Combined Real Estate Transfer Tax Return
,
. TP-584 (10103)
4
Recording office lime slamp
New York State Department 01 Taxation and Finance
Combined Real Estate
Transfer Tax Return,
Credit Line Mortgage Certificate, and
Ge"rtificatioh of Exemption from the.
Payment of Estimated Personal Income Tax
See instructions (TP-584-1) before completing this form. Please print or type.
Schedule A - Information relating to conveyance
GrantorfTransfe ror
lliJ Individual
o Corporation
o Partnership
o Estate/Trust
o Other
GranteefTransferee
o Individual
o Corporation
o Partnership
o Estate/Trust
o Other
Location and description of property conveyed
Name (if individual; lasl, first, middle initial)
Robert V. Oswnld, Jr.
Mailing address
Social security number
064-56-2509
Social security number
1559 Route 82, Ste.
City
Hopewell Junction
Name (if individual: last, first, middle initial)
Mailing address
City
B
Slate
NY
ZIP code
12533
Federal employer ident. number
Social security number
Social security number
State
ZIP code
Tax map designation Addre.ss City/village Town COunty
Section Block Lot
359 04 73003( Robinson Lane l,-Jappingers Wappinger Dutchess
Falls
Type of property conveyed (ch,eck applicable box)
1 0 One- to three-family house 5 0 Commercial/Industrial Date of conveyance
2 0 Residential cooperative 6 0 Apartment building ~
O 0 04/12/05
3 Residential condominium 7 Office building
4 0 Vacant land 8 0 Other Declaration ofmoFllh day year
Rpc;tri ct-;onc;
Condition of conveyance (check alllhat apply)
a, 0 Conveyance of fee interest
b.D Acquisition of a controlling interest (state.
percentage acquired %) ..
c, 0 Transfer of a controlling interest (state
percentage transferred %)
d. 0 Conveyance to cooperative housing
corporation
e. 0 Conveyance pursuant to or in lieu of
foreclosure or enforcement of security
interest (attach Form TP.584.1, Schedule E)
For recording officer's use
Amount received
Schedule B., Part J $
Schedule B., Part II $
Percentage of real properly
conveyed which is residential
real property %
(see inslructions)
f. 0 Conveyance which consists of a
mere change of identify or fOlm of
ownerShip or organization (a! tach
Form TP-5B4.1, Schedule F)
g. D Conveyance for which credit !ior tax
previously paid will be claimed (attach
Form TP-584.1, Schedule G)
h. D Conveyance of cooperative apa rtment(s)
I. 0 Option assignrnent or surrender
m.D Leasehold assignment or surrender
n.D Leasehold grant
o. 0 Conveyance of an easement
i. 0 Syndication
p. 0 Conveyance for which exemption
from transfer tax claimed (complele
Schedule B, Part!J!)
q. 0 Conveyance of property parlly within
and partly outside the state
r. 0 Other (describe) Declaration of
Transaction number estrl tiOl
j.D Conveyance of air rights or
development rights
k.D Contract assignment
Dale I,eceived
/
. rage 2 of 4 TP-584 (10/03)
Schedule 8- Real estate transfer tax return (Tax Law, Article 31)
Part I - Computation of tax due
1 Enter amount of consideration for the conveyance (if you are claiming a total exemption from tax, check the
exemption claimed box, enter consideration and proceed to Part III) ............................ 0 Exemption claimed 1.
2 Continuing lien deduction (see instructions if property is taken subject to mortgage or lien) ................... ................... 2.
3 Taxable consideration (subtract line 2 from line 1) ................................................................................................ 3.
4' Tax: $2 for each'$500, or fractional part thereof, of consideration on line 3...................................................... 4.
5 Amount of credit claimed (seeJn5tructi~ns andatiach Form TP'584.1, Schedule G) ......................."....................... 5.
6 Total tax due' (subtract line 5 'trom line 4)' ................~............................"................................................................ 6.
Part II - Computation of additional tax due on the conveyance of residential real property for $1 million or more
1 Enter amount of consideration for conveyance (from Part I, line 1) ..................................................................... ~31.:
2 Taxable consideration (multiply line 1 by the percentage of the premises which is residential real property, as shown in Schedule A) ..... .
3 Total additional transfer tax due" (multiply line 2 by 1% (.01)) ..............................................................................
Part III - Explanation of exemption claimed on Part !, 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) ............................................................................................................................................. a D
b. Conveyance is to secure a debt or other obligation ........................................................................................................................... b D
c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................. c D
d, Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying
realty as bona fide gifts ...................................................................................................................................................................... d D
e. Conveyance is given in connection with a taxsale .....~...............................,.......................;.............:.......,......................................... e D
f. Conveyance is a mere change of identity or form of ownership or organization ~here thereis 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.) Attach Form TP-584.1, Schedule F ................................................................... D
g. Conveyance consists of deed of partition .......................................................................................................................................... g D
h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................ h D
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 ............................................... D
j. Conveyance of an option or contract to purchase real property with the use or occupancy of such property where the
consideration is less than $200,000 and such property was used solely by the grantor as the grantor's personal residence
and consists of a one., two-, or three-family house, an individual residential condominium unit, or the sale of stock in a cooperative
housing corporation in connection with the grantor transfer of aproprietary leasehold covering an individual residential
cooperative. apartment.. ...,'.... ..... ... .... "." ...... .....,'... .,.... .......,;,:......... .:......... ... .~................ ................ ........... .....,'. .....,'.......: ............ ...:.., .:.....j D
k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401 (e) (attach documents
supporting such claim) .......................................................................................................................................................................... k D
I. Other (attach explanation) ...............,... .... .............. ................................................... ....................................................................... ,.... D
*Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in New York
City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made
payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045,
Albany NY 12205-5045.
Page 3 of 4 TP-584 (10/03)
Schedule C - Credit Line Mortgage Certificate (Tax Law, Article 11)
Complete the following only if the interest being transferred is a fee simple interest.
.1 (we) certify that: (check the appropriate box)
1.0
2.0
The real property being sold or transferred is not subject to an outstanding credit line mortgage.
The real property being sold or transferred is subject to an outstanding credit line mortgage. However, an exemption from the tax
is claimed for the following reason: . '. . .
o The transfer of real property is atransfer of a fee simple. interest to a person or persons who held a fee simple interest in the
real property (whether as a joint tenant, a tenant in common or otherwise) immediately before the transfer. .
o The transfer of real property is (A) to a person or persons related by blood, marriage or adoption to the original obligor or to
one or more of the original obligors or (B) to a person or entity where 50% or more of the beneficial interest in such real
property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for
the benefit of a minor or the transfer to a trust for the benefit of the transferor).
o The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court.
o The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and the real property being sold
or transferred is not principally improved nor will it be improved by a one- to six-family owner-occupied residence or dwelling.
Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as
described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circomstances.
See TSB-M-96(6)-R for more information regarding these aggregation requirements.
o Other (attach detailed explanation).
3.0
The real property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the
following reason: .. .' . '.' . . .'. . . .
D A certificate o(discharge of the credit I.ine rT1o~gage is being offere9 at the time of recording the deed. .
o A check has been drawn payable for transmission to the credit line mortgagee or his agent for the balance due, and a
satisfaction of such mortgage will be recorded as soon as it is available.
4.0
The real property being transferred is subject to an outstanding credit line mortgage recorded in
(insert Iiber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured
by the mortgage is \ . No exemption from tax is claimed and the tax of is
being paid herewith. (Make check payable to county clerk where deed will be recorded or, if the recording is to take place in
New York City, make check payable to the NYC Department of Finance.)
Signature (both thegrantor(s) andgrantee(s) must sign)
Tille
Grantee signature
Title
JR.
Grantor signature
Title
Grantee signature
Tille
Reminder: Did you complete all of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you
checked e, f, or g in Schedule A, did you complete Form TP-584.1? Have you attached your check(s) made payable to the county clerk
where recording will take place or, jf the recording is in New York City, to the NYC Department of Finance? If no recording is required, send
your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETI Return Processing,
PO Box 5045, Albany NY 12205-5045.
" Page 4 of 4 TP-584 (10/03)
Schedule D - Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663)
Complete the following only if a fee simple interest is being trar;tsferred by an individual or estate or trust.
Part 1- New York State residents
If you are a New York State resident transferor(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must
sign the certification below. If one or more transferors/sellers of the property is a resident of New York State, each resident transferor/seller
must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to
accommodate all resident" transferors/sellers.
Certification of resident transferor(s)/seller(s)
This is to certify that at the time of the sale or transfer of the real property, the transferor(s)/seller(s) as signed below was a resident of New York
State, and therefore is not required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of this property.
Print full name
ROBERT V. OSWALD, JR.
Date
4/12/05
Print full name
Date
Signature
Print full name
Date
Signature
Print full name
Date
Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 685(c), but not as a condition of recording
a deed.
Part IT - Nonresidents of New York State
If you are a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-584 (or an attachment to Form TP-584) but
are not required to pay estimated tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the
appropriate exemption below. If anyone 6f the exemptions below applies to the transferor(s)/seller(s), that, transferor(s)/seller(s) is not
required to pay estimated persoliai income tax to New York Sti;ltE) underTq.x Law, section 663. Each nonresident transferor/seller who
qualifies under one of the e'xempiions belowrriust sign in the space provided. If rilorespace is needed, please photocopy this Schedule D "
and submit as many schedules as necessary to accommodate all nonresident transferors/sellers.
If none of these exemption statements apply, you must use Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form,
and pay the full amount of estimated tax, if any, to the recording officer at the time the deed is presented for recording.
Exemption for nonresident transteror(s)/seller(s)
This is to certify that at the time of the sale or transfer of the real property, the transferor(s)/seller(s) (grantor) of this property was a
nonresident of New York State, but is not required to pay estimated tax under Tax Law, section 663 due to one of the following exemptions:
o The property being sold or transferred qualifies in total as the transferor's/seIJer's principal residence (within the meaning of
Internal Revenue Code, section 121) from to (see instructions).
Date Date
o The transferor/seller is a mortgagor conveying the mortgaged property to a mortgagee in foreclosure, or in lieu of foreclosure with
no additional consideration. ",
," . . .
. ....
~ . .
. ..',... .
o The transf~ror or transferee is an agency or authority of the United States of America, an agency or authority' of the state of
New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National
Mortgage Association, or a private mortgage insurance company.
Signature Print fuil name Date
Signature Print fuil name Date
Signature Print fuil name Date
Signature Print fuil name Date
. TP-584 (10/03)
4
Recording office time stamp
New York State Department of Taxation and Finance
Combined Real Estate
Transfer Tax Return,
Credit Line Mortgage Certificate, and
Certification of Exemption from the
Payment of Estimated Personal Income Tax
See instructions (TP-584-I) before completing this form. Please print or type.
Schedule A - Information relating to conveyance
Name (il individual; last, lirst, middle initial)
Robert V. Oswald
Mailing address'
1559 Route 82, Ste. B
City
Ho ewell Junction
Name (il individual: lasl, first, middle initial)
Grantorffransferor
Gd Individual
o Corporation
o Partnership
o EstatefTrust
o Other
Granteeffransferee
o Individual
o Corporation
o Partnership
o EstatefTrust
IX! Other
State
NY
ZIP code
12533
Federal employer iden!. number
Social security number
Town of Wa in er
Mailing address
20 Middlebush Road
City
Wa in ers Falls
Location and description of property conveyed.
Social security number
t
State
NY
Tax map designation Address City/village Town County
Section Block Lot
6359 04 73003C Robinson Lane Wappingers Wappinger Dutchess
Falls
Type of property conveyed (ch.eck applicable box)
1 0 One- to three-family house 5 0 Commercial/Industrial
2 0 Residential cooperative 6 0 Apartment building
3 0 Residential condominium 7 0 Office building
4 0 Vacant land 8 KJ Other Utility
Date of conveyance
Percentage of real property
conveyed which is residential
real property %
(see instructions)
I
Easemeffl:'tg
year
day
For recording officer's use Amount received Date received Transaction number
Schedule B., Part J $
Schedule B., Parlll $
Condition of conveyance (check all that apply)
a. 0 Conveyance of fee interest
b.O Acquisition of a controlling interest (state
percentage acquired %)
c. 0 Transfer of a controlling interest (state
percentage transferred %)
d. 0 Conveyance to cooperative housing
corporation
e. 0 Conveyance pursuant to or in lieu of
foreclosure or enforcement of security
interest (attach Form TP-584. 1, Schedule E)
I. 0 Option assignment or surrender
f, 0 Conveyance which consists of a
mere change of identify or form of
ownership or organization (aftach
Form TP-584..1, Schedule F)
m.O Leasehold assignment or surrender
g. 0 Conveyance for which credit for tax
previously paid will be claimed (attach
Form TP-584.1, Schedule G)
h.D Conveyance of cooperative apartment(s)
n.D Leasehold grant
o. Kl Conveyance of an easement
i.D Syndication
p.D Conveyance for which exemption
from transfer tax claimed (complete
Schedule 8, Part lIl)
q. 0 Conveyance of property partly within
and partly outside the state
r 0 Other (describe)
j.D Conveyance of air rights or
development rights
k 0 Contract assignment
t
Page 2 of 4 TP-584 (10/03)
Schedule B- Real estate transfer tax return (Tax Law, Article 31)
Part I - Computation of tax due
1 Enter amount of consideration for the conveyance (if you are claiming a total exemption from tax, check the
exemption ctaimed box, enter consideration and proceed to Part 111) ............................ D Exemption claimed 1.
2 Continuing lien deduction (see instructions if property is taken subject to mortgage or lien) ...................................... 2.
3 Taxable consideration (subtract line 2 from line 1) ................................................................................................ 3.
4 Tax: $2 for each'$500, or fractional part thereof, of consideration on line 3..:,.........................,........................ 4.
5 Amount of creditclaimed (se.e instructions andatiach Form TP-584.1, .Schedule G) ........;...............',....................... 5.
6 Toial tax due. (subtract line 5 from line 4)............~..............................,............,........:........................................... 6.
Part II - Computation of additional tax due on the conveyance of residential real property for $1 million or more
1 Enter amount of consideration for conveyance (from Part I, line 1) ..................................................................... ~31...
2 Taxable consideration (multiply line 1 by the percentage of the premises which is residential real property, as shown in Schedule A) ..... .
3 Total additional transfer tax due* (multiply line 2 by 1% (.01)) ..............................................................................
Part III - Explanation of exemption claimed on 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) ............................................................................................................................................. a 0
b. Conveyance is to secure a debt or other obligation ........................................................................................................................... b 0
c. Conveyance is without additional consideration to confirm, correct, modify, or supplement a prior conveyance ............................. c 0
d. Conveyance of real property is without consideration and not in connection with a sale, including conveyances conveying
realty as bona fide gifts ...................................................................................................................................................................... d 0
e. Conveyance is. giVen il} .i::onneCtion with ataxsale:....~..........:........:.....:....:,..........;............;..:..........:.......,......;........:....::;.;:............... e .0
." .. . . . . ~ .'
f. Conveyance is a mere change of identity or form of ownership or organization ~here 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.) Attach Form TP-584.1, Schedule F ................................................................... 0
g. Conveyance consists of deed of partition .......................................................................................................................................... g 0
h. Conveyance is given pursuant to the federal Bankruptcy Act ............................................................................................................ h 0
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 ............................................... i 0
J. Conveyance of an option or contract to purchase real property with the use or occupancy of such property where the
consideration is less than $200,000 and such property was used solely by the grantor as the grantor's personal residence
and consists of a one-, two-, or three-family house, an individual residential condominium unit, or the sale of stock in a cooperative
. housing corporation in connection with the grant or transfer of a proprietary leasehold covering an individual residential
cooperative. apartment '...'.......:...:.. ..... :".:........... :...... ,. ...... ............. ........ .:,.. ........ .~........ ....... .:.. .........,............... :".:.............. :............. ...:.'. .,..... . j . 0
k. Conveyance is not a conveyance within the meaning of Tax Law, Article 31, section 1401 (e) (attach documents
supporting such claim) ................. ........................................................................................................... .......................................... .... k 0
\. . Other (attach explanation) .................................................................................................................................................................... 0
.Please make check(s) payable to the county clerk where the recording is to take place. If the recording is to take place in New York
City, make check(s) payable to the NYC Department of Finance. If a recording is not required, send this return and your check(s) made
payable to the NYS Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing, PO Box 5045,
Albany NY 12205-5045.
Page 3 of 4 TP-S84 (10/03)
Schedule C - Credit Line Mortgage Certificate (Tax Law, Article 11)
Complete the following only if the interest being transferred is a fee simple interest.
.1 (we) certify that: (check the appropriate box)
1. 0 The real property being sold or transferred is not subject to an outstanding credit line mortgage.
2. 0 The real property being ,sold or transferred is subject to an outstanding credit line mortgage. However, an exemption from the tax
is claimed for the following reason:. . . . .' ". . '. .
o The transier of real property is atransfer oi a fee simple interest to a person or persons who held a tee simple interest in the
real property (whether as a joint tenant, a tenant in common or otherwise) immediately before the transfer.
o The transfer of real property is (A) to a person or persons related by blood, marriage or adoption to the original obligor or to
one or more of the original obligors or (B) to a person or entity where 50% or more of the beneficial interest in such real
property after the transfer is held by the transferor or such related person or persons (as in the case of a transfer to a trustee for
the benefit of a minor or the transfer to a trust for the benefit of the transferor).
o The transfer of real property is a transfer to a trustee in bankruptcy, a receiver, assignee, or other officer of a court.
o The maximum principal amount secured by the credit line mortgage is $3,000,000 or more, and the real property being sold
or transferred is not principally improved nor will it be improved by a one- to six-family owner-occupied residence or dwelling.
Please note: for purposes of determining whether the maximum principal amount secured is $3,000,000 or more as
described above, the amounts secured by two or more credit line mortgages may be aggregated under certain circomstances.
See TSB-M-96(6)-R for more information regarding these aggregation requirements.
o Other (attach detailed explanation).
3. 0 The r~al property being transferred is presently subject to an outstanding credit line mortgage. However, no tax is due for the
. followlng/eason:.... . . .' ':.' . . '. '. ,..., .' . .' '. . .
o A certificate of discharge of the credit ,line rrlOrtgage is beillg otfere(j at th~ time of, re,cording the deed. '
o A check has been drawn payable for transmission to the credit line mortgagee or his agent for the balance due, and a
satisfaction of such mortgage will be recorded as soon as it is available.
4.0
The real property being transferred is subject to an outstanding credit line mortgage recorded in
(insert liber and page or reel or other identification of the mortgage). The maximum principal amount of debt or obligation secured
by the mortgage is \ . No exemption from tax is claimed and the tax of is
being paid herewith. (Make check payable to county clerk where deed will be recorded or, if the recording is to take place in
New York City, make check payable to the NYC Department of Finance.)
Signature (both thegrf]ntor(s) andgrantee{s) must sign)
.' . . - . .
. . . .' ".' .
The undersigned certify that the abo~e info~rri~tion contained in schedules A, B, and C, incl~dirig any return, certifi~ati'on, schedule, or
attachm s to the best 0 hislher knowledge, true and complete. .
TOWN OF WAPPINGER
Title
BY:
Granlee signature
Tille
Granlor signature
Tille
Grantee signature
Tille
Reminder: Did you complete all of the required information in Schedules A, B, and C? Are you required to complete Schedule D? If you
checked e, f, or g in Schedule A, did you complete Form TP-584.1? Have you attached your check(s) made payable to the county clerk
where recording will take place or, if the recording is in New York City, to the NYC Department of Finance? If no recording is required, send
your check(s), made payable to the Department of Taxation and Finance, directly to the NYS Tax Department, RETT Return Processing,
PO Box 5045, Albany NY 12205-5045.
. Page 4 of 4 TP-584 (10/03)
Schedule D - Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663)
Complete the following only if a fee simple interest is being trar,lsferred by an individual or estate or trust.
Part I - New York State residents
If you are a New York State residenttransferor(s)/seller(s) listed in Schedule A of Form TP-584 (or an attachment to Form TP-584), you must
sign the certification below. If one or more transferors/sellers of the property is a resident of New York State, each resident transferor/seller
must sign in the space provided. If more space is needed, please photocopy this Schedule D and submit as many schedules as necessary to
accommodate all resident transferors/sellers.
Certification of resident transferor(s)/seller(s)
This is to certify that at the time of the sale or transfer of the real property, the transferor(s)/seller(s) as signed below was a resident of New York
State, and therefore is not required to pay estimated personal income tax under Tax Law, section 663(a) upon the sale or transfer of this property.
Signatu
Print full name
Date
Signature
Dale
Signature
Date
Signature
Print full name
Date
Note: A resident of New York State may still be required to pay estimated tax under Tax Law, section 68S(c), but not as a condition of recording
a deed.
Part IT - Nonresidents of New York State
If you are a nonresident of New York State listed as a transferor/seller in Schedule A of Form TP-S84 (or an attachment to Form TP-S84) but
are not required to pay estimated tax because one of the exemptions below applies under Tax Law, section 663(c), check the box of the
appropriate exemption below. If anyone 6f theexemptionsbeloiN applies tothetransferor(s)/seller(s), that)ransferor(s)/seller(s) is not
required to pay estimated personai income tax to New YorK State unaerTq.x Law, section 663.Ear::;h nonresident transferor/seller who:
qualifies under one of the exemptions below .rriust sign in .the space provided. If more. space is needed, please photOcopy this Schedule D .
and submit as many schedules as necessary to accommodate all nonresident transferors/sellers.
If none of these exemption statements apply, you must use Form IT-2663, Nonresident Real Property Estimated Income Tax Payment Form,
and pay the full amount of estimated tax, if any, to the recording officer at the time the deed is presented for recording.
Exemption for nonresident transferor(s)/seller(s)
This is to certify that at the time of the sale or transfer of the real property, the transferor(s)/seller(s) (grantor) of this property was a
nonresident of New York State, but is not required to pay estimated tax under Tax Law, section 663 due to one of the following exemptions:
D The property being sold or transferred qualifies in total as the transferor's/seller's principal residence (within the meaning of
Internal Revenue Code, section 121) from Dale to Dale (see instructions).
D The transferor/seller is a mortgagor conveying the mortgaged property toa mortgagee in foreclosure, or in lieu of foreclosure with
no additional consideration. ....,
D .The transf~ror or transferee is an agency or authority of the' United States of Am~rica, an 'agency or authoritY-of the state of
New York, the Federal National Mortgage Association, the Federal Home Loan Mortgage Corporation, the Government National
Mortgage Association, or a private mortgage insurance company.
Signature Print full name Date
Signature Print full name Dale
Signature Print full name Dale
Signature Print full name Date