HomeMy WebLinkAboutL 12864 P 692 mimmoimumimmio
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SUFFOLK COUNTY CLERK
RECORDS OFFICE
RECORDING PAGE
Type of Instrument: DEED Recorded: 05/17/2016
Number of Pages: 4 At: 01 :02:51 PM
Receipt Number : 16-0076247
TRANSFER TAX NUMBER: 15-28851 LIBER: D00012864
PAGE : 692
District: Section: Block: Lot:
1000 090.00 02.00 029. 000
EXAMINED AND CHARGED AS FOLLOWS
Deed Amount: $530 ,000. 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 $200 .00 NO
Transfer tax $0 . 00 NO Comm.Pres $7 ,600 .00 NO
Fees Paid $7, 995.00
TRANSFER TAX NUMBER: 15-28851
THIS PAGE IS A PART OF THE INSTRUMENT
THIS IS NOT A BILL
JUDITH A. PASCALE
County Clerk, Suffolk County
1 2
Number of pages (f. RECORDED
2016 May 17 01:02:51 PM
JUDITH R. PASCALE
CLERK OF
This document will be public SUFFOLK COUNTY
record. Please remove all L D00012864 •
Social Security Numbers P 692 •
prior to recording. DT# 15-28851
Deed/Mortgage Instrument Deed/Mortgage Tax Stamp Recording/Filing Stamps
3nn FEES
Page/Filing Fee c2(J I Mortgage Amt.
1. Basic Tax
Handling 20. 00 2. Additional Tax
TP-584 -S.
Sub Total
Notation SpeciAssit.
/ or
EA-52 17(County) ' D Sub Total 5� ' Spec./Add.
r
EA-5217(State) 1 a.> TOT.MTG.TAX
�7 i g Dual Town Dual County_
R.P.T.S.A. A ''t Held for Appointment
Comm.of Ed. 5. 00v{ n
fo. 24, Transfer Tax V rt
Affidavit t': '�e Mansion Tax r
The property covered by this mortgage is
Certified Copy or will be improved by a one or two
NYS Surcharge 15. 00 3(j family dwelling only.
Sub Total l ) YES or NO
Other
Grand Total If NO,see appropriate tax clause on
page# of this instrument,
16014020 • (1—,J
4 Dist. 1000 09000 0200 029000 �C'�
f 5 Community Preservation Fund
Real Property R C AY; 11IIIIIIIIIII!i!llII!I!IihIIIIIIihIIjffJIIIlI
IIIJI1 • Consideration Amount$ c;')O000
Tax Service II III
Agency Prax Due $ "7,CP 00
Verification
/ Improved X
Satisfactions/Discharges/Releases List Property Owners Mailing Address
6 RECORD&RETURN TO: Vacant Land
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Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title Company Information
310 Center Drive, Riverhead, NY 11901 Co.Name FIDELITY NATIONAL TITLE •
wvuw.suffolkcountyny.gov/clerk . Title# (- 1\o- 1 qaki- ( oo$g3
8 Suffolk County Recording & Endorsement Page
This page forms part of the attached '' 'L��
made by:
(SPECIFY TYPE OF INSTRUMENT)
sR\OWd .L C):03uest\chts,— v uS��c�1.• 0 oRzThe premises herein is situated in.
�,1Qr\QA,,,ti (-040,‘" .tJ-Nveeosnel-7,c�} SUFFOLK COUNTY,NEW YORK.
In the TOWN of % `�
_ �SS� Yo„,..., a\Q.qxwows In the VILLAGE
' .(a-tr 6,..`f e_ Ci k`u( or HAMLET of 0 LN04\0\G\
BOXES 6 THRU 8 MUST BE TYPED Ok PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
12-0104..aae8kk
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CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY
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THIS INDENTURE,made thy' `day of April,2016
BETWEEN
RICHARD L. PROVENCHER, as Trustee of the Provencher Family Irrevocable Trust,
residing at 39 Twixt Hills Road, Saint James, New York 11780,
party of the first part,and
JESSE PAUL CLEMMENS and JENNY MARIE BAKER, as joint tenants with right of
survivorship, residing at 25 Monroe Place,Apartment 9F, Brooklyn, New York 11201-2626,
party of the second part,
WITNESSETH,that the party of the first part, in consideration of Five Hundred Thirty Thousand and 00/100
($530,000.00)dollars 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, with the buildings and improvements thereon erected, situate,
lying and being in the
SEE SCHEDULE"A"ANNEXED HERETO AND MADE A PART HEREOF.
DIST 1000 BEING AND INTENDED TO BE THE SAME PREMISES conveyed to the party of the first part by Deed
SECT 090.00 dated 02/28/2013 and recorded in the Suffolk County Clerk's Office on 07/24/2013 in Liber 12737 page 767.
BLK 02.00
LOT 029.000
SAID PREMISES also known as 505 Midway Road,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:
HARD L. PROVENC ER, as Trustee
Of The Provencher Family Irrevocable Trust
Standard N.Y.B.T.U,Form 8002-Bargain and Sale Deed,with Covenant against Grantor's Acts—Uniform Acknowledgment
Fidelity National Title Insurance Company
TITLE NO. F16-7404-100893-SUFF
SCHEDULE A-1 (Description)
ALL that certain plot, piece or parcel of real property, situate, lying and being at Cedar Beach Park, in the Town of
Southold, County of Suffolk and State of New York, known and designated as the Westerly part of lot 144 on a certain
Map entitled, "Subdivision Map of Cedar Beach Park, situated at Bayview, Town of Southold,New York" surveyed and
certified by Otto W. Van Tuyl, Engineer and Surveyor and filed in the Office of the Clerk of the County of Suffolk as
Map No. 90 and said portion of Lot No. 144 is bounded and described as follows:
BEGINNING at a point on the Northerly line of Midway Road where the boundary line between lots 145 and 144 on the
• aforesaid map intersects,the said Northerly line of Midway Road;
RUNNING THENCE North 48 degrees 44 minutes 10 seconds East, 106.50 feet to the ordinary high water mark of
Midway Inlet;
THENCE along the ordinary high water mark of Midway Inlet in an Easterly direction 136.11 feet;
THENCE South 21 degrees 14 minutes 40 seconds West, 51.30 feet to the Northerly line of Midway Road;
THENCE along the Northerly line of Midway Road the following two courses and distances:
1)North 70 degrees 43 minutes 50 seconds West, 148.46 feet;
2)North 41 degrees 15 minutes 50 seconds West,30 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.
SCHEDULE A-1 (Description)
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YORK STATE
•
- 'r State of New York,County of Suffolk)ss: State of New York,County of as:
Oh the 4:93 day of April,in the year 2016, On the day of in the year
.' • before me,the undersigned,personally appeared before me,the undersigned,personally appeared
RICHARD L.PROVENCHER,
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 • -• /her/their r - ) on the capacity(ies), and that by his/her/their signature(s) on the
instrument,the indi '• al(s),o��r , .- on upon behalf of which instrument,the individual(s),or the person upon behalf of which
the individual(s) . ted,execu '/ e instrument. the individual(s)acted,executed the instrument.
,_M
(signature and office• indi idual taking acknowledgment) (signature and office of individual taking acknowledgment)
JANET CONNO Y
NOTARY PUBLIC,STATE OF NEW YORK
Registration No.O1-CO6067844
QualifCommfssion Ex. i es December 1in Suffolk 7,2017
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE
STATE 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)are subscribed to the within instrument and acknowledged
to me that they executed the same in their capacities, and that by 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)
DISTRICT 1000
BARGAIN AND SALE DEED SECTION 090.00
WITH COVENANT AGAINST GRANTOR'S ACTS BLOCK 02.00
LOT 029.00
Title No.F(to l4O4 10079 3 S COUNTY OR TOWN Suffolk/Southold
STREET ADDRESS 505 Midway Road
Provencher Family Irrevocable Trust to Southold,NY 11971
Clemmens&Baker
STANDARD FORM OF NEW YORK BOARD OF TITLE UNDERWRITERS RETURN BY MAIL TO:
DAVID OLSEN, ESQ.
OLSEN &OLSEN, L.L.P.
32495 MAIN ROAD, PO BOX 706
CUTCHOGUE, NEW YORK 11935
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INSTRUCTIONS(RP-5217-PDF-INS):www.orps.state.ny.us
FOR COUNTY USE ONLY u `^l New Yolk State Department of
. Cl.pm Code I i71.3, g V I 9 I I Taxation and Finance
,• C2.Date Deed Recorded ()5/ / i Office of Real Properly Tax Services
Q/- y��a/y
Soy r� ,/[] RP-5217-PDF
C8.Book I /1 f O ICD 1271 f C4.Pogo I I F0`-'I 1 Real Properly Transfer Report(8115)
PROPERTY INFORMATION I
1.Propsrty 505 Midway Road
Location
•STREET MASER •aTRFEr NMe
Southold 11971
•pry ORTOLAN Y LAGE .LPCCCE
2.Buyer Clemmens Jesse Paul
Name
•LASTPMFE.00rMIY FIRST FLAME
Baker Jenny Marie
WT NMPJCdPINT ma!WIPE
3.Te` Indicate where future Tax Bills are to be sant )aKe . /clown ee)5 jeA)N�J 3e5x
Billing n Omer than buyer eddresa(at bottom Of form) tart wascomowr FIRST NW[
Address x.61 5M Ave. A2-1-t D.
`-1-ta 1?)9ooK15N iIaI5
STREET MweERNIT MIM RITTER TONS STET RR CODE
4.Indians the number of Assessment 10 Pan of a Parcel (Only If PuPortal)Part of a Pael)Chock as they apply:
Roll parcels transferred on the deed s d Pamab OR 0
IA.Planning Board with Subdivision Autharily Exists
S.Deed X OR 0.28 4B.Subdivision Approval was Required for Transfer
Properly •FRONT FEET •IIEPnt "Me
Size CC.Parcel Approved for Subduction with Map Provided 0
Provencher Family Irrevoc
6.Seller .Lear NMFICOMPMY FIRST NAME
Name
IMT NIMISCOIPAM• HMI ERRE
'7.Select the description which moat accurately describes the Check the boxes below as they apply:
•use of the property at the time of sale: B.Ownership Type is Condominium ❑
A.One.Family Residential 9.New Construction on a Vacant Land C3
- - - - • 10A.Properly Located wean an Agdcufural District 0
10B.Buyer received a disclosure notice indicating that me property Min an 0
Agr culurel District
ISALE INFORMATION Ie_Check one or more of these conditions as applicable to transfer:
A.Sale Between Relatives or Former Relatives
. 11.Sale Contract Data 03/07/2016 =_ B Sale between Related Companies or Partners in Business.
_ C.One of the Buyers is also a Seller
04/28/2016 _ 0 Buyer or Seller is Government Agency or Lending InebMen
'12.Date of SalaRnnsier -E Deed Typo not Warranty or Bargain and Sale(Specify Below)
_ F.Sale of Frontons!or Lass then Fee Interest(Specify Below)
'17.Full Sale Price 530,000.00 _G.Significant Change in Properly Between Taxable Status and Sale Dates
_ H.Sale of Business is Included in Sale Pace
(Full Sala Price Is mproperty including total amount paid for the cluding personal property. I.Other Unusual Factors Affecting Sale Price(Specify Below)
Tide payment may ea in me form of cash.Omer properly or goods,or the assumption of $ J None
mortgages or other obligations.)Please round to ins nearest Mole dollar amount
Commant(e)on Condition:
14.Indicate the value of personal .00
property Included In the sale
IASSESSMENT INFORMATION-Data should reflect the latest Final Assessment Roll and Tax BSI I
16.Year of Assessment Roll from which Information taken(YY) 15 97.Total Assessed Value 5,700
96.Property Clans 210 - 99.School District Name Southold
n0.Tax Map idenUUer(a)1Roll Identifler(s)(It more than four.attach sheet with additional IdenURsr(s))
1000-090.00-02.00-029.000
I CERTIFICATION I
I Certify that all of the Items of information entered on this form are true and correct(to the beat of my knowledge and belles and I understand mat the making of any willful
false statement of material fact herein subject me to the.prOvlalons of.the pannaijaw relative to the making and filing of false Instruments.
DE SIGNATURE BUYER CONTACT INFORMAT101t
�/'� ardd(Einy TAM m wo Sr for IIA Omar.apart
If buyunar. en memocility a d=tad allomveon al
none mopenypo Ole v
areas Mel n not aatlritllMl spar a 1rOna:U uteri a memo and CTed rnfoRN1A d m moYdlerlaepuwble
Y�s'�s pay who eanIrmo rNeaCmawarp Peewlwroust be eil.d Typo ormint sandy)
SELLER SIMMIL E OA%
// / BUYER SIGNATURE
Clemmens/Baker Jesse Paul/Jenny Marie
10 y /
....0,
✓ i •LAST WERE fRdTNME
� '� 11 (999) 999-9999
J_f e �. ...-A,. . e.a 'Maw -rater NE M.RSER I6 SMIM1
:1 TE
505 Midway Road
•STMETlapaER •STREET LAME
++ Southold __ NY 119'11
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