HomeMy WebLinkAbout40378 CHAPTER 2 8.4 5 RC W .,. - ..0 /
PLEASE FILL OUT COMPLETELY
Parcel Number 1% REAL ESTATE EXCISE TAX Is Segregation
� '-' equlred Yes Q
MAKE REMITTANCE PAYABLE TO JEFFERSON COUNTY TREASS ., No Q
NAME
NAME OF SELLER AND COMPLETE ADDRESS
ADDRESS & j,T,,. 1,,, C'1'Y,T, G±t,
T71�. �si� y-,y� 7� ��q1��T�+y, CAROL n�7�y3�r +L �•yq�y� ^t r����
NAME .`T��.. r.l.ALsL�,.'F!:1P.1�.f.:.S 1 A1.xt RI AA�)..�LL.1..0 , .LSSC�I •1 r GO.�'3.Lt1C'�i70i4
NAME OF BUYER AND COMPLETE ADDRESS
ADDRESS
Send Statement to:
Legal description of real property situated in JEFFERSON COUNTY
All of Lot 3 in Block. 55 of the Original Townsite of the City of Port Townsend
as per plat recorded in Vothe 1 of Plats on page 1, records of Jefferson County.
Together with an easement for ingress and egress front Quincy Street to the rear
of the building over the southerly 15' of Lots 2 and 4 in the Original Townsite
of the City of Port Townsend as per plat recorded in Volune 1 of Plats an page 1,
records of Jefferson County, Washington.
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DESCRIPTION OF PERSONAL PFrOIPERTY IF INCLUDED IN SALE If tax exemption is claimed,explain fully the nature of the transfer.
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 '^,rR•r? 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
— above described real estate.
TYPE OF INSTRUMENT �,__ __ ��
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? ❑ Commercial ❑ Residential
❑ Agricultural ❑ Industrial ❑ 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 AFFIDAV/T NUMBER
Does this conveyance involve ? ❑ Partial Interest
❑ Corporate affiliations ❑ Related Parties /
❑ Trust Agreement ❑ Estate Property DEPUTY ✓ o
❑ Trade ❑ Life Estate
THIS BOX FOR STATE DEPARTMENT OF REVENUE USE ONLY (` l�
A.V. CLASS L9.....)V