1 2
Number of pages
This document will be public
record. Please remove all
Social Security Numbers
prior to recording.
Deed / Mortgage Instrument Deed / Mortgage Tax Stamp Recording / Filing Stamps
3
FEES
Page / Filing Fee
Mortgage Amt.
Handling
20. 00
1.
Basic Tax
2.
Additional Tax
TP-584
Notation
Sub Total
Spec./Assit.
or
EA-52 17 (County)
EA-5217 (State)
R.P.T.S.A.
Sub Total
Spec. /Add.
TOT. MTG. TAX
Dual Town Dual County
Held
for Appointment
Comm. of Ed.
5.
00
Transfer Tax
Affidavit
Mansion Tax
Certified Copy
NYS
Surcharge
15. 00
Other
Sub Total
Grand Total
The property covered by this mortgage is
or will be improved by a one or two
family dwelling only.
YES or NO
If NO, see appropriate tax clause on
page # of this instrument.
4 Dist.
Section
Block
Lot
5
Community Preservation Fund
Real Property
Tax Service
Agency
Verification
6
Satisfactions/Discharges/Releases List Property Owners Mailing Address
RECORD & RETURN TO:
Consideration Amount $
CPF Tax Due
$
Improved
Vacant Land
TD
TD
TD
Mail to: Judith A. Pascale, Suffolk County Clerk
310 Center Drive, Riverhead,
NY
11901
www.suffolkcountyny.gov/clerk
7
Title Company Information
Co. Name
Title #
8
Suffolk County Recording & Endorsement Page
This page forms part of the attached made
by:
(SPECIFY TYPE OF INSTRUMENT)
The premises herein is situated in
SUFFOLK COUNTY, NEW YORK.
TO In the TOWN of
In the VILLAGE
or HAMLET of
BOXES
6
THRU
8
MUST BE TYPED OR PRINTED IN BLACK INK ONLY PRIOR TO RECORDING OR FILING.
(over)
