HomeMy WebLinkAbout40377 CHAPTER 28.45 RCW
PLEASE FILL OUT COMPLETELY
Parcel Number 1% REAL ESTATE EXCISE TAXIs Segregation
Required Yes(D
MAKE REMITTANCE PAYABLE TO JEFFERSON COUNTY TREASURER
NAME NO Q
NAME OF SELLER AND COMPLETE ADDRESS
ADDRESS
NAME
ADDRESS NAME OF BUYER AND COMPLETE ADDRESS
Send Statement to:
Legal description of real property situated in JEFFERSON COUNTY
THAT PORTION OF THE NORTHEAST QUARTER OF THE SOUTHWEST
QUARTER
OF SECTION 34, TOW, O O LY
OF OLD STATE ROAD NO. 9 (NOW ATCOUNTY—ROAD).� M SOUTHERLY
NORTHERLY MARGIN OF STATE ROAD N . 9; EXCEPT THAT PORTION THEREOF
, „,.DESCRIBED AS FOLLOWS:
BEGINNING AT THE POINT OF INTERSECTION THE SOUTHERLY LINE OF
SAID OLD STATE ROAD NO. 9 WITH THE NORT,:E:RL' MARGIN OF STATE ROAD
NO. 9; THENCE EASTERLY, ALONG SAID NORTHERLY MARGIN, 220 FEET;
THENCE NORTH 48 FEET; MORE OR LESS, TO "nE SAID SOUTHERLY LINE OF
OLD STATE ROAD NO. 9; THENCE WESTERLY, ALONG SAID SOUTHERLY LINE,
TO THE POINT OF BEGINNING; AND EXCEPT THAT PORTION THEREOF CONVEYED
TO MAURICE R. HULL ET UX. BY DEED DATED NOVEMBER 12, 1963 AND RECORDED
UNDER AUDITOR'S FILE NO. 177769, DESCRIBED AS FOLLOWS:
BEGINNING AT A POINT WHICH IS 2715.4 FEET EAST OF THE WEST. QUARTER CORNER OF SAID EAST—WEST CENTER LINE OF SAID SECTION;
THENCE SOUTH ALONG THE NORTH—SOUTH CENTE.': LINE 2° 15' EAST, A —a
DISTANCE OF 251.6' FEET TO THE INTERSECTION OF THIS LINE AND-THE '
NORTH L'INE OF THE RIGHT—OF—WAY OF UNITED STATES HIGHWAY 101; . J
AritE CE NORTHWESTERLY ALONG THE RIGHT—OF—WAY OF SAID HIGHWAY, A DISTANCE OF 50 FEET; THENCE NORTHEASTERLY 11° 24' EAST, A-DISTANCE N OF 247.15 FEET, MORE OR LESS, TO THE PONT OF BEGINNING; ALL SITUATE IN THELOUNTY OF JEFFERSON, STATE OF WASHINGTON ) .i
e STATE OF WAJnlrvvtviv, r
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GROSS SALES PRICE 1% EXCISE TAX
(equity plus obligated balance) $ (Payable within 30 days of date of sale) • . .. . . $
PERSONAL PROPERTY (deduct) $ PENALTY (1°;, per month) $
TAXABLE SALES PRICE $ TOTAL $
DATE OF INSTRUMENT AFFIDAVIT
(On date of delivery of instrument if that is the closing date provided in The undersigned being first sworn, on oath says that the foregoing is a
contract; otherwise upon execution of contract) true and correct statement of the facts pertaining to the transfer of the
TYPE OF INSTRUMENT above described real estate.
If sale covers property traded in under R.C.W. 28A.45.105 give date and SIGNATURE
affidavit number of prior sale.
DATE AFFIDAVIT NO. Any person willfully giving false information in this affidavit shall be subject
to the PERJURY LAWS of the State of Washington.
TYPE OF PROPERTY? 0 Commercial ❑ Residential
❑ Agricultural ❑ Industrial 0 Recreational
❑ Mobile Home Site ❑ Multiple Dwelling ❑ Bare Land
Does sale include current crop? ❑ YES ❑ NO Subscribed and sworn to before me this day
Served by a public sewer? ❑ YES ❑ NO of 19
Does sale price include real estate commission? ❑ YES ❑ NO
Notary Public in and for the State of Washington
If more than one county
parcel number,will property be used as a single parcel? ❑ YES ❑ NO residing at
Will this property be used with any adjoining
property presently owned by the purchaser? ❑ YES ❑ NO PROCESSED BY AFFIDAVIT NUMBER
Does this conveyance involve ? ❑ Partial Interest
❑ Corporate affiliations ❑ Related Parties
0 Trust Agreement ❑ Estate Property
DEPUTY
❑ Trade ❑ Life Estate
THIS BOX FOR STATE DEPARTMENT OF REVENUE USE ONLY
A.V. CLASS