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INSTRUCTIONS(RP-5217-PDF-INS): www.orps.state.ny.us
FOR COUNTY USE ONLY New York State Department of
C1. SWIS Code Ly q i it | Taxation and Finance
f ‘ iPS cay
C2. Date Deed Recordes L ] [Ly L 5 / a er Dicer eat rsopety tax Seneca womens nae EA 1)
RP- 5217 -PDF
C3. Book ALL f Oy ca. page
Page L 5.0, 4] Real property Transfer Report (8/10)
PROPERTY INFORMATION |
1. Property 3 wee S iyi ie
Location 1234 Center Street
* STREET NUMBER * STREET NAME
Aurora 14052
“CITY OR TOWN VILLAGE * ZIP CODE
“ pnd Kotarski Thomas
* LAST NAME/COMPANY FIRST NAME
Kotarski Amy
* LAST NAME/COMPANY FIRST NAME
3. Tax
Billing Indictate where future Tax Bills are to be sant
Address if other than buyer address (at bottom of form) LAST NAME/COMPANY FIRST NAME
STREET NUMBER AND NAME CITY OR TOWN STATE
4, indicate the number of Assessment 1 gO purciatena {Only If part of a Parcel) Check as they apply:
Rolt parcels transfered on the deed # of Parcels OR art of a a
Parce 4A. Planning Board with Subdivision Authority Exists aye ; {]
6. Deed xX OR 2.02 4B. Subdivisi .
: . Subdivision Approval was Required for Transfer
ow * FRONT FEET * DEPTH “ACRES P "s CJ
Size 4C. Parcel Approved for Subdivision with Map Provided [|
Lillis Edward M.
&. Seller * LAST NAME/COMPANY FIRST NAME
Name Lillis Kathleen A.
LAST NAME/COMPANY FIRST NAME
Check the boxes below as they apply:
*7. Select the descripticon which most accurately describes the - ; ;
use of the property at the time of sale: 8. Ownership Type is Condominium [|
: . 9. New tructi ni
A. One Family Dwelling Construction on Vacant Land L
410A. Property Located within an Agricultural District []
108. Buyer received a disclosure notice indicating that the property is in an []
Agricultural District
| SALE INFORMATION / 45. Check one or more of these conditions as applicable to transfer:
] A, Sale Between Relatives or Former Relatives
+1 Rate Conpece ate 08/03/22 |__| B. Sale Between Related Companies or Partners in Business
. D |_| C. One of the Buyers is also a Seller
* 42, Date of Sale/Transfer rah wors / 2 22 |__| D. Buyer or Seller is Government Agency or Lending Institution
|__| &. Deed Type not Warranty or Bargain and Sale (Specify Below)
* 43, Full Sate Price 510,000 990 |__| F. Sale of Fractional or Less than Fee Interest (Specify Below)
|__| G. Significant Change in Property Between Taxable Status and Sale Dates
(Full Sale Price is the Total amount paid for the property including personal property. |__| H. Sale of Business Is included in Sale P ice
This payment may be in the form of cash, other property or goods, or the assumption of |_| 1. Other Unusual Factors Affecting Sale Price (Specify Below)
mortgages or other obligations.) Please round to the nearest whole dollar amount. [XJ J. None
* Comment(s) on Condition:
14, Indicate the value of personal
property Included in the sale 0 .00
| ASSESSMENT INFORMATION - Data should reflect the latest Final Assessment Roll and Tax Bill |
16. Year of Assessment Roil from which information taken(YY) 22 * 17. Total Assessed Value la, bo. %
* 18. Property Class
A\O
* 20. Tax Map identifier(s)/Roil identifler(s) (If more than four, attach sheet with additional Identifler(s))
* 49. Schoo District Name
6 Aurore
187.00-3-61
| CERTIFICATION
| certify that all of the Items of information entered on this form are true le correct (to the best of my knowledge and bellef) and | understand thet the making
of any willful false statement of material fact herein subject me to the provisions of relative to the making and filing of faise instruments.
IGNATURE BUYER CONTACT INFORMATION
Xdarec Dn Lol Loe lo /zolez. (Ermer for the buyer, Note: If buyer is LLC, society, association, corporation, joint son company, estate or
SELLER SIGNATURE entity that is not an individual agent or fiduciary, then a name and contact of an |
party who can answer questions regarding the transfer must be entered, Type or print clearfy.)
Kotarski Thomas
C2EY * LAST NAME FIRST NAME
BUYER S| o RE t “AREA CODE * TELEPHONE NUMBER (Ex: 6000999)
‘‘ LUIS 1234 Center Street
* STREET NUMBER * STREET NAME
sr ann il East Aurora NY 14052
i * CITY OR TOWN * STATE * ZIP CODE
B R'S ATTORNEY
Scott Karen Gaughan
LAST NAME FIRST NAME
716 6491571
| AREA CODE TELEPHONE NUMBER (Ex: 9006908)
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