HomeMy WebLinkAboutL 12841 P 455 NN
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SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 11/19/2015
Number of Pages: 3 At: 09: 49 :54 AM
Receipt Number : 15-0161598
TRANSFER TAX NUMBER: 15-11375 LIBER: D00012841
PAGE: 455
District: Section: Block: Lot:
1000 054 .00 07 .00 022.000
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $0 . 00
Received the Following Fees For Above Instrument
Exempt Exempt
Page/Filing $15. 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 $250 .00
TRANSFER TAX NUMBER: 15-11375
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
1 2
Number of pages
RECORDED
2015 Nov 19 09:49:54 AM
JUDITH A. PASCALE
This document will be public CLERK OF
record.Please remove all SUFFOLK COUNTY
Social Security Numbers L D00012841
prior to recording. P 455
DT# 15-11375
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
3 I FEES
Page/Filing Fee /
Mortgage Amt.
1.Basic Tax
Handling 20. 00
2. Additional Tax
TP-584 Sub Total
Notation
EA-52 17(County) 5 Sub Total / Spec./Assit.
/ or
7 Spec./Add.
EA-5217(State) ( K TOT.MTG.TAX
Go %OW Dual Town Dual County
R.P.T.S.A. l�0 ,;*,r %f'•:,
O
Held forAppointment
Comm.of Ed. 5. 00 u4 j Transfer Tax
Affidavit
`i •< „t'lil, ' Mansion Tax
Certified Copy "° .'' The property covered by this mortgage is
or will be improved by a one or two
NYS Surcharge 15. 00 C family dwelling only.
Sub Total YES or NO
Other
Grand Total //,I`-' If NO, see appropriate tax clause on
(9- page# of this ins u nt.
4 I Dist. 15032959 1000.05400 0700 022000 22.000 5 Community Preservation Fund/�
Real Propel PTS I IlU
Consideration Amount$ �/Tax
Agency e 17-LNPOI-1 VIII I1IIIIl �II I�III I U IIIIII� CPF Tax Due 5
Verificatioi
Improved X
6 Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD&RETURN TO: Vacant Land
TD 1 0
Nancy Burner&Associates,P.C.
12 Research Way • TD
East Setauket,NY 11733
TD
Mail to:Judith A.Pascale,Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name
www.suffolkcountyny.gov/clerk Title#
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached Quitclaim Deed made
by: (SPECIFY TYPE OF INSTRUMENT)
Annamae P.Johnson,individually and as The premises herein is situated in
surviving tenant by the entirety SUFFOLK COUNTY,NEW YORK.
TO In the TOWN of Southold
Annamae Johnson Revocable Trust In the VILLAGE
or HAMLET of Southold
BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
(over)
Quitclaim Deed-Individual or Corporation(single sheet)
THIS INDENTURE,made the 1 day of Q,- a e,E Vtwo thousand fifteen
BETWEEN
ANNAMAE P.JOHNSON,individually and as surviving tenant
by the entirety of RALF H.JOHNSON,deceased,who died a
resident of Suffolk County
4130 Hortons Lane,Southold,New York 11971
party of the first part,and
ANNAMAE JOHNSON,AS TRUSTEE OF THE
ANNAMAE JOHNSON REVOCABLE TRUST
4130 Hortons Lane,Southold,New York 11971
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 party,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 real property,with the buildings and improvements therein contained,situate,lying
and being at Southold,Town of Southold,County of Suffolk and State of New York,bounded and described as follows:
BEGINNING at a monument at the intersection of the southeasterly line of North Road with the easterly line of Hortons
Lane;and
RUNNING THENCE along said southeasterly line of North Road,North 33 degrees 01 minute 50 seconds East a distance of
182.78 feet to a monument;
THENCE along land of Mahlon D.Dickerson three 93)courses,as follows:
1)South 28 degrees 33 minutes 30 seconds East a distance of 161.94 feet to a monument;THENCE
2)South 17 degrees 47 minutes 40 seconds East a distance of 50.0 feet to a monument;THENCE
3)South 72 degrees 12 minutes 30 seconds West a distance of 185.52 feet to a monument set on said easterly line of Hortons
Lane;
THENCE along last mentioned line North 09 degrees 30 minutes 50 seconds West a distance of 94.66 feet to the point of
BEGINNING. Containing.a597 of an acre,according to survey of Otto W.Van Tuyl&Son dated August 30,1952.
BEING AND INTENDED to be the same premises conveyed to the party of the first part by deed dated July 17,1964 and
recorded in the Suffolk County Clerk's office on July 23,1964 in Liber 5582 at Page 462.
SAID PREMISES being known as and by the street address: 4130 Hortons Lane,Southold,New York 11971
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:
ANNAMA .JOHNSON
STATE OF NEW YORK,COUNTY OF SUFFOLK SS.: STATE OF NEW YORK,COUNTY OF SS.:
On the day of OCkfat— ,2015,before me,the On the day of , 2015,before me,the undersigned,
undersigned, personally appeared ANNAMAE P. JOHNSON, personally appeared personally known
personally known to me or proved to me on the basis of satisfactory to me or proved to me on the basis of satisfactory evidence to
evidence to be the individual(s)whose name(s)is(are)subscribed to be the individual(s)whose name(s)is(are)subscribed to the
the within instrument and acknowledged to me that he/she/they within instrument and acknowledged to me that he/she/they
executed the same in his/her/their capacity(ies), and that by 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 his/her/their signature(s)on the instrument,the individual(s),
person upon behalf of which the individual(s) acted, executed the or the person upon behalf of which the individual(s) acted,
instrument. /• executed the instrument.
10 if #
I '
Notary Public Notary Public
6RWTTNi ANN SULLIVAN
Notary Public,State of New Yolk
No.01UH6275314
Qualified in Suffolk Countn.4-,-
Commission Expires Jan.28, f T
ACKNOWLEDGMENT TAKEN OUTSIDE NEW YORK STATE
STATE OF NEW YORK,COUNTY OF SS.: STATE OF ,COUNTY OF SS.:
(or insert District of Columbia,Territory,Possession or Foreign Country)
On the day of 2015,before me personally came On the day of 2015,before me,the
to me known,who being by me duly sworn,did depose and say that
he resides at No. ;that he is the undersigned personally appeared
of the corporation personally known to me or proved to me on the basis of
described in and which executed the foregoing instrument;that he satisfactory evidence to be the individual whose name is
knows the seal of said corporation; that the seal affixed to said subscribed to the within instrument and acknowledged to me
instrument is such corporate seal;that it was so affixed by order of the that she executed the same in her capacity, that by her
board of directors of said corporation,and that he signed h name signature on the instrument,the individual or the person upon
thereto by like order. behalf of which the individual acted,executed the instrument,
and that such individual makes such appearance before the
undersigned in the
(add the city or political subdivision and the state or country or other place of
the acknowledgment was taken)
Notary Public
Notary Public
QUITCLAIM DEED
ANNAMAE P.JOHNSON,individually and as SECTION 054.00
surviving tenant by the entirety
BLOCK 07.00
TO
ANNAMAE JOHNSON,AS TRUSTEE OF THE for 022.000
ANNAMAE JOHNSON REVOCABLE TRUST
COUNTY OR TOWN SUFFOLK
RETURN BY MAIL TO:
Nancy Burner&Associates,PC
12 Research Way
E.Setauket,New York 11733
•
INSTRUCTIONS(RP-,5217-PDF-INS):www.orps.state.ny.us
FOR COUNTY USE ONLY i f/ ^i New York State Department of
Cl.SWIS Code L/1 (� 'R, JcU Taxation and Finance
C2.Date Deed Recorded i ///1 /7/ /6"."I Office of Real Property Tax Services
Mae Yew r'�//�`/, RP-5217-PDF
C9.Book I / a giyl ill C4.Page I t /I�J 1�+I Real Property Transfer Report(0110)
PROPERTY INFORMATION I
1.ProPetty 4130 Hortons Lane
Location
•STREET ROWER •STREET NAME
Southold Southold 11971
•arae.TOM VLAGE •T.P Cow:
2.Buyer Annamae Johnson Rev Trust
Name
•WT NAMEA:CIPAM SIM NAC
WT NAaJCOMFAY .Pel NAPE ,
S.Tax Indicate where future Tax Bills are to be sent
Billing if other then buyer address(et bottom of frim) LAST InalE COMr•AM FAIT NAME
Address
STREET MASER NC+ANE OP'OR man elA:E act cost
4.Indicate the number of Assessment 1 ❑Part d a Parcel (��If Part of a Parole)Cheek aa they apply:
Roll parcels transferred on the deed a d Poroels OR PManningI=14A. ning Board with Subdivision Authority Exists
S.Deed X OR 0.59 -_- 4R Subdivision Approval was Required for Transfer ❑
Property •FROM FEET •DEPTH 'ACRES
SW 40.Parcel Approved for Subdivision with Map Provided ❑
Johnson, surv. TBE Annamae P.
II.Seller 'UST NAME/COMPANY a PS:NAPE
Name
LAST NMEtCCMFANV FART NNYE
'7.Select fie description which most accurately describes the Check the boxes below as they apply:
use of the property at the rima of sale: 8.Ownership Type is Condonerium ❑
A.One Family Resident lel 8.New Construction on a Vacant Land El
10A.Property Located within an Agricultural District III
10B.Buyer received a dedosers notice indicating that the property is in an ❑
Agricultural District
SALE INFORMATION' 15.Check one or more of these conditions as applicable to transfer.
A Sale Between Relatives or Former Relatives
11.Salo Contract Data B.SW between Related Companies or Partners in Beninese
1O /01 /7Og5 D.One
erorsaurisovernmalso•Saner
A 12.Dab of 8sleRnssfar D.Buyer or Seller is Government Agency or Londmg Institution
E.Deed Type not Warranty or Barysin and Sale(Speaty Belau)
F.Sete of Fractional or Less than Fee Interest(Specify Below)
13.Full Sale Price 0_0Q G Significant Change in Properly Between TexaNe Status and Sale Dales
H Sala of Business is Inducted in Sale Price
(Full Sale Price is the triol amount paid for the property Including personal properly. I.Other Unusual Factors Affecting Sate Price(Specify Below)
This payment may be in the form of cash,ether property or goods,or the assumption of J None
mortgages or other obligstlons.)Please round to the nearest whole dollar amount.
'Commends)on Condition:
14.Indicate the value of personal
property included In the sate 0 .00 Transfer co 'roust:
ASSESSMENT INFORMATION-Data should relied the latest Final Assessment Roll and Tax Bill I
1e.Year of Assessment Roll from which Infomtatlon taken(YY) 15 '17.Total Assessed Value 5,800
•1e.Property Class 210 _ •18.School District Name Southold CSD
'20.Tax Map Identlf erisyRog Mentalism la more than four,attach sheet with addklonal Ideneller(s0
1000-054.00-07.00-022.000
I CERTIFICATIOJ
I Certify that all of the Items of information entered on this form are true end correct(to etre best of my knowledge and belief)and I understand that the making of any willful
false statement of met rtal fact herein sublect me to ths_@0ylelene-of the.penal lew.rslaWo to the making and filing of false Instruments.
SE LER SIGNALUBE BUYER CONTACT INFORMATION
(EMI RRarmesn tar mw buyer Naw II Pryer is LLC.aadety,eumeabn.=protan,pax stack CSmprly,MIA Sr
,�,,
MIKE cwt IS no e'edmdual spent r nenery.awn a rum and Taxm xxanneaan a en ndnraswwpeubls
5
aoco_o lobi I I f SI party ere can sneer queuaaneregerdep ow tremor Rust be weaned.Type ar print asedy.)
LLER SICHATWE DATF
Johnson Annarnae
BUYER SIGllAIUBE
•W 1 RWM, FIRST NAME
[ ." (631) 765-8054
�/�' l'61 1( f L VACS WOE •:El1PND1C wMr[R IE.sasrm ni,
EI ERncwiATunL RAIL
4130 Hof tons Lane
•STREET WIEDER •STREET NAME
I. I. f ' r 1' a Southold NY 11971
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