INSTRUCTIONS(RP-5217-PDF-INS): www.orps.state.ny.us
FOR COUNTY USE ONLY
C1. SWIS Code
C2. Date Deed Recorded
C4. Page
C3. Book
Month Day Year
RP- 5217-PDF
Real Property Transfer Report (8/10)
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
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
# of Parcels
Part of a Parcel
4A. Planning Board with Subdivision Authority Exists
4B. Subdivision Approval was Required for Transfer
4C. Parcel Approved for Subdivision with Map Provided
(Only if Part of a Parcel) Check as they apply:
OR
5. Deed
Property
Size
* FRONT FEET
* DEPTH
*ACRES
X
OR
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:
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
Check the boxes below as they apply:
Billing
Address
( 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.
11. Sale Contract Date
* 12. Date of Sale/Transfer
*13. Full Sale Price
14. Indicate the value of personal
property included in the sale
SALE INFORMATION
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:
16. Year of Assessment Roll from which information taken(YY)
*17. Total Assessed Value
*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))
ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill
_
15. Check one or more of these conditions as applicable to transfer:
BUYER CONTACT INFORMATION
SELLER SIGNATURE
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 SIGNATURE
DATE
DATE
FIRST NAME
*AREA CODE
*TELEPHONE NUMBER (Ex: 9999999)
BUYER SIGNATURE
* STREET NUMBER
* LAST NAME
*ZIP CODE
FIRST NAME
LAST NAME
AREA CODE
TELEPHONE NUMBER (Ex: 9999999)
*STATE
*CITY OR TOWN
* STREET NAME
SELLER SIGNATURE
BUYER'S ATTORNEY
(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.)
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