HomeMy WebLinkAboutexample- summary instructions for cwd outside user application SUMMARY INSTRUCTIONS FOR CWD OUTSIDE USER APPLICATIONS
1. LOCATION: Applicant must be adjacent or near a water main owned by the Town of Lansing
Consolidated Water District or one of its official extensions (tile"CWD").
2. INITIAL PLAN: Applicant must develop a rough plan for the installation, including:
a. A rough map of the proposed location of any water or service lines, and the meter pit and curb box
adjacent to or near where the water main will be tapped.
b. A list of all landowners from whom permission, in the form of a permanent easement, is needed to site
and install the water line and meter pit/curb box.
c. The name and contact information for the proposed contractor or other person installing the connection,
together with a preliminary cost estimate.
3. PRELIMINARY REVIEW: Applicant brings initial plan to the Town of Lansing Water and Sewer
Committee(the"Committee")for preliminary review.The Committee acts per§7 of Local Law No.2 of 2012 as
the Water Advisory Committee, and examines the feasibility of the proposed outside user location in terms of
engineering,fiscal viability,and planning impacts.If the Committee issues a preliminary approval the applicant
should proceed.If the Committee issues a disapproval then the process ends unless applicant can promptly and
suitably address the reasons for disapproval.
4. DOCUMENT APPROVAL & EXECUTIONS: If approved, the applicant needs to obtain specific
approvals as to the final form of the applicable easements and the Outside User Agreement("OUAG")with the
Town. These are generally approved by the Town's Attorney and Engineer. As contracts and easements are
significant Iegal documents and can affect titles and land values, applicant should consult with an attorney of
its own choice for representation and advice. Once the easements and the OUAG have been approved the
applicant needs to the easements and related filing documents fully executed and notarized.
5. FINAL COMMITTEE RECOMMENDATION:Once all documents required for filing are signed by all
landowners applicant should finalize all documents and submit a formal application, together with the
application fee, to the Town. The matter will then be returned to the Committee for a final review. If all is in
order the Committee will issue its approval of the application and refer the matter to the Town Board. if the
Town Board accepts the Committee's recommendations the Town Board will issue a formal resolution
approving the OUAG and the Town Supervisor(or other designated public officer) will sign the OUAG.
6. BOLTON POINT PERMIT & CONSTRUCTION: That signed Outside User Agreement will act as a
form of notice to Bolton Point that it may now proceed to approve the water connection permit which applicant
should now submit or file.If approved,installation may commence and all permit reviews and inspections must
be undertaken or approved by Bolton Point. Also, if any installation is to occur within the bounds of any
highway,a roadway work permit will be required from the Town,County,or State Highway Departments,and
these will require general construction plans.
7. OTHER ISSUES TO CONSIDER:All individual service lines require their own line and their own and
separate meter pit and curb box. If at any time a formal district extension is required, either a different process
applies or applicant will be required to approve such extension. Absent unusual circumstances neither the
Committee nor the Town Board will generally approve a plans or OUAGs where multiple applicants are
proposed to share easements or review processes. Finally, all approvals of the Committee and the Town Board
are valid for only one year,after which they expire.
IF YOU HAVE QUESTIONS PLEASE CONTACT THE TOWN PLANNING OFFICE
TOWN OF LANSING
CONSOLIDATED WATER DISTRICT
OUTSIDE USER AGREEMENT
THIS AGREEMENT (the "Agreement") is an "outside user agreement" made by and between the
Town of Lansing, 29 Auburn Road, POB 186, Lansing New York 14882, acting as a municipality and
on behalf of the Consolidated Water District and its extensions (herein, the "Tow " ,, and
(herein, the"tplica t�').
WHEREAS, the Town of Lansing Consolidated Water District ("CWD") provitte-inuniciml water
through the CWD and its extensions from Bolton Point,an intermunicipal waters er of Wcch the
Town of Lansing ("Town') is a member, and certain land-,are n r or adjacent to e�ltiripxr planned
water mains and often desire to obtain public water,even tho f*,ttot within the existin 15ounds of the
CWD or any of its organized extensions;and
WHEREAS, the Town Board is the body that makes raben d setsNrulethe QWD and its extensions,
IN
and accordingly the Town Board has authorized butsid sers for mUp*al water supplies and
services,but only upon the execution of an outsir t riser agi;c ement and up6n the consent of the Town
Board.
NOW,THEREFORE, the Town and the Alicant agree y Ilows:
1. CONNECTION: Applicant may tap, z tm CWD maids and lines at locations approved by the
Town in accord with permits properly issukd by -Rolton Point and the Town. In all cases operations
under such permits and tho a & w,ater end w@ r lines and appurtenances remains subject to
inspections and the rules for users of Bin Voinr and Town of Lansing water supplies, including
Town of Lansing Local Law#2 of 2011,,,E-1ppT1=8 is aware that it may need a Town of Lansing or other
highway permit for disturbing Iand or rdgcting excavation or construction within a highway right-
of-way.
2. INSTALLATI AND INDEMNITY,MAINTENANCE: Applicant will be and remain solely
Iiable and responsible for excalvtion,installation,maintenance,repair,replacement,improvement,
and , Tgriiding of all cutb boxes, residential water service lines, and related infrastructure, including
all vests a-nd expenses th r f and permit fees, and further including the cost and expense of any
liaWities, losses,, injuries,,.ir claims arising from or in relation to this Agreement, however caused.
App$ ani:sh0 b1clemnify, defend,and hold harmless the Town, the CWD,and Bolton Point from and
againstaAy loss, dhim, liability, and the like, including a reasonable attorneys' fee, arising from or in
relation to this 4kgreement and any work or installations performed hereunder, including all
consequenti incidental, exemplary, and indirect damages, costs, and losses. These indemnity
obligations shall be enforced to the greatest extent permitted by law.
3. WATER FEES; ESCROW: As an outside user of the CWD Applicant will pay 2.0 times the
combined Town water rate. This increased cost pays for the capital costs and depreciation and use of
CWD infrastructure, and the costs of this agreement and future proceedings to bring the Applicant's
property within the CWD. Applicant acknowledges that both the water rates and this multiplier are
subject to change at any time. Also a one-time permit fee of$200.00 to cover Future Extension costs (as
defined below)is required at or before the time of signing,when an application for review is submitted.
4. LIMITED OBLIGATION OF TOWN: Water shall only be furnished to an outside user from
any surplus of water existing within the CWD and only when the supply to an outside user will not
adversely affect the water supply, pressure, or services to those within the CWD or its extensions.
Applicant acknowledges that this Agreement does not guarantee a continuous or uninterrupted water
supply (unless Applicant's lands are hereafter brought within the CWD or "rce -of its extensions)
because pressure, water quality, moratoria, capacity, water supply, and emel ency i4sues can curtail
or interrupt the supply of water. Applicant is advised to maintain an alte fc*,-burce 4f ater and the
Town assumes no responsibility or liability for any interruption or loss of water.
5. LIMITED USE RIGHTS; PAYMENT AND SHUT-OFF; This Agreement and -4f1y water lines
or infrastructure installed in relation hereto are approved and. allowed only for use in M. ation to one
residential dwelling unit (or equivalent dwelling unit or improwement) located at
(TPN ),in the Town of LarMng. No Water may be supplied
to any other location or structure and no person (inckudiitg Applicant} arty taV into said water line to
extend service to any other user, location, or strut re. Applicanes failvxc.T to timely pay any bill or
invoice for water services or water usage shall ode, the Town, the CWD, and Bolton Point to jointly
or severally terminate water service to Applicant. Ln-iaddidan, any payment made more than 25 days
after invoicing shall be subject to a late pay-ment charge ak set by the Town or Bolton Point.
6. FUTURE EXTENSIONS: In the ev M�ffiat the Town c es or extends any existing or hereafter
created water improvement or benefit disilri'bt -.r area (a " uture Extension") Applicant covenants,
warrants, promises, and agrees as follows:-(i) Alicant will participate in and fully support such
Future Extension and vote 'rye' ppQiD and refervocTum arising in connection with such Tuture
Extension; and (ii) Applicant will s4-botcliW ipr srender its easements to the Town or such Future
Extension, if needed. The promises anti obligations of this paragraph shall survive the termination of
this Agreement, shall be perpetual, shaff oot- e subject to any period of limitations, repose, or lathes,
and shall extinguisla orLW after a Future E tm%ion has been indefeasibly created.
7. MISCELLANY- ThiRAIyVemvnt is and shall be and remain enforceable at law in the Town of
Lansing Town Court, car ;A law ox in equity in such other court with appropriate jurisdiction. In the
event ft Town is required to bring suit to enforce this Agreement or collect any amount due
hereunder, the Town shall be entitled to recover its reasonable attorneys' and experts' fees and
expnses ir#.,trtaci in connection therewith, together with its costs and expenses. No waiver by the
Tow%x)f a.ny re cement of this Agreement or default hereunder shall be deemed a waiver of any
prior or subsequot requirement or default of the same or other provisions or obligations of this
Agreement„ If airy provision hereof is held invalid or unenforceable by a court of competent
jurisdiction, vxh invalidity shall not affect the validity or operation of any other provision hereof.
Section headings are for convenience only and do not define or limit the phrases thence following.This
Agreement constitutes the entire understanding of the parties, revokes and supersedes all prior
agreements between the parties, and is intended as a final expression of their agreement. This
Agreement is personal to the Applicant and does not run with the land or to the benefit of any heirs,
successors,or assigns of the Applicant unless the Town shall so agree either in writing or by resolution
of the Town Board. This Agreement may not be filed in the County Clerk's Office or any office of any
land registrar.
S. RIGHT TO PROCEED: Each owner of record of the lands of the Applicant must sign this
Agreement for it to be valid. Once properly executed, this Agreement may be supplied to the Town, to
Bolton Point, or to any other person or entity as verification that the Applicant has the legal right to
connect to and obtain municipal water (or to continue to connect, effect repairs to connections, or to
continue to receive municipal water) through the CWD and its extensions,whe er fOT permit issuance
or any other purpose or reason.
9. SUNSET DEADLINES; LIMITATION OF RIGHTS: This Agreement and all approvals
associated herewith are valid for only one year from the date this Agreement is exe0_1z d by Cbe'Town,
whereafter all such approvals and this Agreement shall expiry and be of no forte or -effect. No
"permanent" or "vested" rights (or similar rights) to connect to the CWD or any of itK,V`xtensions or
infrastructure arise under this Agreement,by implication or othetwiw,until a final connection is made
and a final permit approval and close-out is issued by Bolton Point, but such ri&As in all cases remain
subject to the requirements of this Agreement, and all ulek laws, and ulatibns affecting the use of
CWD and municipal water and water systems.
Agreed this_day of
Town of Lansing Consolidated Water Dtstiict,
by the Town of Lansing
By:
Town,supervisor
Landowners:
RIGHT-OF-'WAY AND EASEMENT
THIS INDENTURE is made the clay of ,20_ ,by and between
_ of New York the"party of the first part",and
_ of New York the"party of the second t",a d
The TOWN OF an incorporated municipal subdivision of the Stato of New York,having;i neipal a ce at
the"Town".
WITNESSETH: that the party of the first part, in consideration of$1.00 and other good and valuable consider on paid by
the party of the second part, does hereby grant and release unto the Town and the party of the second part, their successors
and assigns,the following described rights of an easement appurtenant in and to ftijollowing described parcels:
PARCEL I-CURB BOX&METER PIT
A RIGHT-OF WAY AND EASEMENT to inspect,construct,operate,maintain,and repLa"curb box and meter pit
for water service, together with a 1V diameter circle there-around for the purposes a excavation and repair, if
needed, together with the rights of free ingress and egress igozver, upon, and under the below-described lands,
such lands bung and denoting the areas of the permanegtasemk?Ats and rights-of--way as located in a parcel of
land situate in the Town of . County of__.._._ i#W Stabvof New York, being a portion of the property
known as pursuant to a map entitle€ _ _ as drawn by
and dated_ said map being recorded in the Tompkiry tbunty Clerk's Office at .said land being
further known and identified as Town of Tax Map Parma )los. and said permanent
easement and right-of-way area being more pa uIarly bounded ancieescribed as follows:
BEING...
PAR :U-VkkT0k1JNES&EASEMENTS
A RIGHT-OF-WAY AND EASEMENT t I Ttruct, operate, maintain, alter, repair, remove, replace, and
change the size of residential service water Iines abd pipes,together with such appurtenances and parts necessary or
desirable therefor, together with the rights of free ingress and egress in, over, upon, and under the below-
described lands, suctr ids being and denoting the areas of the permanent easements and rights-of-way as
located in a parcel of l4d--atgate in the Town of . County of and State of New York, being a
portion of the property kiipwTju%.___ pursuant to a map entitled ,as drawn
by and da#rd said map being recorded in the Tompkins County Clerk's Office at
said land being h�Tther known and identified as Town of Tax Map Parcel Nos.
and said permanent easement vtd right-of-way area being more particularly bounded and described as follows:
BFG...
BEING Aloe purpo � f said easement and right-of way to convey rights to the Town and the party of the second part for
the purposes of pro ding a private,. residential water service line and connection, access to a curb box to connect prI.vate
waterlines t ub . water mains, and to run waterlines to the residences and lands of the party of the second part, but
only so long a e Town and the party of the second part reasonably restore the land after any entry or excavation and
reseed any disturbed areas.
AND AS TO EACH OF THE ABOVE GRANTS AND PARCELS OF LAND, the party of the First part does herf-by further
covenant and agree-
l
1. The party of the first part, for himself and all of his successors and assigns,covenants and agrees that no building, or
structures shall be constructed or placed within or upon the aforesaid easement and right-of-way areas,and that no trees
or other plants will be planted or cultivated that may interfere with the said easement and right-of-way areas.
2. Tha party of the first part, for himself and all of his successors and assigns,covenants and agrees he WjlL.not permit or
conduct any mining,excavation,construction or blasting within said easement and right-of-way areas,
3. The party of the first part, for himself and all of his successors and assigns, covenants and agreN 9tat Re }+W1 not
allow, permit, i-ncourage, or engage in any conduct, directly or indirectly, that blocks, obstructs, or ngterfere with the
ingress and egress rights of the Town,its successors,assigns,employees and agents,
TO HAVE AND TO HOLD said right-of-way and easement unto the Town and party of the second part, their successors
and assigns forever, it being; the intent of the party of the first part and the Town agd the party of the second part that this
easement and right-of-way shall now and forever hereafter run with the land.
IN WITNESS WHEREOF,the party of the first part has hereunto set his hand and seal ay and ar first above written.
IN PRESENCE OF
L.S.
L.S.
STATE OF NEW YORK }
COUNTY OF ) ss:
On the day of in ti 20 a me, the undersigned, personally appeared
personally known to me or proved to me ' C
#satisfactory evidence to be the individual whose name is
subscribed to the within instrument and ackno�Vo me that he executed the same in his capacaty, and that by his
signature on the instrument, the individual, or t�person upon behalf of which the individual acted, executed the
instrument.
Notary Public
TP-584(4/13) Now York State Department of Timilon and Finrariml Recording office time stamp
Combined Real Estate
L4 Transfer Tax Return,
Credit Line Mortgage Certificate, and
Certification of Exemption from the
Payment of Estimated Personal Income Tax
See Form T'P-584-1, Instructions for Form TP-584,before com this form. Print or
Schedule A T Information relating to conveyance
Grantorlfransferor Name(it individual,last,first,middle rnitraq(❑ check if morn than one grantor} Social sacunty number
❑ Individual
❑ Corporation Mail ng address Social security number
❑ Partnership 6.
❑ Eetate/Trust City �slngle
ZIP Crade Federal EIN
❑ Single member LLC _ _ v ___ _
❑ Other 3ingle mentber's name it gram mber LLC(see rn ruchons} Single member EIN or SSN
Grantee/Transferee Name(if individual,last,firsr,middle initiaq(LJ chock Hmare than one grant.e) Social security number
❑ Individual
Corporation Mailing address - Social security number -
L ] Partnership
❑ E-,tate/Trusl CRY 21P code Federal EIN
❑ Single member LLC
❑ Other Single member)a name if grant single membw LLC(we 1nay Aviiim} Single member EIN or SSN
Location and description of property conveyed
Tax map designation— SWIS code Street address City,town,or village County
Section,block&lot (six digits)
(include dots and dashes)
Type of property conveyed(check applicable box)
1 ❑ One-to three-family house 5 ❑Commercial ustrial DrAe of eonw-yance Percentage of real property
2 ❑ Residential cooperative B ❑Apartment building conveyed which is residential
3 ❑ Residential condominium 7 Office building real property %
4 ❑ Vacant land 8 ❑Other "7Ont' dry Yew (see in5'ruction-)
Condition of conveyance(check all that apply) f.❑ 0,m vvxanrffivhjch consists of a I.❑ Option assignment or surrender
a. El Conveyance Cnnveyance of fee interest ''nT' of identity or form of
o Hersh ip or organization(attach
F TP-584.1,Schedule O m.El Leasehold assignment or surrender
b. ❑ Acquisition of a controlling interest(state
percentage acquired %) g.❑ Conveyance for which credit for tax n.❑ Leasehold grant
previously paid will be claimed(att rch
c. ❑Transfer of a controlling interest(state Form 7P-584.1,Schedule G) o,❑ Conveyance of an easement
percentage transferred %) h.❑ Conveyance of cooperative apartment(s)
p.❑ Conveyance for which exemption
d. ❑ Convey.fnee to cooperative housing i.❑ from transfer tax claimed(complete
corporation Schedule B, Part 111)
j.❑ yen If air rights or q.❑ Conveyance of property partly within
e. ❑ Conveyance pursuant to or in lieu of development tights and partly outside the state
foreclosure or enforcement of security k.❑ Contract assignment r.❑ Conveyance pursuant to divorce or separation
interest(attach Form TP-584.7,Schedule P 5.;] Other(describe)
For recording officer's usa Amount received Date received Transaction number'
Schedu;a B. Part t $
Schedule B.,Part 11 $
Page 2 of 4 TP-584(4/13)
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(f you are claiming a total exemption from tax,check the
exemption claimed box,enter consideration and proceed to Part Iff)............................. ❑ Exemption claimed 1.
2 Continuing lien deduction(,ee l-istructions It property is taken subject to mortgage or lien)......................................... 2.
3 Taxable consideration(subtract line 2 from fine 1)................................................................................................... 3.
4 Tax: $2 for each$500,or fractional part thereof,of consi ati Ilne 3....................................................... 4.
5 Amount of credit claimed for tax previously paid(see inst t and tacit Form TP-584.1,Schedule G) .............. .
6 Total tax due'{subtract tine 5 from tine 4).............................. ............................................................... .
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 t,line 1)....................................................................... 1.
2 Taxable consideration{multiply tine 1 by the percentage of the premises which is res.rpntial real property,as shown in Schedule W... 2.
3 Total additional transfer tax due"(multiply h rie 2 by 1%(01) .................................................................................. 3.
Part III-Explanation of exemption claimed on Part 1,line 1 ch oxes that apply)
The conveyance of real property is exempt from the real est a tr for the following reason-
a. Conveyance is to the United Nations,the united States erica,the state of New York,or any of the r instrumentalities,
agencies,or political subdivisions(or any public corporation,Including a public corporation created pursuant to agreement or ❑
compactwith another state or Canada)............................................................................................................................................ a
b. Conveyance Is to secure a debt or other obligation........................................................................................................................... b ❑
c. Conveyance is without additonal consideration to confi dify,or supplement a prior conveyance............................ c ❑
d. Conveyance of real property is without consideration and onnection with a sale,including conveyances conveying
realtyas bona fide gifts............................................................ ................................................................................................ d ❑
e. Conveyance!s given in connection with a tax sale............ ................. ........................................................................................... 9 ❑
f. Conveyance is a mere change of identity or form of ownership or organization where there is no change In beneficial
ownership.(This exemption cannot be claimed for a conveyance to a cooperative hous!ng corporation of real property
comprising the cooper i We dwelling or dwellings.)Attach Form TP-584.1,Schedule F................................................................... f ❑
g. Conveyance consists of deed of partition.......................... ..................................................................................I........ g ❑
h. Conveyance is given pursuant to the federal Bankruptcy Act.... h ❑
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 ❑
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 w;�- by the grantor as the grantor's personal residence
and consists of a one-,two-,or three-family house,an inc vidual rosidential condominium unit,or the sale of stock
in a cooperative housng corporation in connection with t t9rant or transfer of a proprietary leasehold covering an
indiv-dual residential cooperative apartment...................................................................................................................................... j ❑
k. Conveyance is not a conveyance within the meaning of Tax Law,Article 31,section 1401(e)(L31t,ich documents
supportingsuch claim)........................................................................................................................................................................... k ❑
'The total tax(from Part 1,line 6 and Part 11,line 3 above)is due within 15 days from the date conveyance.Please make checks)payable
to the county clerk where the recording i° to t 3ke pi ice. If the record ng is to take place in the New York CGty boroughs of Manhattan,
Bronx,Brooklyn,or Queens,make check(,)payable to the NYC Department of Finance.If a recording Is not required,send this return
and your check(-.)made payable to the NYS Department of Taxation and Finance,directly to the NYS Tax Department, RETT Return
Process ng,PO Box 5045,Albany NY 12205-504ti.
Page 3 of 4 TP-W4(4/13)
Schedule C —Credit Line Mort age Certificate(fax'[--w,Art1, 1+= 11)
Complete the following only If the interest being transferred is a fee simple interest.
I(we)certify that:(check the appropriate box)
1. ❑ The real property being sold or transferred is not subject to an outstanding credit line mortgage.
2. ❑ The real property being sold or transferred is subject to an outstanding credit line mortgage.However,an exemption from the tax
I;claimed for the following reason,
❑The trap:far of real property Is a transfer of a fee mpl t to a person or pf-rsons who held a fee simple Interest in the
real property(whether as a joint tenant,a tenant I o Fon otherw!se)immedi,.tely before the transfer.
❑The transfer of real property is(A)to a person or persons rela, d 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 beneficol int.�rest 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 she transferor).
❑The transfer of real property is a transfer to a trus ee >ptcy,a receiver,a=,s gnee,or other officer of a court.
❑The maximum principal amount secured by the c ne mortgage is$3,000,000 or more,and the real property being sold
or transferred,s not principally improved nor will be?mproved by a one-to sox-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 circumstances.See
TSB-M-96(6)-R for more information regarding these aggregation requirements.
s
❑Other(attach detailed explanation).
3. ❑ The real property being transferred is presently subject fb'-L-a putstanding credit line mortgage.However,no tax is due for the
following reason:
❑A certificate of d scharge of the credit line mortga4je is being oiffered at the time of recording the deed.
❑A check has been drawn payable for transmir.ion to the credit line mortgagee or his agent f-ir the balance due,and a
satisfaction of such mortgage will be recorded a-3 soon as it is available.
4. ❑ The red property being transferred is subject to an ci,t,tandinq credit line mortgage recorded in
(im.f-rt Iiber and p,+ge or reel or other identification of r. --r- i-).The maximum principal amount of deaf or obli jation secured
by Vie mortgage is .No exemption from tax is claimed and the tax of
i! being paid herewith.(M-eke check payable to county clerk',# a deed will be recorded or,if the recording k to t-ike place in
New York City but not in Richmond County,make check payable to the NYC Department of Finance.)
Signature (both the grantor(s)and grantees] must si n
The undersigned certify that the above information contains in schedul s A,B,and C,including=-ny return,certification,schedule,or
attachment, is to the best of his/her knowledge,trut3 and co fete,and authorize the person(r)submitting such form on their behalf to
receive a copy for purposes of recording the deed or other ins rument affecting the conveyance.
-- Grenlor Nodure tdo Grantee signature
-- C,mm or signature lid f:r.
Reminder.Did you complete all of the required information n Schedun-,A,B,and C?Are you required to complete Schedule D9 if you
checked e,f,or g in Schedule A,did you complete Form TP--184.1?Have you attached your check()made payable to the county clerk
where recording will take place or,if the recording k in the New York City boroughs of Manhattan,Bronx, Brooklyn,or Queens,to the NYC
Department of Finance?If no recording is required,send your check( ),made payable to the Department of Taxation and Finance,
directly to the NYS Tax Department, RETf Return Processing,PO Box 5045,Albany NY 12205-5045.
Page a of 4 TP-584(4/13)
Schedule D-Certification of exemption from the payment of estimated personal income tax(Tax Law,Article 22, section 663)
Complete the following only it a fee simple interest or a cooperative unit is being transferred by an individual or estate or trust.
If the property is being conveyed by a referee pursuant to a foreclosure proceeding,proceed to Part II,and check the second box
under Exemptions for nonresident transferor(s)Iseller(s)and sign at bottom.
Part I-New York Slate residents
If you are a New York State resident transferors)/seller(s)li-i-ad in tche.'ule A of Form TP-584(or an attachment to Form TP-584),you must
sign the certification below.If one or more transferom/sellerf of 0 rF al,property or cooperative unit is a re.r dent of New York State,each
resident transferor/seller must sign In the space provided.If Mr,—sp..LL�is needed,please photocopy this Schedule D and submit as many
schedules as necessary to accommodate all resident transferors/sellers.
Certification of resident transferors)/seller(s)
This is to certify that at the time of the sale or transfer of the real property or cooperative unit,the transfemr(s)/seller(:)as signed below was
a resident of New York State,and therefore is not required t pay estimated personal income tax under Tax Law,section 663(a)upon the
sale or transfer of this real property or cooperative unit.
Signal= I Print fill m ~ ,{ — D.
Signature Prin namo date
�.gnature Print full name pata
Signature Print full nanw Date
Note-A resident of New York State may still be required to pray as tax under Tax Law,section 685(c),but not as a condition of
recording a deed.
Part II-Nonresidents of New York State
If you are a nonresident of New York Str.t 3 listed as a transf ror/seller i Schedule A of Form TP-584(or an attachment to Form TP-584)
but are not required to pay estimated personal income tax because one of the exemptions below applies under Tax Law,section 663(c),
check the box of the appropriate exemption below.If any ono of the exemptions below applies to the transferor()/E eller(:),thd,
transfemr(s)/seller(..)is not required to pay estimated personal Income tax to New York State under Tax Law,section 663.Each nonresident
transferor/seller who qualifies under one of the exemptions below must sign in the space provided.If more space k needed,plea,e
photocopy this Schedule D and submit as many schedules to accommodate all nonresident transfemrs/sellers.
If none of these exemption statements apply,you must co late orm -2663.Nonresident Real Property Estimated Income Tax Payment
Form,or Form IT 2664,Nonresident Cooperative Unit Estimated I Tax Payment Form. For more information,see Payment of estimated
personal income tax, on page 1 of Form TP-584-1.
Exemption for nonresident transferors)/seller(s)
This is to certify that at the time of the sale or transfer of the real property or cooperative unit,the transferors)/seller(s)(grantod of this real
property or cooperative unit was a nonresident of New York State,but Is not required to pay estimated personal income tax under Tax Law,
section 663 due to one of the following exempt ons:
❑The real property or cooperative unit being soldrrtrans err quali-.ies in total as the transfemr's/seller's principal residence
(within the meaning of Internal Revenue Code, 121)from o to pLra (see instructions).
❑The transferor/seller is a mortgagor convey,ng the mortgaged property to a mortgagee in foreclosure.or in lieu of foreclosure with
no additional consideration.
❑The transferor or trK,nsferee is an agency or authority of the United States of America,an a-�(-ncy or authorty of the state of
New York,the Federal National Mortgage Assoc:�vjDn thr-r ,deral Home Loan Mortgage Corpora ion,the Government National
Mortgage Association,or a private mortgage Ins ranc co any.
Sigrtshrre Prinft name Cave
Signature Print full name Date
Signature Print full name 'Date
Signalure Print full name 'Date