"Statement Identifying Real Property" - Nassau County, New York

Statement Identifying Real Property is a legal document that was released by the Supreme Court - Nassau County, New York - a government authority operating within New York. The form may be used strictly within Nassau County.

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SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
STATEMENT IDENTIFYING
-----------------------------------------------------------------------X
REAL PROPERTY
Pursuant to Mental Hygiene Law
In the matter of the Application of
§81.20 (a)(6)(vi)
As Guardian for the Personal Needs and Property
Record and Index:
Management of
Section:
Block:
An Incapacitated Person
Lot:
-----------------------------------------------------------------------X
Incapacitated Person
Address
Guardian of Property
Address
Phone #
__________________________________
[ ] Check box if there is/are Co-Guardians of the property and List Below
Guardian of Property
Address
Phone #
Guardian of Property
Address
Phone #
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
STATEMENT IDENTIFYING
-----------------------------------------------------------------------X
REAL PROPERTY
Pursuant to Mental Hygiene Law
In the matter of the Application of
§81.20 (a)(6)(vi)
As Guardian for the Personal Needs and Property
Record and Index:
Management of
Section:
Block:
An Incapacitated Person
Lot:
-----------------------------------------------------------------------X
Incapacitated Person
Address
Guardian of Property
Address
Phone #
__________________________________
[ ] Check box if there is/are Co-Guardians of the property and List Below
Guardian of Property
Address
Phone #
Guardian of Property
Address
Phone #
Adjudication of Incapacity:
Supreme Court
Nassau County
Index Number
Date of Order and Judgment
Date of Decision/Verdict
Surety Name:
Address:______________________________________________________________________
Bond Number:
Phone Number:
Real Property
Address
Tax Map Designation:
Name of Municipality:
Section
Block
Lot
Signature of Guardian
Signature of Co-Guardian
Name of Guardian
Name of Co-Guardian
State of New York County of
} ss:
On this
_ day of
in the year 20___ before me, the undersigned,
personally appeared _______________________________, personally known to me or proved to me on the
basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within
instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that
by his/her/their signature(s) on the instrument, the person(s), or entity upon behalf of which the person(s)
acted, executed the instrument.
Signature and office of individual taking acknowledgment
________________________________________________
Notary Public
Record and Return to:
______________________________________
STATEMENT IDENTIFYING REAL PROPERTY
Pursuant to Mental Hygiene Law '81.20 (a)(6)(vi)
Record and Index:
Incapacitated Person
_________________________________________________________
Name
_________________________________________________________
Address
Guardian of Property
__________________________________________________________
Name
__________________________________________________________
Address
[ ] Check box if there is/are Co-Guardians of the property and list below
_______________________________________________
Name
Address
_______________________________________________
Name
Address
Adjudication of Incapacity:
Date of Decision/Verdict
Date of Judgment
_______________________________________________________________________________________
Court
County
Index Number
Surety:_________________________________________________________________________
Name
Telephone
Address
Bond Number
Real Property
Address:
Tax Map Designation/Municipality:
Section
Block
Lot
Name of Municipality
(Check if: [ ] city [ ] town [ ] village)
Dated: ______________________
Signed
____________________________________
Name of Guardian OR Co-Guardian of Property
State of New York County of
} ss:
On this
day of
in the year 20___ before me, the undersigned, personally appeared
_______________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the
individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the
same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the person(s), or entity upon behalf of
which the person(s) acted, executed the instrument.
_________________________________
Notary Public
___________________________________________________________
RECORD AND RETURN TO:
*Tax Lot Identification required for recording
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