Madison Title Agency

FOR CITY USE ONLY
C1. County Code	\|	C2. Date Deed Recorded	//

C3. Book

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C4. Page

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ORC5. CRFN

PROPERTY INFORMATION

REAL PROPERTY TRANSFER REPORT

STATE OF NEW YORK
STATE BOARD OF REAL PROPERTY SERVICES
RP - 5217NYC
(Rev 11/2002)

SALE INFORMATION

10.	Sale Contract Date	//
		Month 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	, , ,

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 SIGNATURE

DATE

STREET NUMBER

STREET NAME (AFTER SALE)

CITY OR TOWN

STATE

ZIP CODE

BUYER'S ATTORNEY

BUYER SIGNATURE

FIRST NAME

AREA CODE

TELEPHONE NUMBER

SELLER

SELLER SIGNATURE

DATE

3.	Tax	Indicate where future Tax Bills are to be sent
	Billing	if other than buyer address (at bottom of form)	LAST NAME	FIRST NAME
	Address

4.	Indicate the number of Assessment		# of Parcels OR Part of a Parcel	4A. Planning Board Approval - N/A for NYC
	Roll parcels transferred on the deed			4B. Agricultural District Notice - N/A for NYC

5.	Deed		X		OR		Check the boxes as they apply:
	Property	FRONT FEET		DEPTH		ACRES	6.Ownership Type is Condominium
	Size						7. New Construction on Vacant Land

8.	Seller
	Name	LAST NAME / COMPANY	FIRST NAME

		LAST NAME / COMPANY	FIRST NAME
9.	Check the box below which most accurately describes the use of the property at the time of the sale:

A One Family Residential	C Residential Vacant Land	E Commercial	G Entertainment / Amusement	I Industrial
B 2 or 3 Family Residential	D Non-Residential Vacant Land	F Apartment	H Community Service	J Public Service

1.	Property
	Location	STREET NUMBER	STREET NAME	BOROUGH	ZIP CODE
2.	Buyer
	Name	LAST NAME / COMPANY		FIRST NAME

		LAST NAME / COMPANY		FIRST NAME

14.	Check one or more of these conditions as applicable to transfer
A	Sale Between Relatives or Former Relatives
B	Sale Between Related Companies or Partners in Business
C	One of the Buyers is also a Seller
D	Buyer or Seller is Government Agency or Lending Institution
E	Deed Type not Warranty or Bargain and Sale (Specify Below )
F	Sale of Fractional or Less than Fee Interest ( Specify Below )
G	Significant Change in Property Between Taxable Status and Sale Dates
H	Sale of Business is Included in Sale Price
I	Other Unusual Factors Affecting Sale Price ( Specify Below )
J	None

15.	Building Class	\|\|\|	16.	Total Asessed Value (of all parcels in transfer)	, , ,
17.	Borough, Block and Lot / Roll Identifier(s) ( If more than three, attach sheet with additional identifier(s) )

RP5217 NYC