HomeMy WebLinkAbout53086 Submit to County Treasurer of the This form is your receipt when stamped
` county in which property is located. 0 111REAL ESTATE EXCISE TAX by cashier. Pay by cash or certified
CHAPTER 82.45 RCW � check to County Treasurer.
PLEASE TYPE OR PRINT CHAPTER 458-61 WAC
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ITEMS 0 THROUGH O ARE FULLY COMPLETED
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Name `1 1 o .4 e(tnt e.r Name .-_ 1 I 1y r / 1 r
WZw tibM
no! enrldli { Cum !i -Qct / ;Z W�.11l
y� i 1 m0 f { { t
Street Street py.
City .' °,, / .#,. State ,J'fi Zip is City (r ', i State , ,' ' Zip ' :) , t'
3 Z / �"' ALL TAX PARCEL NUMBERS iNEW OWNER'S Name i/-/ ,„; r f" "� t- t. yPERMANENT ADDRESS )
FOR ALL PROPERTY Street / A i p `' L'�../t 9.0/// /
TAX RELATED `,
CORRESPONDENCE I' r° ' ; i, Zi , /" , „‹ ,
City/State p t
0
j(> ill LEGAL DESCRIPTION OF PROPERTY SITUATED IN UNINCORPORATED ', { COUNTY ❑ OR IN CITY OF - ° '-
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Is the property currently: YES NO 0 Description of personal property if included in sale(furniture,ap-
Classified or designated as forest land?
Chapter 84.33 RCW CI ®' pliances,etc.)
Classified as current use land(open space, El and agricultural,Chapter 84.34 RCW or timber)?
Exempt from property tax under Chapter If exemption claimed,explain
84.36 RCW?(nonprofit organizations) ❑
Receiving special valuation as historic k
property under Chapter 449,Laws of 1985? ❑ ❑ t • k J
Type of Docun err�t `� t i 1 �i, ,',,t'
Type Property: ❑ land only ❑ land with new building 41
Date of Sale or Conve ance 1 is "` I.
'" El land with previously Q.,4find with mobile home Gross Sale Price 1/ $
used building Personal Property(deduct)2/ $
SEE TAX OBLIGATIONS ON REVERSE SIDE
Taxable Sale Price $
0 Excise Tax State 3/ $ - „I
(1) NOTICE OF CONTINUANCE (RCW 84.33 or RCW 84.34) Local4/ $
If the new owner(s) of land that is classified or designated as current use or Delinquent Penalty 5/ $
forest land wish(es)to continue the classification or designation of such land, Total Tax Due $ °�.
the new owner(s) must sign below. If the new owner(s) do(es) not desire to `
continue such classification or designation, all compensating or additional tax (SEE 1-5 ON REVERSE SIDE)
calculated pursuant to RCW 84.33.120 and 140 or RCW 84.34.108 shall be due O
and payable by the seller or transferor at the time of sale.To determine if the AFFIDAVIT
land transferred qualifies to continue classification or designation, the county I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE
assessor must be consulted.All new owners must sign. STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND
This land ❑ does ❑ does not qualify CORRECT (see#6 on reverse for penalties).
for continuance. DEPUTY ASSESSOR "
r
DATE SIGNATURE. r �,, /a.. ' a , 'r'<�• ` ' .I
f }p d
(2) NOTICE OF COMPLIANCE(Chapter 449,Laws of 1985) NAME (print): V f It`"' °6 f 7 —' 1
If the new owner(s) of property with special valuation as historic property } f > )41
wish(es)to continue this special valuation the new owner(s)must sign below.If DATE & PLACE OF SIGNING: `+ ^' " ( 4`/ f ...>.. i
the new owner(s)do(es)not desire to continue such special valuation,all addi-
tional tax calculated pursuant to Chapter 449, Laws of 1985,shall be due and SPECIFY (circle): grantor/grantee/grantor's agent/grantee's agent
payable by the seller or transferor at the time of sale.
Address of residence or place of business of person signing(specify):
(3) OWNER(S)SIGNATURE
"idi i.y 1,, ( '1 , -# toR ee
The following optional questions are requested by RCW 82.45.120
Is property at the time of sale: e. Does conveyance involve a trade,partial
interest corporate affiliates,related parties, 1❑ 2
trust,receivership or an estate?
a. Subject to elderly,disability,or physical improvement
exemption? 1❑ 2❑ f. Is the grantee acting as a nominee for a third 1❑ 2
CI
party?
b. Does building, if any, have a heat pump or solar 1❑ 2 0
heating or cooling system?
g. Principal use: ,
Alt c. Does this conveyance divide a current parcel of land? 1❑ 2❑
1 ❑ agricultural 2 El condominium 3 ❑ recreational
d. Does sale include current crop or merchantable 1❑ 2❑ 4 0 apt(4+ units) 5 ❑ industrial 6 ❑ residen(ial
timber?
7 con)mercial 8 CI mobile home " 9 El timber
r .-_I '.`,
FOR TREASURER'S U ON
10/27 ‘4
( i 1
COUNTY ASSESSOR
FORM REV 64 0030 (Rev. 10/85) -485- /
J1,=♦ r. 1 •
the 7 thw Quarter the Southeast Quarter
Teat .portion o= _he Southwest Q..a. er of
and the Southeast Quarter of the Southwe ;i: Quarter of Section
11 , Tcwns'hi'a 2 .) North.. .:anc'e 1 West W.t . described as follows:
Co'n^ienc ing ..t the ,.-+•.itn Quarter Corner of said Section 11 ;
• thence South 89 5 . V2499 East �, . . .`05 feel: to the center of
an v ,:n-.ame i creak; thence fol:o::lr.7 said creek in a Northerly
ie._ti_0r_ the following d'' '.sta^c ; No_r•i l 13°13' 17 ' West
.. :, � thence
3 feet ; thence North .Jua ' __t•" t�1�:�'.: I. 261 . 33 feet ; 1 ence
North . ' 7 . 14 tWest 165 . 72 ecn .... . .. •. e North _2 53 `2
East 9. 73 feet to the --?'= '� "1- C '',9al: �:'ti ._..ce North
85°' r _ r E - 531 . 54 mo a or lass to the center c_
Count r 7.oad No. 18 ; thence Nor ..herly along said centerline
Z. feet ;
3 . 71 . et ; thence North E7` . 3 ' 0O09 East 28 . 01 feet
more or _ess , o the center of ,'.le aforementioned unnamed creek;
_ r -+ 9c East2 . 55
E
`hence Southe.�:y along said c.r :.., ;.>u.u,:h 28°15 . 20 ° 8
feet ; thence continuing ^ _on:. _: id creek South _.2 59' 42 East.
5. 77Js to :he ._.-u N,=' 07 feet more or less i
r 9:� also known as Tract 4 of
.-�r�:nT County '_,ad ri u:A:. o� h .�_ ...
G r T q,'�t way anoro„r iated by drainage
Cra:y�ea_ Survey, �,X r � r�. _ - C� _� '.Vo --'
d + _ n L ef_ers`o:. County 5:.ierior ou .. Case .
.�.5 .."��.� :'pry .
3193
Situated in Jefferson Count...-. Washington .
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