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HomeMy WebLinkAbout45598 7111111111 Submit to County Treasurer of the 1% REAL ESTATE EXCISE TAX This form is your receipt whenstamp county in which property is located. by cashier. Pay by cash 7 certifie CHAPTER 82.45 RCW check to County Treasurer. CHAPTER 458-60 WAC ki THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ITEMS 0 THROUGH 0 ARE FULLY COMPLETED O Name Name CC IX w w1- CC wla J- Z YZ y cc IX (7 Street m((5 Street City State Zip City State Zip © NEW OWNER'S ALL TAX PARCEL NUMBERS Name PERMANENT ADDRESS FOR ALL PROPERTY Address TAX RELATED CORRESPONDENCE City/State Zip O LEGAL DESCRIPTION OF PROPERTY SITUATED IN UNINCORPORATED det.Lers<. `.OUfltCOUNTY ❑ OR IN CITY OF Lots 9 and 10, Block 6, Supplemental Plat of the Iowu' ow, o.c ,',arrisbur:.- as per plat recorded in Volume 1 of Plats, on page 21, records of Jefferson County. O Is this property currently: YES NO O Description of personal property if included in sale (furniture, Classified or designated as forest land? ❑ Elappliances,etc.) Chapter 84.33 RCW Classified as current use land (open space, If exemption claimed,explain farm and agricultural,or timber)? ❑ ❑ Chapter 84.34 RCW Exempt from property tax under Chapter ❑ ❑ If transfer is a gift, gift taxes are due and payable to State of Washington 84.36 RCW? (nonprofit organizations) by April 15th of the following year. Type of Document Type Property: ❑ land only ❑ land with new building. Date of Sale Elland with previously used building Gross Sale Price 1/ $ Personal Property(deduct) 2/ $ SEE TAX OBLIGATIONS ON REVERSE SIDE Taxable Sale Price $ 0 NOTICE OF CONTINUANCE 1%Excise Tax 3/ $ If the new owner(s) of land that is classified or designated as current use or Delinquent Penalty 4/ $ 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 1-4 ON THE REVERSE SIDE) calculated pursuant to RCW 84.33.120 and 140 or RCW 84.34.108 shall be due and payable by the seller or transferor at the time of sale. To determine if the land 0 transferred qualifies to continue classification or designation,the county assessor AFFIDAVIT must be consulted. All new owners must sign. I, the undersigned, being first sworn, on oath state that the foregoing information to the best of my knowledge is a true and correct statement of the facts pertaining to the transfer of the above described real estate. Any person willfully giving false information in this affidavit shall be Signature(s) subject to the PERJURY LAWS of the State of Washington. SEE 5/ON REVERSE FOR PENALTIES. Signature (Specify: Grantor/Grantee/Agent for Grantor/Grantee) Subscribed and sworn to me this day of . 19 , Notary Public This land CIdoes ❑ does not qualify for continuance. nand for the State of Deputy residing at Assessor Date O The following optional questions are requested by RCW 82.45.120. YES NO e. Does conveyance involve a trade, partial Is property at the time of sale: YES NO interest corporate affiliates, related parties, trust, 1 ❑ 2 Ei a. Subject to elderly, disability, or physical improvement ❑ ❑ receivership or an estate? exemption? 1 2 f. Is the grantee acting as a nominee for a third b. Does building, if any, have a heat pump or solar ❑ 2 ❑ party? 1 ❑ 2 CI heating or cooling system? g. Principal use: c. Does this conveyance divide a current parcel of land? 1 El 2 El 1 ❑ agricultural 2 ❑ condominium 3 El recreational d. Does sale include current crop or merchantable 4 ❑ apt(4+units) 5 ❑ industrial 6 ❑ residential timber? 1 ❑ 2 ❑ 7 ❑ commercial 8 ❑ mobile home 9 ❑timber FOR TREASURER'S USE ONLY © • • ¢ �+ ' Ill .r FORM REV 64 0030(9/81) COU1 VTY ASSESSOR