NY Orleans County Clerk's Office Recording Page

Receipt#

Instrument#

Envelope Enc./Doc.Held
*Return To:

CAROL LONNEN
ORLEANS COUNTY CLERK
3 SOUTH MAIN STREET
Albion, NY 14411-1498
585-589-5334 phone
585-589-0181 fax

*GRANTOR/MORTGAOR/DISCHARGOR/ASSIGNOR:
(For a Discharge Insert Individual or Bank Signing Document)

*GRANTEE/MORTGAGEE/
*DISCHARGEE/ASSIGNEE:

Mortgage Recording Tax Receipt

State of New York) Serial No.:
County of Orleans)
I certify that I have rceived on the within
Mortgage $ Basic Tax, $
Special Additional Tax; & $ Additional
Tax (7/1/03 Transportation Authority) being the amount of Recording Tax imposed thereon and paid at the date of recording thereof.

By:
Recording Office of Orleans County

Mortgage Amount $
Hold Mtg:

CHECK IF IT IS OR TO BE PRINCIPALLY IMPROVED BY A 1 OR 2 FAMILY RESIDENCE OR DWELLING:

Received:

Real Estate Transfer Tax

Consideration $

Taxed Amount $

Deed Stamp No.

CLERK NOTES:

*TO BE COMPLETED BY CUSTOMER
WARNING: This sheet consitutes the Clerk's endorsement, required by section 316-A(5) of the real property law of the State of New York...DO NOT DETACH. DO NOT REDUCE
Staff Initials:

SIZE OF COVER SHEET, MUST REMAIN 8 1/2 X 14.

*TYPE OF DOCUMENT

*NO. OF PAGES

*ABSTRACT CO.
*CUSTOMER *MAIL

*Location of Property
*Street:
*Town:
2nd Town:
*Village:

*Lot: *Sec:
*Twnsp: *Range:

*Tax Map No.

State of New York)
County of Orleans) ss

Recorded on
200 at: O'Clock M
Book of RECORDS
Page and Examined.

Carol R. Lonnen, Orleans County Clerk

SPACE FOR CLERK'S VALIDATION STAMP
(IMAGING 3/1/03):

RECORDING COVER PAGES NY04: ORLEANS COUNTY CLERK'S OFFICE RECORDING PAGE

Orleans County Clerk's OfficeRecording Page

Orleans County Clerk's Office
Recording Page