Westchester County Clerk Recording Sheet Form
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1WESTCHESTER COUNTY CLERK RECORDING SHEET
110 Dr. Martin Luther King, Jr. Boulevard
White Plains, NY 10601
---------- THIS FORM MUST BE COMPLETED AND SUBMITTED WITH EACH DOCUMENT ----------
This page is part of the instrument; the County Clerk will rely on the information
provided on this page for purposes of indexing this document.
To the best of the submitter’s knowledge the information contained on this
Recording Sheet is consistent with the information contained in the attached
document.
SUBMITTER INFORMATION:
Title Number: __________________________________
Company: ______________________________________________________________________________________________
Address: ________________________________________________________________________________________________
City ____________________________ State: ___________ Zip: ______________
Telephone: _____________________
Attention: _______________________________________________________________________________________________
# of pages -
Mortgage Amount
Dwelling Type:
Document type:
On page _____ of document
For Mortgage Only
$_______________________
On page _____ of document
1st party name(s) (i.e. grantor/mortgagor)
Business
On page _____ of document
Entity
OR
[ ] 1 to 2 family
_________________________________________
[ ]
Consideration/Conveyance Amt:
[ ] 1 to 6 family
_________________________________________
[ ]
$_______________________
[ ] Not 1 to 6 family
_________________________________________
[ ]
Check if submitted:
$250
[ ] RP-5217 - [ ] $125
_________________________________________
[ ]
[ ] TP-584 - Type of property conveyed [1 through 8] _______
[ ] TP-584.1
[ ] IT-2663
_________________________________________
[ ]
TAXES PAID:
Reference #
2nd party name(s) (i.e. grantee/mortgagee)
Business
Amount
Or Check #
On page _____ of document
Entity
Mortgage Tax
$___________________
_________
_________________________________________
[ ]
Transfer Tax
$___________________
_________
_________________________________________
[ ]
Mansion Tax
$___________________
_________
_________________________________________
[ ]
RECORDING
Reference #
FEES PAID:
Amount
or Check #
_________________________________________
[ ]
$___________________
_________
_________________________________________
[ ]
Tax designation (Section, Block & Lot)
MORTGAGE TAX AFFIDAVITS SUBMITTED:
On page _____ of document
[ ] 252
[ ] 255
[ ] 280
Other: ____________
__________________________________________________________
[ ] 253
[ ] 260
[ ] 339-ee
____________
Cross Reference(s):
On page _____ of document
City(ies) or Town(s) for Property Description
On page _____ of document
___________________________________________________________
__________________________________________________________
___________________________________________________________
Property Description -- If required, check the one contained
Record and Return To:
within the document.
____________________________________________________
On page _____ of document
[ ] Metes & bounds
____________________________________________________
[ ] Lot number on map filed in the Office of the County Clerk
____________________________________________________
[ ] Refer to deed recorded in the Office of the County Clerk
____________________________________________________
____________________________________________________
Revised 05/29/2009
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