ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill
SALE INFORMATION
PROPERTY INFORMATION
LAST NAME / COMPANY FIRST NAME
LAST NAME / COMPANY FIRST NAME
STATE OF NEW YORK
REAL PROPERTY TRANSFER REPORT
SELLER
CITY OR TOWN STATE ZIP CODE
STREET NUMBER STREET NAME (AFTER SALE)
BUYER SIGNATURE DATE
( 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.
STATE BOARD OF REAL PROPERTY SERVICES
FRONT FEET DEPTH ACRES
Check the boxes below as they apply:
6. Ownership Type is Condominium
7. New Construction on Vacant Land
STREET NUMBER AND STREET NAME CITY OR TOWN STATE ZIP CODE
1. Property
Location
Name
4. Indicate the number of Assessment
Roll parcels transferred on the deed
5. Deed
Property
Size
8. Seller
Name
9. Check the box below which most accurately describes the use of the property
at the time of sale:
10. Sale Contract Date
11. Date of Sale / Transfer
Sale of Fractional or Less than Fee Interest ( Specify Below )
Deed Type not Warranty or Bargain and Sale (Specify Below )
Sale Between Related Companies or Partners in Business
Sale Between Relatives or Former Relatives
14. Check one or more of these conditions as applicable to transfer:
Community Service
Industrial
Public Service
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 will subject me to the provisions of the penal law relative to the making and filing of false instruments.
A
B
C
D
E
F
G
H
I
J
4B. Agricultural District Notice - N/A for NYC
None
FOR CITY USE ONLY
//
Month Day Year
STREET NUMBER STREET NAME BOROUGH ZIP CODE
LAST NAME / COMPANY FIRST NAME
LAST NAME / COMPANY FIRST NAME
Billing
Address
2. Buyer
3. Tax
LAST NAME / COMPANY FIRST NAME
OR
Part of a Parcel
# of Parcels
X
.
4A. Planning Board Approval - N/A for NYC
Commercial
Apartment
Entertainment / Amusement
One Family Residential
2 or 3 Family Residential
Residential Vacant Land
Non-Residential Vacant Land
A
B
I
J
/
/
/
/
Month Day Year
Month Day Year
Significant Change in Property Between Taxable Status and Sale Dates
Other Unusual Factors Affecting Sale Price ( Specify Below )
Sale of Business is Included in Sale Price
One of the Buyers is also a Seller
Buyer or Seller is Government Agency or Lending Institution
,,,
17. Borough, Block and Lot / Roll Identifier(s) ( If more than three, attach sheet with additional identifier(s) )
AREA CODE TELEPHONE NUMBER
LAST NAME FIRST NAME
RP - 5217NYC
(Rev 11/2002)
SELLER SIGNATURE DATE
OR
15. Building Class
16. Total Assessed Value (of all parcels in transfer)
13. Indicate the value of personal
property included in the sale
BUYER
BUYER'S ATTORNEY
Indicate where future Tax Bills are to be sent
if other than buyer address (at bottom of form)
C2. Date Deed
Recorded
C1. County Code
C3. Book
C4. Page
12. Full Sale Price
,
,
,
,
G
H
C
D
E
F
C5. CRFN
,
O R
