For recording officer's use
Amount received
Date received
Transaction number
Type of property conveyed (check applicable box)
Date of conveyance
Dual Towns:
Improved
month
day
year
Condition of conveyance (check all that apply)
a. - Conveyance of fee interest b. - Acquisition of a
controlling interest (state
percentage acquired ______________ %)
c. - Transfer of a controlling interest (state
percentage transferred ____________ %)
d. - Conveyance to cooperative housing
corporation
e. - Conveyance pursuant to or in lieu of
foreclosure or enforcement of security
interest
f.
- Conveyance which consists of a mere
change of identity or form of ownership or
organization
g. - Conveyance for which credit (or tax
previously paid will be claimed
h. - Conveyance of cooperative apartment(s) i.
- Syndication
j.
- Conveyance of air rights or development
rights
k. - Contract assignment
l.
- Option assignment or surrender
m. - Leasehold assignment or surrender n. -
Leasehold grant
o. - Conveyance of an easement p. -
Conveyance for which exemption is
claimed (complete Schedule B. Part II)
q. - Conveyance of property partly within and
partly without the state
r.
- Other (describe) ____________________
Schedule B - Community Preservation Fund
Part I - Computation of Tax Due
1. Enter amount of consideration for the conveyance (from line 1 TP584 Schedule B)
2. Allowance (see below)
3. Taxable consideration (subtract line 2 from line 1)
4. 2% Community Preservation Fund (of line 3) make certified check payable to SUFFOLK COUNTY CLERK
5. Property not subject to CPF Tax (See Schedule C)
1
2
3
4
Allowance:
East Hampton
$250,000.00 Improved
$100,000.00 Vacant Land (Unimproved)
Shelter Island
$250,000.00 Improved
$100,000.00 Vacant Land (Unimproved)
Southampton
$250,000.00 Improved
$100,000.00 Vacant Land (Unimproved)
Riverhead
$150,000.00 Improved
$ 75,000.00 Vacant Land (Unimproved)
Southold
$150,000.00 Improved
$ 75,000.00 Vacant Land (Unimproved)
12-0213.. 09/01cg
Peconic Bay Region
Community Preservation Fund
Please print or type.
Schedule A Information Relating to Conveyance
Name (individual; last, first, middle initial)
Social Security Number
Mailing address
Social Security Number
City
State
ZIP code
Federal employer idenl. number
Name (individual; last, first, middle initial)
Social Security Number
Mailing address
Social Security Number
City
State
ZIP code
Federal employer idenl. number
Location and description of property conveyed
Tax map designation
Address
Village
Town
Dist
Section
Block
Lot
Grantor
Individual
Corporation
Partnership
Other
Grantee
Individual
Corporation
Partnership
Other
Proceeds of this transfer tax are disbursed to the
Townships in which the transaction takes place for
its acquisition of land, development rights, and
other interests in property for conservation
purposes.
Townships:
East Hampton 03
Riverhead 06
Shelter Island 07
Southampton 09
Southold 10
5
Schedule C - (continued)
Part II - Explanation of Exemption Claimed in Part I, line 1 (check any boxes that apply)
The conveyance of real property is exempt from the real estate transfer tax for the following reason:
a. Conveyance is to the United Nations, the United States of America, the state of New York or any of their instrumentalities,
agencies or political subdivisions (or any public corporation, including a public corporation created pursuant to agreement or
compact with another state or Canada)
b. Conveyance is to secure a debt or other obligation
c. Conveyance is without additional consideration to confirm, correct, modify or supplement a prior conveyance
d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying
realty as bona fide gifts
e. Conveyance is given in connection with a tax sale
f. Conveyance is mere change of identity or form of ownership or organization where there is no change in beneficial ownership.
(This exemption cannot be claimed for a conveyance to a cooperative housing corporation of real property comprising the
cooperative dwelling or dwellings.)
g. Conveyance consists of deed of partition
h. Conveyance is given pursuant to the federal bankruptcy act
i. Conveyance consists of the execution of a contract to sell real property without the use or occupancy of such property or the
granting of an option to purchase real property without the use or occupancy of such property
j. Conveyance or real property which is subject to restrictions which prohibit the use of the entire property for any purposes
except agriculture, recreation or conservation, pursuant to Section 1449-ee (2) (j) or (k) of Article 31-D of the Tax Law.
(See required Town approval, below)
k. Conveyance of real property for open space, parks, or historic preservation purposes to any not-for-profit tax exempt
corporation operated for conservation, environmental, or historic preservation purposes.
l. Other list explanations in space below (Grandfather/Contract)
o. The conveyance is approved for an exemption from the Community Preservation Transfer Tax, under Section 1449-ee of
Article 31-D of the Tax law. (See j in Schedule C)
_______________________________________________________________
Town Attorney or other designated official
Signature (both the grantor(s) and grantee(s) must sign).
The undersigned certify that the above return, including any certification, schedule or attachment, is to the best of his/her
knowledge, true and complete.
Grantor
Grantee
Grantor
Grantee
12-0213:: 09/01cg
Penalties and Interest
Penalties
Any grantor or grantee failing to file a return or to pay any tax within
the time required shall be subject to a penalty of 10% of the amount
of tax due plus an interest penalty of 2% of such amount of each
month of delay or fraction thereof after the expiration of the first
month after such return was required to be filed or the tax became
due. However, the interest penalty shall not exceed 25% in the
aggregate.
Interest
Daily compounded interest will be charged on the amount of the
tax due not paid within the time required.
(attached approved application)
m. Conveyance of real property as a primary residence where the grantee is a first-time homebuyer
n. Conveyance of real property to a tax exempt, not-for-profit corporation for the purpose of providing affordable housing.