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ALLEGANY COUNTY CLERK’S OFFICE Robert L. Christman, County Clerk 7 Court St., Belmont, NY 14813 Phone: (585) 268-9270 Fa...

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ALLEGANY COUNTY CLERK’S OFFICE Robert L. Christman, County Clerk 7 Court St., Belmont, NY 14813 Phone: (585) 268-9270 Fax: (585)-268-9659 THIS SPACE RESERVED FOR COUNTY CLERK

RECORDING PAGE

After Recording Return To:SPACE (PLEASE TYPE OR PRINT) THIS RESERVED FOR COUNTY CLERK PAGES SCANNED _____

Parties: (PRINT OR TYPE NAMES IN FULL)

(Only one 1st party and one 2nd party name required)

1st Party ___________________________________________ 2nd Party ___________________________________________ TITLE COMPANY NAME ________________________________________

COUNTY CLERK’S USE ONLY – DO NOT WRITE BELOW THIS LINE INSTRUMENT # _____________

NUMBER OF PAGES ___________________ (INCLUDING THIS PG.)

DOCUMENT TYPE __________________________________________ NUMBER OF PAGES SCANNED _________ TOWNSHIP(S) ______________________________________________

MORTGAGE RECORDING TAX RECEIPT

AMOUNT OF CONSIDERATION $_____________________

Amount secured by mortgage $________________

RECEIVED $ __________________

Mortgage Tax Serial # ______________________ Check any of the following that apply: ( ( ( (

REAL ESTATE TRANSFER TAX ALLEGANY COUNTY

) 1-2 Family Dwelling Exemption ) Mortgage Tax Affidavit Attached ) To Be Apportioned ) Special Additional Tax Exempt

I do hereby certify that I have received on the within mortgage: $ _________________ Basic Tax $ _________________ Additional Tax $ _________________ Special Additional Tax $ _________________ Total being the amount of the recording tax imposed .

State of New York County of Allegany

s.s.

Recorded on the _________ day of _________, 20 ____ at ___________ o’clock ____M. in Liber ___________ of Index at Page ____________ and examined.

_______________________________________Clerk ____________________________________ (Recording Officer of Allegany County) THIS SHEET CONSTITUTES THE CLERK’S ENDORSEMENT REQUIRED BY SECTION 319 OF THE REAL PROPERTY LAW OF THE STATE OF NEW YORK Clerk’s Initials _____________

DO NOT DETACH