STATE OF NEW YORK OFFICE OF REAL PROPERTY SERVICES RP-5217-CF (7/94) REAL PROPERTY TRANSFER REPORT SALE INFORMATION CORRECTION FORM I am seeking your assistance in determining whether an error was made in the completion of the Real Property Transfer Report from (RP-5217) for the transfer of the following real property: (Street Address) (City/Town/Village) (Date of Sale) (RP-5217 Swis/Book/Page) (Tax ID ­ Optional) Please complete Part(s) _______________ and the Certification on the reverse side and return the form to me at: _______________________________________________________________________ Thank you for your cooperation. American LegalNet, Inc. www.USCourtForms.com RP-5217-CF (7/94) 2 PART I: ERROR IN FULL SALES PRICE 1. State the Full Sales Price. (Full sales 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). $___________________ 2. Indicate the value of the personal property included in the sale. 3. Indicate the sale contract date. If land contract sale, specify date of initial contract. 4. Indicate the date of sale/transfer. $___________________ ____________________ ____________________ PART II: ERROR IN CONDITION OF TRANSFER 5. Check one or more of these conditions as applicable to transfer: _______ Sale Between Relatives _______ Sale Between Related Companies or Partner in Business _______ One of the Buyers is also a Seller _______ Buyer or Seller is a Government Agency or a Lending Institution _______ Deed Type is not Warranty or Bargain and Sale (specify deed type) _______________________________________________________________ _______ Sale of Fractional or Less than Fee Interest (specify) _____________________ _______ Sale of Business is Included in Sale Price _______ Other Unusual Factors Affecting Sale Price (specify) _____________________ _______ None of the above conditions apply. CERTIFICATION Your participation in the transfer was: _____Buyer _____Seller _____Agent ______Other (specify) _____________________ Were you the person who signed the original Real Property Transfer Report Form (RP -5217)? ______Yes ______No I certify that all the items of information entered on this page 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. Name (Print or Type): _____________________________________ Telephone # (_____) ____________________ Signature _______________________________________________ Date _________________________________ American LegalNet, Inc. www.USCourtForms.com