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