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Home My WebLink AboutL 12920 P 942 IIIEEE111111111111111111111E1111111111111 EEIEI 11111111 111111 IIIII 11111 illi IIII SUFFOLK COUNTY CLERK RECORDS OFFICE RECORDING PAGE Type of Instrument: DEED Recorded: 07/18/2017 Number of Pages: 3 At: 04 : 36 : 06 PM Receipt Number : 17-0120888 TRANSFER TAX NUMBER: 16-37478 LIBER: D00012920 PAGE : 942 District: Section: Block: Lot: 1000 128 . 00 06. 00 004 .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 $5 . 00 NO RPT $200 . 00 NO Transfer tax $0 . 00 NO Comm.Pres $0 . 00 NO Fees Paid $395 . 00 TRANSFER TAX NUMBER: 16-37478 THIS PAGE IS A PART OF THE INSTRUMENT THIS IS NOT A BILL JUDITH A. PASCALE County Clerk, Suffolk County amber of 'ages, ✓ RECORDED -'017 Jul 18 04:36:06 PM JUDITH A. PASCALE This document will be public c;LF�t, of record. Please remove all SUFFOLK COUNTS/ Social SecurityNumbers L D00012920 P 942 prior to recording. DT# 16-37472 Deed/Mortgage Instrument Deed!Mortgage Tax Stamp Recording/Filing Stamps 3 FEES Page/Filing Fee 5 Mortgage Amt. 1. Basic Tax }}andling 20. 00 2. Additional Tax TTI-584 co Sub Total Spec./Assit. flotation or 6A-52 17 (County) `> Sub Total �� Spec./Add. �A-5217 (State) 7i�I W TOT.MTG.TAX �Qu J a� Dual Town Dual County_. R.P.T.S.A. — . Held for Appointment Comm.of Ed. 5. 00 Transfer Tax Mansion Tax Affidavit The property covered by this mortgage is Certified Copy or will be improved by a one or two ✓ family dwellin only. NYS Surcharge 15. 00 Sub Total YES or NO Other TT Grand Total •�V If NO,see appropriate tax clause on page# of this instr m t. 2 i 4 1 Dist•1000 Se 17023882 1000 12800 0600 004000 5 Community Preservation Fund Real Property P T S Consideration Amount $ TAgencyCe (R e°u°,� IIIIIIIIIIIIIaIIIBIIIIIIlIIIIIIIIIIIIIIIIIIfIIII GpF Tax Due Verification - Improved 6 Satisfactions/Discharges/Releases List Property Owners Mailing Address RECORD&RETURN TO: Vacant Land WILLIAM F. BATES, ESQ. 120 Court Street TD Riverhead NY 11901-3003 TD TD Mail to: Judith A. Pascale, Suffolk County Clerk 7 Title Company Information 310 Center Drive, Riverhead, NY 11901 www.suffolkcountyny.gov/clerk Title# $ Suffolk County RecordinFr & Endorsement Page This page forms part of the attached Bargain s Sale Deed with Covenants made by: (SPECIFY TYPE OF INSTRUMENT) IRREV. TRUST AGREEMENT The premises herein is situated in MADE bjZzi/1989 SUFFOLK COUNTY,NEW YORK. TO In the TOWN of SOUTHOLD ROBERT D. KELSEY In the VILLAGE or HAMLET of LAUREL BOXES 6 THRU 8 MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING. 2-0104.10108kk Over Form 3290 CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY THIS INDENTURE, made the 29th day of June,2017, SjwkC� PZ t -- BETWEEN ROBERT D. KELSEY,drustee under the IRREVOCABLE TRUST AGREEMENT MADE June 23, 1989 residing at 2345 Rose Walk Drive,Alpharetta,Georgia 30005,Party of the First Part, And ROBERT D.KELSEY, residing at 2345 Rose Walk Drive,Alpharetta,Georgia 30005, Party of the Second Part, WITNESSETH, that the Party of the First Part, in consideration of TEN DOLLARS AND 001100*****($10.00)***** 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,with the buildings and improvements thereon erected,situate, lying and being in the Town of Southold, County of Suffolk and State of New York, bounded and described as follows: Dis. BEGINNING at a point on the Southerly side of Peconic Bay Boulevard,where the same is intersected by 1.000 the Northwest corner of land of John T.Young; Sec. RUNNING THENCE South 16 degrees 30'East 605.38 feet to Peconic Bay; 128.00 THENCE South 28 degrees 36'30"West along the high water mark of the Peconic Bay 100 feet to the land Blk. of Edward P.Lavern; 06.00 THENCE along said land North 16 degrees 30' West 605.38 feet to the Southerly side of Peconic Bay Lot Boulevard; 004.000 THENCE North 28 degrees 36' 30" East alonth Sou herly side of Peconic Bay Boulevard to the Northwest corner of land of John T.Young,the poin>^or place of BEGINNING. BEING AND INTENDED TO BE the same premises described in Deed to Grantor herein dated 06123/1989 recorded at Liber 10912 Page 272. TOGETHER with all right,title and interest 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 convents 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 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 nay 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. 1N WITNESS WHEREOF,the part of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF IRREV BLE TRUST AGREEMENT MADE June 3,1 9 BY: FCO—BERT D.KELS Y,Trus e i TO 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 29th day of June in the year 2017 On the day of in the year before me,the undersigned personally appeared before me,the undersigned personally appeared ROBERT D.KELSEY 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 Satisfactory evidence to be the individual(s)whose name is subscribed to the within instrument and name(s) is(are)subscribed to the within instrument and acknowledged to me that he executed the same in his acknowledged to me that he/she/they executed the same in capacity,and that by his signature on the instrument,the his/her/their capecity(ies),and that by his/her/their signature(s) individual or the person alf of which the on the instrument,the individual(s)or the person upon behalf of individual acre x ted th ins rument. which the individual(s)acted,executed the instrument. (signature and bffioroT indi idualg the acknowledgment) (signature and office of individual taking the acknowledgment) NOTARY PUBLIC WILLIAM F.BATES Notary Public,State Of New York No.02BA4671530 Qualified In Suffolk County Commission Expires December 31, TO BE USED ONLY WHEN THE ACKNOWLEDGMENTS IS MADE OUTSIDE NEW YORK STATE State of COUNTY OF SS: On the day of in the year 2017, before me,the undersigned,personally appeared 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 he signature on the instrument,the individual,or the person upon behalf of which the individual acted,executed the instrument and that such individual made such appearance before the undersigned in the Town of , State of (signature and office of individual taking acknowledgment) NOTARY PUBLIC (Stamp or Sea[) My Commission Expires BARGAIN AND SALE DEED SECTION WITH COVENANTS AGAINST GRANTOR'S ACTS BLOCK LOT COUNTY OR TOWN SUFFOLK/SOUTHOLD Title No. STREET ADDRESS ROBERT D.KELSEY,TRUSTEE UNDER THE IRREVOCABLE TRUST AGREEMENT MADE June 23,1989 TO ROBERT D.KELSEY RETURN BY MAIL TO: WILLIAM F.BATES,ESQ. SAFE HARBOR TITLE AGENCY 120 Court Street 1529 Main Street Riverhead NY 11901-3003 Port Jefferson,NY 11777 (Reserve this space for recording office) INSTRUCTIONS(RP-5217-PDF-INS):www.orps.slate.ny.us FOR COUNTY USE ONLY op New York State Department of C1.awls code 171 .�j Z¢s 101 7 I Taxation and Finance C2.Date Dead Recorded " / fi Lq Office of Real Property Tax Services "' . Car5,f` RP-5217-PDF C3.Book 9 n C4•Page ` Real Property Transfer Report(0110) PROPERTY INFOR3M2N 1•P-Pery 3790 Feconic Bay Boulevard Location •Sr RFETmAlY9ER •5•REET NAME Southold Laure_ 11948 VL-AGE .sN CO3E 2.Buyer KELSEY Robert D. Name •LAST NAYaICCYFANY FIRST W W E LAST NAYFROaA4W F RST N IFF 3.Tax. Indicate where future Tax Bills are to be sent Billing y other than buyer address(al bclfom at form) LAST NAVLAMHOWr FIRST hAME Address STREET M.LwFRNra WWE CITY OR TOM aTA'[ . =MC 4.Indicate the number of Asaesement 1Pan a Parcel (Only If Part of a Parcel)Check as they appy: Roll perosis rrameh rred on the dead a d Pervle OR ❑ d 4A.Planning Board with Subdivision Authority 6cials El L Dead x OR 0.oC 4B.Subdivision Property 1 Rail FrtT Approval was Required for Trendier TxPrh 'ACRES ❑ Shia 4C.Parcel Approved for Subdivision with Map Provided ❑ !•�r1.5 E`i 4 �'b 'C�us-r -rrzu.�'►�txr ab�a3 I r 4 g� 0.Sailer •LAST wuLA'nYFANY r xm-Nwr Name LAS-WHEICCV^ANY FIRST NAVF '7.Salad the description which most accurately describes the Check the boxes below as they apply: use of the property at the time of sale: L Ownership Type is Condomnlum ❑ 0.New construction on a Vacant lend ❑ • �� "`�L� tOA.Properly Located within an AgrirxMural District ❑ 108.Boyar received a diselesure notice indicating that the property Is In an ❑ Agricultural District SALE INFORMATION 15.Check one or more of these conditions as applicable to transfer: ASale Belween Reletivn or Former Relatives 11.Sale Contract Dab B.Sale behiresn Related Companies or Partners in Business. C.One of the Buyers Is also a Salim 12.Dab of Salelrranafer lob �J D Buyer or Seller Is Government Agency or Lending Insalullon E.Dead Type not Warranty or Bargain and Sole($peaty Below) F.Sale of Fractional or Lass than Fee Interest(Specify Below) '13.Full Side Price 0,00 G.Significant Change in Property Between Taxable Statue and Selo Dees (Full Sale Priv Is the kml amount paid ice the pmpery Including personal _ H.Sala r nu Business is Included to Sale a Price properly. ` I.Other Unusual Fedora Affecting Sea Prise(Seedy Below) This payment may be m the farm d cash,other property a pocds,a the assumption of J Nolte mortgage or other obligations)Presse round to rhe nearest whale dollar amount. Comments]on Condition: 14.Indicate the value of personal 0 X12 prcpery included In thassle .00 ASSESSMENT INFORMATION-Data should reflect the latest Final Assessment Rolland Tax Bill 16.Year of Assessment Roll from which Information taken(YY) 17 '17.Total Assessed Value 116.Property Clan ;LID _ _ .19.School District Name If\the I-ru C.*_, - '20.Tax Map Identif er(ayltoll ldont6iw(s)pfmors than four,attach aheatwllh addkbnal IdodMer(sp 1000-128.00-06.00 004.000 CERTIFICATION 1 Certly thatall of the Rents of Inform intim entered on this form are tats and correct(to the beat Stray knowledge and WHIM and I understand th d the making of any willful false statement of material fad herein subject me to the pMVlplans of the panel low relative to the making and filing of false Instruments. SELLER SIGNATURE Iil7YFR CONTACT INFORMATION tEntar Elio' @tFw for acs buyer Noce IF buyer a LLC,weaty.asabasbm,mrporaton,P!n mock company Grua o• mbty Thele not an MMd.RI Mesa or ed.cary,than a nacre a'le Cw ..lGorrllelran H m llaaduW sepmable G/19 party who can an—grweoma r.prdma the Emeriti moa be craned TEAR or prw cisady) MLLER SCNATLRE I��[�ijltt��"'A��'�FJ�`��•'•' DAT , B(jYER 31r:ueTr�o_e_ KELSEY Robert D. I 'LEST NAVE -PST hAYE ey (678) "46-9997. / •ARLACOM •TE.EPWMIE LYEER:E.WAanr —•� IIJYER aaNATURE CATE 12345 Rose Walk Drive -STREET WIRIER 'STREETAYVE ' Alpharetta GA 30005 'CrYoi Tom/ -STArL '11-Cala BU.Y.EIVA ATTORNEY I BATES William `. 1 149"NAYF RBST RAIIE �I I (621) 727-0050 AR'-•LOGE TF.FNIME MIWF.R:FF awwie I