HomeMy WebLinkAbout40379 COUNTY CHAPTER 28.45 RCW
ASSESSOR'S COPY PLEASE FILL OUT COMPLETELY
• 1% REAL ESTATE EXCISE TAX )02.,
P r,MAKE REMITTANCE
f(PAYABLE
T rO JEFFERSON COUNTY TREASURE
NAME ,A J• GLul. Cal. EAriA.1 ifs CLOUbi, HI R'V.
ADDRESS 2011 Redwood Et., .ro.rlTownseNA;E VaS.ELWWD COMPLETE ADDRESS !!
NAME LTaT°.,i.t.: �.�• --, Jf .
NAME OF BUYER AND COMPLETE ADDRESS
ADDRESS
Legal description of real property situated in JEFFERSON COUNTY
LOTL 2 IN BLOCK 29 of the California Addition to the City of Port Townsend,
Washington, as per plat recorded in Volume 2 of Plats, on Page 99, records of Jefferson
County.,
SALE
HANDLED
BY
GROSS SALES PRICE (Meaning-equity plus obligated balance) $ 1%Excise Tax $ _.
PERSONAL PROPERTY (Deduct) $ Penalty (1%per month after 30 days) $
TAXABLE SALES PRICE $ TOTAL
E
DATE OF INSTRUMENT- (on date of delivery of instrument if that is closing date provided in AFFIDAVIT
contract;otherwise upon
execution of contract.) Ir.,_ter. _ _ The undersigned being first sworn,on oath says that the foregoing information
TYPE OF INSTRUMENT is a true and correct statement of the facts pertaining to the transfer of the
above described real estate.
If tax exemption is claimed explain fully the nature of the transfer
SIGNATURE
If sale covers property traded in under Section 61,Chapter 149,1967 Ex.Session,give date Any person willfully giving false information in this affidavit shall be subject
of prior sale Prior Affidavit No.
to the perjury laws of the State of Washington.
FOR STATE DEPARTMENT OF REVENUE USE ONLY
Subscribed and sworn to before me this
LAND. $ SCHOOL DISTRICT
day of. ,r ,19
IMPROVEMENTS $ YEAR LAST APPR
Notary Public in and for the State df Washington,
TOTAL. $ PROPERTY CLASS residing at •
DO NOT WRITE IN THIS SPACE
OFFICE USE ONLY
This becomes your receipt when stamped paid by the county treasurer. Payment
❑ Cash "-Return$
must be made by cash or certified check. This return is subject to audit and verifica-
❑ M.O. ❑ Cash
tion by the State Department of Revenue, and an incomplete affidavit will be re- ❑ Check ❑ Check
turned.
Processed By
❑ Warrant
Initial
After Recording,Mail Tax Statement To DATE PAID RECEIPT NO. AMOUNT
Note: Only 3 Lines on Tax Plates K ��