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98-538 CERTIFICATE OF OCCUP,A►.NCY TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK september 11 98 �. J Date t9 _ >\ � v � \ 98538 This is to certify that work requested to be done as shown by Permit No. has been completed. MOBILE HOME This structure may be occupied as a LOT 174 HOMESTEAD VILLAGE Location ROVELLI JAMES & VIRGINIA C Kvner L MAP NO I. 9 3 . - 2 - 1 1 . 1 By Order Town Board ��.��EENs vrty Director of Bldg. & 'Code Enforcement BUILDING PERMIT VALUE $ 11000 TOWN OF QUEENSBURY 98538 TAX MAP NO . 93 . - 2 - 11 a 1 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to ROVELLI .TAMES & VIRGINIA OWNER of property located at LOT 174 HOMESTEAD VILLAGE Street, Road or Ave. at the Town of Qation in a To Construct or place a MOBILE HOME at the above location in accordance to application together with plot Plans � �� rrt information hereto filedand approved and in compliance with the Town of +Queensbury Building and Zoning t. OWNER s Address Is LOT 174 HOMESTEAD VILLAGE LUZERNE ROAD QUEENSBURYr NY 12804 2. CONTRACTOR or GUI LOERS Neme GLENS FALLS MOBILE HOME INC . 3. CONTRACTOR or BuILDERS Address 39 SARATOGA RD GANSEVOORTr NY WON 4. ARCHMCTS Name COMMONWEALTH ELECTRICAL AGENCY PHAGUEr NY 12836 6. TYPE of Construction - if>lease Indicate by xI MOBILE HONE i t Wood Flame i f Masonry f I Steel f l 7. PLANS and Speoificatior % 14f 7Aq.706 MOBILE HOME AS PER PLOT FLAN SPECIFICATION'S 8. Proposed Use MOBILE HOME September 10 2000 41 19 PERMIT FEE PAID - THIS PERMIT EXPIRES llf a longer' period Is ragvifed an application for en extension must be n+ade to the Building and Zonirq inspsator of the town of Ouasndwry before the expiration date.l 199$ 10 September Dated at the Town of OueanstwrY this Day 19 > for the Town of aueensbury SIGNED BY Buildl and L+dliing Inspector x s Y 11 rl/'�J� yyyyy /�/''y}y i]�vJ� 1 7) � (*r r7 �}�r AAAw. 'F 1! W '!/ � f O U L E 1 T S A4 r V I. lR REVIEWED " Ye L� FEE PAID : PERMIT NO . { APPLICATION FOR PERMIT MOBILE 11OME Olt MODULAR A OUILOING PERMIT MUST BE OBIAINED BEFORE PLACEMENT OF MOBILE IIDME , NO INSPECTIONS WILL BE MADE UNTIL A VALID BUILDING PERMIT HAS BEEN ISSUED . The owner of this# property is : {� P . O . Address : (� �r�{, _ �' dSZst_� l'hofiie Number � � -� �C Property Location r Tax Maly No . � r NAME OF APPLICANT . cc Address of Applicant . ��� Gt All applicants spaces on this application MUST be completed and the signature of the applicant MUST appear on the reverse side of this application . PERS N RESPONSIDL - - OR SUPERVISION OF WORK AS REGARDS BUILDING CODES AUG40a lggs MOBILE 11014E INFORMATION APPROX IMA I E VALUE OF IIDME : New ifome Yes 0 ZONING INFORMATION Replacement Uome es No Size of Property : ft x ft Size of mobile home af t X720 t Existing Buildings : 5inglewide Doublewide Proposed building- distance from property line : Noe of rooms ( exclude baths ) •`S, Front Yard ft Rear Yard ft . Side Yards ft and ft . No . bedrooms Occupancy Information . Noe of bathrooms Primary dwelling : Yes No Fireplace `--Woodstove Accessory Buildings } : Detaclied garage one car / two car car Foundation style and size . Attached garage one car=/ two car car ' Storage building Piers- No . ofeeeeeee�Size ft x ft Other Depth below grade ft a * * * * * * * # Ar 4 Foundation-Footing size " x Proposed date of placement : Wall material Wall thickness " Ileight " 'Water Supply ; Well Mun # cRip�al, ✓�. Total depth below grade f t . Septic permit required ? Grade to home floor. level ft . FURTHER INFORMATION REQUESTED ON TIIE REVERSE SIDE OF 1-IIIS SIIEET AECNAME OF INSTALLER/M01111_E IIOMEr~,,,DEALER : ADDRESS/PIIONE NUMBER ,C" , STATE OF NEW YORK DIVISION OF 110US I Nt; AND COMMUNITY RENEWAL INSIGNIA OF APPROVAL OF TIIE STATE BUILDING CODE 1 . Insignia serial ntlFrrber 2 . Nante of Manufacturer -- 3 . Plan Approval ffuntber 4 . Model or Contponen L Designation 5 . Date of Manufacture All the alcove infornration is to be round on a plat. e or slAcke•: r which should he affixed, to the Mobile Iloore . Cowplete above with that lnfornlation , i-miri of Otwenslitrry State: of New York Cootr Ly of Warren AFF I l)AV I T i swear that to the hest of my knowledge and belief the statements contained in this application . together with the plans tt "d specifications submitted . are a true and coinplet.e statement of all proposed work to bq. done oil the described , prentl ses and that: all provisions cif the 1111I LDING CODE , the ZOUING ORD INANE. [' . and all other laws pertaining to the proposed work shall he cotnpl 1 ed with . whether speclfleel or lint , and that sttclt work is authorized by the owner . Si Una tare Owner , owner ' s anent , architect , contrar. Lor SPECIAL CONDITIONS OF PERMIT : F By Corse nforcentent 0 f IF i cer DECLARA17TUN: Please sign below caller you have carefhlly read the statentent. 'I'o (tic best of illy kriowlcclgc the sl.ticnients curllitined in this application, logether with [lie plans and specifications submitted , are a true and complete statement of all proposed work to be done on the described premises and Ihal all provisions of the Building Code, the Zoning Ordinance and all ollier laws pertaining to [lie proposed work shall be complied with, whether specified or noted, and that such work is authorized by the owner. further, it is understood that I/we shall submit prior to a Certi ficate of Occupancy or Certificate of Compliance being issued , :in AS BUILT PLOT PLAN by a licensed stu-veyor; drawn to scale, showing acttral lc c:alion of project on premises. Signature: (owner, owner's agent, architect, contractor) Af- tNSPEG ICA" FtiN coc►uLjk I R MOH11..E �' M � INX Town of Queensbury Building $ e Enforcement 742 Batt' Road ' r,�]`•" Queensburys NY 12804 (518) 761-8256 ARRIVE: DEPART: INSP: DATE INSPECen Cl1V REQUEST CEiVED: NAME: L LOCATION-, PERMIT # DATE: OI1I3'!�� OUR _�---- MpSILB HDMB FRAkA1NG N A YES NO puler sTmc per 103anaf. 2. anchorin8 per manuf. . . . . . . . . .. .. . g, water line shut,a . .. s 4. sewer line e pI' blewide) Off — $ heating crossover ( --- ented outside 7. skirting . .. . _- g b water relief PiP B deck, porches, steP+s' raylm8furnacerrmot ... ' . .. WSW Operr'adng garage fire lire p'roo ns --- 12. dom closers . ... . — -- 13. plumtnn8 fixt� .. .. .. .: •+ __-- latiun (if apP ) 14. fcxxdatiam u�au 1 -- _- stooke detectors 17. variance r ed _{lutr ls. data Plate �- 19. mobile MD seal okay . . Serial !� Model # Manufacturer Date of Manufacturer OKAY TO ISStE C10 (} yp�s NO Comments: � fI Ui6k)"S L 10 FNVAL. IIVMi §Ej=" 3N Ri1:Pti�R� M 3a11=6 / MC30UL= Pt Town of pueensbury Building & Code Enforcement 742 Bay Road pUeensbury, NY 12W4 (518) 761-8"2..s56 ARRIVE: DEPART; NSP: DATE SNsPEC`TI REQUEST RECEIVED: NAME.: L.C7+CATI )N-. IF7 DATI': �� 9 PERMIT Il �'�_._—.—.-- ! ODIKL.E laou B "01w LAII H01t[8 pptn'If1G5 � FOUNDATION � SA CKFILL FRAMING yES NO 1. foundation support, Frier else°' per snanuf. ... .. .. .. .. 2. anchoring per rnanuf. 3, water line shut, off . ... .. I. .. .. .. -- -- 4. sewer line support (W 4 feet -- 5. heating crossover (dblewide) off grd. G. dryer vented outside ., ,. .. ..... . 7» skirting ventilated ... outside hot water relief valve piput8 -- 9 deck, porchv steps, railing .. .. .. .» fnrnacelbot water operating . garage fire proofing . ..... .. .. .. .. ... . -- 12. door closers .. .. -- 13. plumbing fixture . .. .. I. ... .. .. .. . .. .. . -� 14. foundation insulation (if appl.).. .... f51 smoke detectors » -- fuaa] electrical 17. variance required . .. ... .. .. .. . . . .. .. .. -- 18* data plate okay .. ... .. » -- 19. mobile HUD seal okay . .. .. . . — model # serial # Manufacturer Date of Manufacturer OKAY To ISSUE CIO YES NO C'..+..rr eats: L /f-tG. Vw vkgr+2 Pr ¢ffVAL ffV'SPLG7'f�L7►hf i�lEpvi=ir T MCiBfLE / 1McmULI Town of Queensbury Building & Code Enforcement 742 Bay Road +Queensbury, NY 12804 (518) 76143256 ARRIVE: DEPART; 11 ' INSP: DATE INSPECTION REQUEST RECEIVED: NAME: LOCATION: DATE: PERMIT # MOBILE HOM>E5 MOEK L&R HOME FOOTINGS FOUNI7A N � RACI Frti FRAM G NIA NO 1. foundation support, Pier ing per manuf. » .. .. ., ... .. 2. anchoring per rnanuf. .. .. .. . 3o water line shut-off . .. .. .. . . . .. , .. 44 sewer line support a 4 fleet . ... + 5. heating crossover (dblewide) $rd• 64 dryer vented outside . ..,. 7* skirting ventilated .. .. .... . .. .. ...» — $* hot water relief valve Piping outs 9. deck, porches, steps, railing . .. .. •• • -- lo. furnacethot water operating �n 11. garage fire proofing . .. ••. .. .. . V 12. door closers . .. .. ... .. .. .. . .. .. .. . —{ 13. plumbing fracture .. .. .. ... .. .. .. . . .. .. 14,. foundation insulation (if app - yF is. smoke detectors ,.. 16. final electrical-'ylc.� -- 17, variance required ... .. .. . .. ... .. .. .. . -»— — 18. data plate okay -- 19. mobile BUD seal oka . .. .. d .. . — -- Model # 5(7��8 Serial # CuB ~ 0 5 f3t3 Manufacturer `- I lot,) Date of manufachwee J_ I q/S 5 OKAY TO LIWE CIO YES No III- CommenIe c,E��A,G^ '� . ©lCE L��T • l��' S TA-� t s � RIIVA�- �IV�PILGTICIIV IRit:1�i�Fe r' � , lylOB1L / MC30 L=^Ft Town of ©uoensbury Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 (518) 7611111 APJUV'E: DEPART: DATE INSPECTICSN RHCtIJ T RECEIVED: "NAME L0CAT10N: DATE. CT ` " �` PI # C1 MOHIILK 2901A E 11tOE"Jillill RO1M E I00TVqi ! FOUNDAMON SACKFML _ FRAMR40 NIA Y'ES NO 1. foundation suppi pies` spai per Tnanuf. .. .. .. ... .. .. .. ... . . .» .» 2. anchoring per manuf. .. .. .. .. . .. .. .. 3, water line shut, ") hut, o . . 4, sewer line Support c 'feet . .. . ... 5, heating crossover (dbl de) off grd. -- 6. dryer vested outside .... . .. ..,.. ». .. ., .. . 7. & ventilates# ...»... . . .... —S. hot water relief valve pi -- 94 deck, porches, steps, 1 1©. furnacefhot water -- 11 . garage fire proofing .. . .. . — -- 12, door closerS 13, plumbing fixtur ., ». .. .. ... . 14, foundation insulation (if appl.). .. ... 154 smoke detectors .. .. .. .»... .. .. .. . .. .. . — -- 16. final electrical . .. .. . .. .. .. . . . .. .. .. ... -- 17. variance required .. ..... .. ., .». . . .. . -- 18. data plate okay . ..... ....... .. .. .. . .. » -- 19. mobile HUD seal okay Model # Serial # Manufacturer Date of Manufacturer OKAY TO Issim CIO YES NO CommentS: ► J DUe + � �U/ZY cays .r s ��.� rnrl®I��crrnnr rct��+vr�s r iBrL.E i MC30Uua.Fr Town of ©ueensbury Building & Cade EnforcerneM 742 Bay Raab Clueensbury, NY 12804 (518) 761-8266 ARRIVE: DEPART: ' f 0 1NSP: DATE INSPECnON REQUEST RECEIVED: NAME: LOCATION: C DAB; -' PERMIT # MOl nun HOFAK MO11 M716" HOME FOOTINGS FOUNDATION BACK.FQ3 FRAMING NIA YES NO 1. foundation support* Pier sPacing permanuf.. . .. . .. . .. .. .. .. . .. .. .. . 2. anchoring per manuf. 3. water line shut off 4. sewer Line support ® 4 feel — 1. S. heating crossover (dblewi ) a 6. dryer vended outside . . 7. skirting ventilated . . , .. .. .. , .. . S. hot water relief valve 'ping Outside 9. deck, porches, steps railing . .. .. .., 10, furnace/hot water ling I 11. garage fire prao _ j12. door closers .. .. . »» .. .. . .. .. .. .. . . .. . j 13. plumbing fix — 14. foundation insulation (if RPPI.)..... » _ LS, smoke detectors ..... .. .. ... .. .. .. .. ... _ 16. final electrical . ... .. . ..... . .. .. .. . . . . . _ 17. variance required .. .. .. ... .. .. . . .. . .. . Igo data plate allay .. ... .....0 ... .. .. .. ... 19, mobile 13UD seal okay .. ... .. .. .. .. . I Model # Serial # Manufacturer f Date of Manufacturer , OKAY TO ISSUE C/O YES NO leqI Canu��}}nenas: �iL� .,r� dltr17 '"►C� �r.�n�-5?�•�D . TUE 13 : 30., ,F 'e1 . 11554441 ; 4 TITAN LIMES XF1 illYl � 1'III ia manul a AM lured rjUnar ham oC n e 1F C r maliy lnt UI k!C a Mn a L e d It lost , ,.,:I the r au irernet bi the ledera! nnamllartnted fnmr. contitructinn And =tWty standards fee ..th lacalio Within 010111.110 tone. PAI Box 5 Q llaanng egvlprmxnl maaulacivrrr and model (srr rise rl kit), Th4p snag" h"mg oqulpment naf Iho a p, I to ntrtat47n an a•r+Ape 70' F Ismprraevri t�aa�errield , 4-AY 131455 +� W Ili lane XI M aula Sat 6 [sling ea d F. piOnt Number rd fnAslnllfe falydraa dre.indz ec en6MS• Intl to eOnan�e enirgY.�1„1 ecam.s^nh..+,4 . }r Ihi.�eI her,ln<{wrinA:J,optn at* of a"W dciurw Hut) NO. � 7r Rd to ova Farmsen holf. tiro.: RA no b61 AAAO 14- !l6 1 ^a �1 O V,J rn6 arrnv« v.r...n..n... .« ...po.. _i....i..+„� ........:..w . .....�... ,..I..a....i,..ii>• ... ,< ....1 G7 rflndPnd Ptnf ilpr rule preosLmr - Mlssliuiar.:tutri•al Sell dl Nut Iluel d+tJ Musloi vi tit Cle:Aiyt,aln Lli l � COA1i OAT C0010116 Uj 0 Air CgddiMaaer grvatded attaotory IAHerAA1a 11 al5l yit Apl,fl Vyel L Ff (n'1' ,I.A_'i m Air COerlrlfbnvr rsanvtaeltargr end RlndAl {aaa list of I IM 4rar fu%DcO _ �Jr ChAlMod Gobui tilt --.- U,T,OI.r'liCYf iit aCFordbnCr Willi Ihr 0"0*0.: l his maM "acturag harms t7 dbSr bad to Comply with ills lwdefal rea erlactarwd hamg i art 40li:rt llilrtlniJ and rkrrlaCra ttOn !n'StllYlr Cd in trda Q Q Y rnr COnllnl air and+ll6tr a over,m t roa obb in RLIs it[vTC rlaS aMliil Aland is.urYng Ipboo too S1fCCIraA sae SAlcfy slant arda to Ia1Ca at p010 of rRa RdtOCItIfB. �„i Oftenlal ion of the Arent the eh end! of We homC lac ling . nnlhtse:,x7c I For ad ditiba al infefalalige, C0 FM aft 0WR OF'$ MOA OaI-I in system is :kAigned to mardain an Indoor IemPerslum or 7$" It wnrn evia The laclory Instatled equlpmvnt Ill CludOS: 0 lionise N turra r or bulb add F wel bulb. F_quipminl Manufacturer Model yLt+yl�aignaltion r Rl TiM. fan+M talus! to +.tlicrl rh:a home can its cooled vled w hn ill capr drpn adunq Loan 3.esar Scicrler coo 100 PC L antaur+ e r s d l of .eew rr of the indow of Fa m race hoe lathe sun'[ and fr al. The rvlMaps. �' For haa.tl iota �nJ.`,' raJnt+'s t,,,-.o y a."N wtn v,a,y MAMM nrr4Vt„ 4taMn nn• 4r+rnte„Vn iu ..,..........•u.inrin.,n,w,. For air cnenrig ick - wd LnfaMg Prnwd*dl WO101i4110ti Cdrtahmrlg the Cilr Lll+l.rt OI toof Ao !pint at rarit J c`nr c�ek.n4 rlp*�lal ir} � �y" � O roeabena. winetewe:egsateS and Ahadi„grareprL.».feaincl..,Purr22ofu,rlKlaledil CL _u L�l. t'�rft?�. �4v j• m xm In ordlhv ASHA Ai Handbdaa ryi fort damsrt4ts. 2 R C!r 11,781 ilt cl A �71w rZ InTOlmslWn pdtecsira le^alculof. adoring+aadf it various joealie no end 0 F0rtalbn Q ANOX{'r 11031C!" Vi ste Stove sci 4o Lox provided in the most:in cAntldn co olin0 hsforntat;dn ptovided with this hefne idh3.1'3.1]C7171 LA C/3 p gidy � air fsdaditloner not provided of factory (Ahernale II$ 4.e$9fY z,e rL She S1r aVsnilau l:6n aySfom Ol tl+xs bOrdC !z zul}a bin for the ins,rf aeon at rrnPai Whir CXOXnr.9 Ur'✓1'r 1 r �"" .� .... .. morp", ..1. .,1............... .r..,.,.. ....... .._, ..<... .. .,.....,....-......., , e� may`...-. ., ❑iel^wmshimr - y TJ'. .•y I' tl T.ii .-no rated Chs nell Wh:rll fgn�a er fl Ivir 6 acciilnil: c " nm 0' nM 14 a r GArhttcle TI iSp Cadl115111: uiuMO2 a m accar daf is "in me attarelrrin fir CanadianmP o I ran laerae6d mmlrt kw cislomf0:. lqc in she air e:rrularr Jr .vcn 'al' randirinrr,i' .Yto he m ar t;bv inert he Firltif#OCtk e7� eolimn xta$e der kzurc vn trio star toll Ihr eadirrs irr dc!irrwd lO the mandiaelvn•d he W "poly air duct lystom 1111161011.1410" necocyary to ratculaI& rbel+mt load: at vzliaus 11uM4l1Cn4 end OnCrdalnanr ev:•rP i,the sper,•t retttfaM arm rllootir l.r-nsi:rn e.i.ridra with fMi•+n rnutss In,M him [� do wrrI lvnrintr rabbit rswutr wrnlud 4Altai nal,a Ills - "a air distribution system or this home hat tool been dreignrd moot iciaahan a Ift n won s enables all cor4omwfend {ynim . TarOaMAyIo If pROWIM0 for THE MAO(HIA010111R DESIGN tMNQ �r�A 2otie l l-t Zune 11 r/CCEaaAlty TO CALCOCAT[ at RarRLI, HEAT QASN 0 e 013Y. ;ON[ MAP - j-7 Sturc arp :rJlnd -Hlurrie:inv Rr6milan - • C] 1d FASF HO ryzln:n i ' 25 P$r HCrgontal Wdlx {.Alhoul Wieklowa adA Q6 CTa} . . . . . . . . . . . . . . . . . . . . . . . . . U �r.�•-��yy�/ M - It v e V i t 9 FSF L'pbll Is aSF l.:P'ift Ceif{nts rnd reefs e{ Rght aefee . .. . . . . . . . . . . . . . . . . - 'U" ey 0 V YV Colinas and eodlsd dark solar . . . . . . . . . . . . . . . . .. .. . . . . . . . . �..+�-�rTi' rleers. . . . . . . . . . . . . . . . .. . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. V V a 4.->U Air 14011 In ItOw . . .. . . . . . . . . . . .. . . . . . . . . . .. . . . . "Ll„ w�lylTrt- VrVVV FAir pVetz lit belling . . .. . . . . . . . . . ,V`•�+elt7r Qe ZI'SFdl i Ai• dealt pit lal rtd buts+d6 me Lame . . . . . . . - ,, - Tom . . . . . . . . .. . . . . . . . . . . 'ii" $Allowing era 4M duct heat, In Shia hOmt: 2129 4i- w.r due fA in Tiger - . - . . . . . , .................... N All duo% In erillda . '...................... 9 P ! q Pin Air :Lola oulaid4 the hOma. � . . . . . . . • . . . . . . . . . . . - - - AV rV fJ Te idlinrion g dnvthe,A u�,edea djol 61s ul rod -T tool rhbmrad Md air ieand Itamt mb: r^—'^I • raulint'b}d lriPAl lliinl na'rutaNpn to r.au+rM-The it Ca"g toad 1c asp end enten<he api lalnon.l vealion and fire s!rvclutc al the hard e.CeMeafaircuneilianersOGr,NlMbOtalruli and Pror:de the grnateu ne"llori when Ma:r capacity clgmrty npprOwitr+atss the calrvie tattling to ant. Lich home'[ air e0ndi+;one r shaald be aieed in art atdarite wdlt ch sP Wr 2 n" n,,...,F,...., L.wsn.-iY ,., a P..e,III y. ....A.,y-._„i^1 ....v /b:, Is ...bo".III....,y e..a..,. 'Z OCtN6ri "OOF LOAD _„., rlrrth all potF =-- -.rkmam 2a rnit lfsndpoalm of runif , trials, enve the loral.ov and v,irntat:an art 1n6401 ua ZONE MAP Z Nhddle 30 P$r � Lltner �PSr 0011t0gs wINIFR dtSl4lf YY:MF. TOAtEa NORTH w III MIDDLE MIQt]'LC f r J Q MIQQLL ZONE 2 f.� ✓ 9!f3IlTH r zq E t + Cr .. NTSRTH i? i" ,l` •o o_..._ ;' ..,4,_ REV. F 3 3 FILE COPY [ IIi KdlL11Yh JI NI LI14CIY1 1a 01 CLCIIICU 1U G 1141119 U{114C1 IVU, UI HUWUUIIaI t oursuant to the Uniform Commercial Code. Sheets Presented: 3. ❑ The debtor is a transmittin g unlit . J4 4 a. ucvw'is,; (Last Name Firsq and Address;es): 2. Secured Party(ies] Name(s) and Address{es): 4. Fa(r'FHing officer: Date, Time. No. Filing Office Orr BCCKER, LYNK fl. AMSTER€111MII SAHl1M8 B 1 BROOKYIEM KHP liifi l� �iYISiOtt $� `r GREENFIEi n CI R. , RY 12833 Mnshfda�tt, Fltw yakI�1 t_ L? f iP4. P . 5, This Financing Statement covers the following types for items) of property. 0 _6,,_4ssignee(sl bfts(byied Party and Address(es): ONE ; USED YEAR >i 1985 SZZE : 14 X 70 ! "' � MANUFACTURER : CHAMP10H 9 SERIAL * : 57a8 WITHA all furn1whIngs, 7. ❑ The described crops are growingortobegrownon:* X® Products of the Collateral are also covered. ❑ The described goods are or are to be affixed to: ❑ The lumber to be cut or minerals or the like 8- Describe Real Estate Here: 0 This statement is to be indexed in S. Name of yincluding oil and gas) is on:* the Real Estate Records: a Retard *(Describe Real Estate Below) Owner ` No. &.Street Town or City County Section Block Lot 10. This statement is filed w4hout the debtor's signature to perfkt a security interesOn collateral (check appropriate box) under a security agreement signed by debtor authorizing secured party to file this statement, or _ _JV; El which is proceeds of the original collateral described above in which a security interest was perfected, or ❑ acquired after a change of name, identity or corporate structure of the debtor, or ❑ as to which the Filing has lapsed, or already subject to a security interest in another jurisdiction: ❑ when the collateral was brought into the state, or ❑ when the debtors location was changed to this state. 1 r Y N N I4 ER fRt9AM Q$ B11WK, FM By Signatures f Oebtor(s) By 73watarlffs) of Secure Pa les) (2 ) FILING OFFICE COPY — ACKNOWLEOGENIENT (5/82) STANDARD FORM--FORM UCC-t—Approved by Secretary of State of New York V. 1. b`4iy i s S.: k of em k� E .. VV7. r fl 1 i F oa'* ti 1 it x 1 16, M i+ e � � 1 •p_.11 Nh_71 v } Y cyr ' }Y � r f f 1 r1�.irr tf T t p� ?16 4 rL E� 16 ,�yv'C �1 � p II SEPR31998 �� 2 nN