Rp- 5217-Pdf - Real Property Transfer Report

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INSTRUCTIONS(RP-5217-PDF-INS):

FOR COUNTY USE ONLY

C1. SWIS Code

C2. Date Deed Recorded

RP- 5217-PDF

Month

Day

Year

C3. Book

C4. Page

Real Property Transfer Report (8/10)

PROPERTY INFORMATION

Clear Form

1. Property

Location

* STREET NUMBER

* STREET NAME

VILLAGE

* CITY OR TOWN

* ZIP CODE

2. Buyer

Name

FIRST NAME

* LAST NAME/COMPANY

FIRST NAME

LAST NAME/COMPANY

3. Tax

Indicate where future Tax Bills are to be sent

Billing

if other than buyer address(at bottom of form)

FIRST NAME

LAST NAME/COMPANY

Address

STATE

CITY OR TOWN

ZIP CODE

STREET NUMBER AND NAME

(Only if Part of a Parcel) Check as they apply:

4. Indicate the number of Assessment

Part of a Parcel

# of Parcels

Roll parcels transferred on the deed

4A. Planning Board with Subdivision Authority Exists

5. Deed

0.00

4B. Subdivision Approval was Required for Transfer

Property

* FRONT FEET

* DEPTH

*ACRES

Size

4C. Parcel Approved for Subdivision with Map Provided

6. Seller

* LAST NAME/COMPANY

FIRST NAME

Name

FIRST NAME

LAST NAME/COMPANY

Check the boxes below as they apply:

*7. Select the description which most accurately describes the

8. Ownership Type is Condominium

use of the property at the time of sale:

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

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.

11. Sale Contract Date

C. One of the Buyers is also a Seller

D. Buyer or Seller is Government Agency or Lending Institution

12. Date of Sale/Transfer

E. Deed Type not Warranty or Bargain and Sale (Specify Below)

F. Sale of Fractional or Less than Fee Interest (Specify Below)

.00

G. Significant Change in Property Between Taxable Status and Sale Dates

*13. Full Sale Price

H. Sale of Business is Included in Sale Price

( Full Sale Price is the total amount paid for the property including personal property.

I. Other Unusual Factors Affecting Sale Price (Specify Below)

This payment may be in the form of cash, other property or goods, or the assumption of

J. None

mortgages or other obligations.) Please round to the nearest whole dollar amount.

Comment(s) on Condition:

14. Indicate the value of personal

.00

property included in the sale

ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill

*17. Total Assessed Value

16. Year of Assessment Roll from which information taken(YY)

*18. Property Class

*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.

BUYER CONTACT INFORMATION

SELLER SIGNATURE

(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.)

DATE

SELLER SIGNATURE

BUYER SIGNATURE

* LAST NAME

FIRST NAME

*AREA CODE