Real Property Transfer Report {RP-5217-PDF}

INSTRUCTIONS(RP-5217-PDF-INS): www.orps.state.ny.us FOR COUNTY USE ONLY C1. SWIS Code C2. Date Deed Recorded Month Day Year RP- 5217-PDF Real Property Transfer Report (8/10) C3. Book PROPERTY INFORMATION C4. Page 1. Property Location * STREET NUMBER * STREET NAME * CITY OR TOWN VILLAGE * ZIP CODE 2. Buyer Name * LAST NAME/COMPANY FIRST NAME LAST NAME/COMPANY FIRST NAME 3. Tax Billing Address Indicate where future Tax Bills are to be sent if other than buyer address(at bottom of form) LAST NAME/COMPANY FIRST NAME STREET NUMBER AND NAME CITY OR TOWN STATE ZIP CODE 4. Indicate the number of Assessment Roll parcels transferred on the deed 5. Deed Property Size # of Parcels OR Part of a Parcel (Only if Part of a Parcel) Check as they apply: 4A. Planning Board with Subdivision Authority Exists 4B. Subdivision Approval was Required for Transfer 4C. Parcel Approved for Subdivision with Map Provided * FRONT FEET X * DEPTH OR 0.00 *ACRES 6. Seller Name * LAST NAME/COMPANY FIRST NAME LAST NAME/COMPANY FIRST NAME *7. Select the description which most accurately describes the use of the property at the time of sale: Check the boxes below as they apply: 8. Ownership Type is Condominium 9. New Construction on a Vacant Land 10A. Property Located within an Agricultural District 10B. Buyer received a disclosure notice indicating that the property is in an Agricultural District SALE INFORMATION 11. Sale Contract Date 15. Check one or more of these conditions as applicable to transfer: A. Sale Between Relatives or Former Relatives B. Sale between Related Companies or Partners in Business. C. One of the Buyers is also a Seller D. Buyer or Seller is Government Agency or Lending Institution E. Deed Type not Warranty or Bargain and Sale (Specify Below) F. Sale of Fractional or Less than Fee Interest (Specify Below) G. Significant Change in Property Between Taxable Status and Sale Dates H. Sale of Business is Included in Sale Price I. Other Unusual Factors Affecting Sale Price (Specify Below) J. None Comment(s) on Condition: * 12. Date of Sale/Transfer *13. Full Sale Price .00 ( Full Sale Price is the total amount paid for the property including personal property. This payment may be in the form of cash, other property or goods, or the assumption of mortgages or other obligations.) Please round to the nearest whole dollar amount. 14. Indicate the value of personal property included in the sale .00 ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill 16. Year of Assessment Roll from which information taken(YY) *18. Property Class *17. Total Assessed Value _ *19. School District Name *20. Tax Map Identifier(s)/Roll Identifier(s) (If more than four, attach sheet with additional identifier(s)) CERTIFICATION I Certify that all of the items of information entered on this form are true and correct (to the best of my knowledge and belief) and I understand that the making of any willful false statement of material fact herein subject me to the provisions of the penal law relative to the making and filing of false instruments. SELLER SIGNATURE BUYER CONTACT INFORMATION (Enter information for the buyer. Note: If buyer is LLC,society, association, corporation, joint stock company, estate or entity that is not an individual agent or fiduciary, then a name and contact information of an individual/responsible party who can answer questions regarding the transfer must be entered. Type or print clearly.) SELLER SIGNATURE DATE BUYER SIGNATURE * LAST NAME FIRST NAME *AREA CODE BUYER SIGNATURE DATE *TELEPHONE NUMBER (Ex: 9999999) * STREET NUMBER * STREET NAME *CITY OR TOWN *STATE *ZIP CODE BUYER'S ATTORNEY LAST NAME FIRST NAME AREA CODE TELEPHONE NUMBER (Ex: 9999999) American LegalNet, Inc. www.FormsWorkFlow.com