DOCUMENT WILL NOT BE RECORDED UNLESS COVER SHEET IS COMPLETED

PLEASE TYPE OR LEGIBLY PRINTINFORMATION WITH BLACK INK

OSWEGO COUNTY CLERK’S OFFICEGEORGE J. WILLIAMS - COUNTY CLERK

SUBMITTED BY:TYPE OF DOCUMENT:

(CLERK’S OFFICE ONLY)PARTIES TO TRANSACTION

TO

RECORD & RETURN TO(Name, Address & Zip Code)

RECORDING FEES

RECORDING & ENDORSEMENT FEE ..................................... $

# OF IMAGES TO BE SCANNED ________ (COUNTY CLERK USE ONLY)

# OF PAGES (INCLUDING COVER SHEET) ________x 5.00 = ........ $

# OF EXTRA NAMES _______ x .50 = ...................................... $

# OF REFERENCES _______ x .50 = .......................................... $

# OF EXTRA MTGE. ASST/LEASE RELEASE ____ x 3.00 = .. $

TOTAL .......................................................................................... $

20.00

MISCELLANEOUS FEES

LOC GOVT .............$

TP 584 ......................$

TP 584.1 ...................$

RP 5217 ....................$

RP5217 .....................$

AFFID ......................$

TOTAL .......................................$

20.00

5.00

5.00

125.00

250.00

5.00

X

(CLERK’S OFFICE ONLY)REVENUE

(CLERK’S OFFICE ONLY)MORTGAGE

COMMENT(CLERK’S OFFICE ONLY)

DEED TRANSFER TAX

CONSIDERATION AMT

REVENUE STAMPS $

TOWN/CITY/VILLAGE(COMPLETE FOR MORTGAGE ALSO)

TAX MAP NUMBER #

GRAND TOTAL FORTHIS DOCUMENT..........$(include Revenue or Mtge Tax in this total if applicable)

MORTGAGE TAX

MORTGAGE AMT. $

TOTAL MTGE. TAX $

MORTGAGE TYPES

COMMERCIAL/VACANT

1 – 2 FAMILY (THIS MORTGAGE IS TO FINANCE THE ACQUISITION OR IMPROVEMENT OF A ONE OR TWO FAMILY DWELLING.)

CREDIT UNION / INDIVIDUAL

REVERSE MORTGAGE

EXEMPT

THIS PAGE IS PART OF THE INSTRUMENT

DO NOTDETACH

I HEREBY CERTIFY THAT THE WITHIN AND FOREGOING WAS RECORDEDIN THE CLERK’S OFFICE FOR OSWEGO COUNTY, NEW YORK. Oswego County Clerk

COVER SHEET

THIS IS NOT A BILL

MICHAEL C. BACKUS, COUNTY CLERK

OSWEGO COUTY CLERK

APPLICATION FOR COVER SHEET