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