :58 : 11 PM
Receipt Number : 15-0140544
TRANSFER TAX NUMBER: 15-07410 LIBER: D00012836
PAGE : 111
District: Section: Block: Lot:
1000 115 . 00 06.00 022 .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 $250 . 00 NO
TP-584 $5 . 00 NO Notation $0 . 00 NO
Cert.Copies $5 . 00 NO RPT $60 . 00 NO
Transfer tax $0 . 00 NO Comm.Pres $0 . 00 NO
Fees Paid $385 . 00
TRANSFER TAX NUMBER: 15-07410
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
4 •
1 2
RECORDED
Numbi;r of pages 1 701:c
015. Oct 1_+ 01:52:11 PM
JUDITH A. PASCALE
CLERK OF
This document will be public SUFFOLK COUNTY
record.Please remove all L 00001283E
Social Security Numbers F 111
prior to recording, DT# 15-07410
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
3 I FEES
Page/Filing Feekr Mortgage Amt.
�/ 1.Basic Tax
Handling 20. 00
2. Additional Tax
TP-584 5- Sub Total
Notation Spec./Assit.
or
EA-52 17(County) 5 - Sub Total 50 Spec./Add.
EA-5217(State) dr.A MI= TOT.MTG.TAX
;.1111! Dual Town Dual County
R.P.T.S.A. cr i ��, ,; `, �',, Held for Appointm nt
Comm.of Ed. 5. 00 ?,4" T Transfer Tax
Affidavit
• ... Mansion Tax
3 _ _ . ��.
�-?- The property covered by this mortgage is
ertified Cop or will be improved by a one or two
NYS Surcharge 15. 00 335 family dwelling only.
Sub Total J YES or NO
Other
Grand Total 3� f NO, see appropriate tax clause on
Q page# of this instrument. 31
t5
7111:77115028001( 1000 11500 0600 022000 5 Community Preservation Fund
Real Property P T s Ill II IIli1 I iiil
ler �IR11Consideration Amount$Tax
AgeCye 02-OT-A 111IIIIIIIIII IIIIII VIII�IIIII /(C-1;F ax Due $
Verification
- - Improved
6 Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD&RETURN TO: Vacant Land
TD I
Wickham,Bressler&Geasa,P.C.
P.O.Box 1424 TD
Mattituck,New York 11952 TO
Mail to:Judith A.Pascale,Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901Co.Name hdelitt1 Natio-flatl Trim
w+Nw.suffolkcountyny.gov/clerk Title# 2_06.341 —Zq
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached Bargain&Sale Deed w/Covenants made
by: (SPECIFY TYPE OF INSTRUMENT)
Roger K.Siejka The premises herein is situated in
SUFFOLK COUNTY,NEW YORK.
TO In the TOWN of Southold
Roger K.Siejka and Adam Siejka In the VILLAGE
or HAMLET of Mattituck
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
(over)
2053q-i
Standard N.Y.B.T.U.Form 8002-Bargain and Sale Deed,with Covenant against Grantor's Acts—Uniform Acknowledgment
Form 3290
CONSULT YOUR LAWYER BEFORE SIGII�NG THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
THISJNDENTURE,made the 3/ day of August,2015
BETWEEN
ROGER K. SIEJKA, residing at 955 Blossom Bend, Mattituck, New York 11952,
party of the first part, and
ROGER K. SIEJKA, residing at 955 Blossom Bend, Mattituck, New York 11952 as to an
undivided 99% interest, and
ADAM SIEJKA, residing at 1285 Kenny's Road, Southold, New York 11971, as to an undivided
1% interest, party of the second part,
WITNESSETH,that the party of the first part, in consideration of Ten and 001100--($10.)--Dollars, and
other good and 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,
All that certain plot, piece or parcel of land, situate, lying and being at Mattituck,Town of
Southold, County of Suffolk, and State of New York, known and designated as Lot No. 22 on a
map entitled, "Map of Mattituck Estates, Inc. and filed in the Office of the Clerk of the County of
Suffolk on September 8, 1965 as Map No.4453; said lot being be bounded and described as
follows:
SEE SCHEDULE"A"ATTACHED HERETO AND MADE A PART HEREOF
Being and intended to be the same premises as described in deed dated July 30, 1015, and
being recorded in the Office of the Suffolk County Clerk.
ecordeck g- t7_ ,Zot
L . la8 /5
�, acv
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.
IN PRESENCE OF: fc
L �
ROGER K. SIEJ44'
f/deedsiefka2
•
Fidelity National Title Insurance Company .
TITLE NO.F15-7404-98234-SUFF
SCHEDULE A-1 (Description)
•
•
I Amended 07/29/15 •
ALL that certain plot, piece or parcel of land, situate, lying and being in the Town of Southold, County of Suffolk and
State of New York, known,as Lot No, 22 on map entitled, "Map of Mattituck Estates, Inc.",and filed in the Office of the
Clerk of the County of Suffolk on September 8, 1965 as Map No.4453,bounded and described as follows:
BEGINNING at a point on the northerly side of Blossom Bend, said point being at the division line between Lots 21 and
22 on the above described map where same intersects the northerly side of Blossom Bend;
THENCE North 25 degrees 20 minutes 39 seconds West along the division line between Lots 21 and 22,265.00 feet;
THENCE North 50 degrees 40 minutes 10 seconds East,77.92 feet;
THENCE South 87 degrees 26 minutes 30 seconds East, 12834 feet;
THENCE South 04 degrees 36 minutes 32 seconds East,259.88 feet to the northerly side of Blossom Bend;
THENCE westerly along the northerly side of Blossom Bend along an arc of a curve bearing to the left having a radius of
243.41 feet a distance of 100.00 feet to the point or place of BEGINNING.
•
•
•
THE POLICY TO BE ISSUED under this commitment will insure the title to such buildings and improvements on the premises which
by law constitute real property.
FOR CONVEYANCING ONLY: Together with all the right,title and interest of the party of the first part, of in and to the land lying
in the street in front of and adjoining said premises.
•
SCIIEDULEA-I (Description)
Rev.(03/04) •
BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN New York STATE
State of New York,County of Suffolk,ss: State of New York,County of ss:
On the 81 y of August,in the year 2015 On the day of , in the year
before me,the undersigned,personally appeared before me,the undersigned,personally appeared
ROGER K.SIEJKA
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(s) on the instrument,the individual(s),or the person upon behalf of which
instrument, the individual(s), or the per n upon behalf of the individual(s)acted,executed the instrument.
which the individual(s �d t��instrument
1114
- (signature and office of individual taking acknowledgment)
(signature and office of individual taking acknowledgment)
Notary Public •GbeiyIStrnona Notary Public
Notary Public,State Of New York
No.31-4970341
Qualified In Suffolk County 49
Commission Expires February 4,20
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE
State(or District of Columbia,Territory,or Foreign Country)of 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,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 acknowledgement)
Notary Public
BARGAIN AND SALE DEED SECTION 115
WITH COVENANT AGAINST GRANTOR'S ACTS BLOCK 6
Title No. LOT 22
COUNTY OR TOWN Mattituck
ROGER K.SIEJKA
TO
ROGER K.SIEKJA,as to an undivided
99%intererst and ADAM SIEJKA,as to an
undivided 1%interest
STANDARD FORM OF NEW YORK BOARD OF TITLE UNDERWRITERS Wickham, Bressler&Geasa, P.C.
P.O. Box 1424
Mattituck, New York 11952
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INSTRUCTIONS(RP-5217-PDF-INS):www.orpa.state.ny.us
FOR COUNTY USE ONLY New York State Department of
,. Cl.SIMS code I Lin 1 r 3:3 S I Taxation and Finance
0 ?j Office of Real Property Tax Services
C2.Date Deed Recorded I / / I S
Q more n� Y... RP-5217-PDF
C9 Book i t�m I�X i C4 Page T n `t �r i Real Property Transfer Report(SI10)
PROPERTY INFORMATION I
1.Property 955 Blossom Bend
Location
•STREET NWIER •MEET NAME
Mattituck 11952
•CtTYa TORN VLIAOE •aFCODE
2.Buyer Siejka Roger K.
Name
•LAW NAYECOTWNIY ROSTRUM
Siejka Adam
LAST NAMEICOUPIAY FOIST NAME
3.Tax Inflate where future Tax Site are to be sant
Billing If other then buyer addrees(at bottom d fano) par NAIECMAPANY MIST NAME
Address
S TREET ISMER ANDNAME CITY OR TORN STATE TP COOL
4.IndIaate the number of Assessment 1 s d PWds ❑Pen d aarce
Parcel (Only If Pert of a Parcel)Check as they apply: El percale transferred on the deed OR 4A.Planning Board with Subdivision Authority Exists
e.Deed _XXXK 0.93
X OR 4B Subdivision Approval wee Remind for Tranalr El
Property •FRONT FEET •DEPTH galas
Sin
4C.Parcel Approved for SubSviala with Map Plaided
Siejka Roger K.
S.Seller •LAW NmeOOOp . FIRST NATE
Nome
LAST NArs.COMPN Y Air NAME
•7.Select the descrlpllen which most accurately describes the Cheek the boxes below as they apply: •
use of the property at the time of sale: S.Ownerehrp Type le Condominium 0
residential vacant land a New Construction on a Vacant Land 0
10A.Property Located within el Agricultural datdd ❑
10B.Buyer received■6sdosure notice Indicating that the property is in an
Agricultural D(stnd 0
ISALE INFORMATION' 10.Check one or more of these conditions as applicable to transfer:
A.Sale Between Relatives or Former Relatives
11.Sale Conhad Deb _ B.Sale between Related Companies or Penner'in Business.
! _ C.Onsdthe Buyers is also a Seller
•12.Date of SalsiTrensM 0 it = D.Buyer or Selly u Government Agency a Lenale ng(Sp Institution
J E.Deed Type not Warranty or Bargain and Sala(Spedly Below)
_ F.Sale of Fractional or Leas than Fee Intermit(Specify Below)
•17.Full Bale Prim .00 _ G.Sigrifica t Change in Property Between Taxable Status end Sale Dates
H.Sale Cl Bualnes is Included In Sale Price
Pd
(Full Sale os is the total amount paid for the propertyincluding including personal property. — I.Other Unusual Fedora Matting Sale Price(Specify Below)
The payment may he In the form at cesh,ether pmpeNty or goods,or the assumption of X .1None
mortgages or other obligations)Please round to the nearest whole cigar amount
Camment(el on Condition:
14.Indicate the value of personal
property Included In the sale .00
I ASSESSMENT INFORMATION-Data should reflect the latest Final Assessment Roll and Tax Bill I
10.Year of Assessment Roll from which Infownetoa takes(YY) 15 •17.Total Assessed Value 300
•10.Property Class 311 _ •1e.School Dlsbkt Rome Mattituck/Cutchogue
10.Tea Mop IdMLSser(sfRoll Identifier(s)(1f more than lour,attic!'sheet with additional Identif e,fs))
1000-115-6-22
CERTIFICATION I
I Carey that as of the Mems of Information entered on this farm are bus and correct(to the hest of my knowledge end belief)and I understand that the making of any willful
fats*statsnem of motorist fact herein subject me to the orovlakne of the gene jJew relative to the malting and filing of false lestmmenta.
-LB r,l,; IMIXER.O.QMEASELRECIBMAIION
glEs (Elarednnn■tlonta tie toyer.Note:*buyer Is LLC,eodery,mneoa■er,mrpaesm.pin ewd.m.pwry,eaaes sr
— �� anal)maonMen helMltalepeem Othiab mens mete rdmeedkdolnacon dinlr maearoeeponeaI.
pray who Can anew0mM:oereUwdnp Ow Milds mud be altered Typo r print dearly.)
R.:-. f . ��
�.; Siejka Roger K.
- 7 •IASTNAME FOST NAME
og • 'rte,/ - 631 298-8353
AP_.._ �./7/ AREA CaaG •TELEOHONEnumosn E•perm
Adam e�L1ia DATE P.O. Box 23
•CRAW NUM&Cp •STREETNAME
1 Mattituck NY 11952
li 'r J}, 1 I�,,,`1' I' ;,� 1 �I 'n
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it •aTYORTON. SATE •apmx
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IJ1�� S�� ill, 1� ��1'i?Ito'. �i 'n11 ' �1ir 1'I i 11Lnr
SUYER'SATTORNEY
)I 1'1 }}�l�e 1) 1111 }�fri1 r1 T II T �IP,11.,piii
11o��1I'i�.i �Ilif�l+I'r l'(II� I1�.'f�lr`AnI pi1tel ylIl�.1.1 , Wickham Abigail A.
II J 1II'f(f133r i�IIlill iI 77iIliWT NML ROSTRATE
11 1 '1q114711 1 �,1 r . e.1 1 I I,ijt I 1,I1 '��'II r1 . Aril l�rM , ) �r'r 'r{If l�lj+ 631 298-8353
'Jl1{Iyi' / l'. ISI ire I �,'1'� Ih�l {r1 11 h}1��iII 1 l ARCA CODE TELEPHONE MAWR it.BOOM
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