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HomeMy WebLinkAbout123065 -31r Department of Revenue`re Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED (See back of last page for instructions) ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name. In Name Bruce Brown and Linda Brown. husband and wife Name Sumner Riverpark. LLC. a Washington limited o w liability company az Mailing Address 46 Rvlies Way z Mailing Address 65 Juniper Mobile Estates city/State/Zip Port Townsend.WA 98368 City/state/zip Seauim.WA 98382 Phone No.(including area code) Phone No.(including area code) © Send all property tax correspondence to:®Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers—check box if personal property Name 978-700-001 ❑ $545.068.00 Mailing Address PI D: 35935 City/State/Zip I� Phone No.(including area code) n IIIStreet address of property: 6062 Hiahwav 20 This property is located in Port Townsend ❑Check box if any of the listed parcels are being segregated from another parcel,are part of a boundary line adjustment or parcels being merged. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) Brown's Mobile Home Court Division One,as described in Plat Alteration MLA 07-00449/Sub 07-00029,recorded in Volume 8 of Plats, Pages 101 and 102,records of Jefferson County,Washington. Situate in the County of Jefferson,State of Washington ® Select Land Use Code(s): III List all personal property(tangible and intangible)included in selling I15-Mobile home parks or courts price. enter any additional codes: (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under ❑ O chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? U YES NO If claiming an exemption,list WAC number and reason for exemption: Is this property designated as forest land per chapter 84.33 RCW? ❑ p WAC No. (Section/Subsection) 456-618-217 Is this property classified as current use(open space,farm and ❑ 12 agricultural,or timber)land per chapter 84.34? Reason for exemption Is this property receiving special valuation as historical property ❑ p Re-recording per chapter 84.26 RCW? I`C`./'fv> -.?'il. ? C I1Z.7C`l Iz2.,,jt7 If any answers are yes,complete as instructed below. Type of Document Statutory Warranty Deed (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S):To continue the current designation as forest land or Date of Document 2/27/15 classification as current use(open space,farm and agriculture,or timber)land, you must sign on(3)below.The county assessor must then determine if the Gross Selling Price $ land transferred continues to qualify and will indicate by signing below.If the *Personal Property(deduct) $ land no longer qualifies or you do not wish to continue the designation or Exemption Claimed(deduct) $ classification,it will be removed and the compensating or additional taxes will be due and payable by the seller or transferor at the time of sale.(RCW Taxable Selling Price $ 0.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax: State $ 0.00 your local county assessor for more information. 0.0050 Local $ 0.00 This land El does ❑does not qualify for continuance. *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) 0.00 NEW OWNER(S):To continue special valuation as historic property, Subtotal $ sign(3)below.If the new owner(s)does not wish to continue,all *State Technology Fee $ 5.00 additional tax calculated pursuant to chapter 84.26 RCW,shall be due and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ 5.00 (3) OWNER(S)SIGNATURE Total Due $ 10.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of � �• . Signature of Grantor or Grantor's Agent l Grantee or Grantee's Agent Name(print) Christin Newton Name(print) Angela Little Date&city of signing: 04/23/15 Port Angeles,WA Date&city of signing: 04/23/15 Port Angeles,WA Perjury:Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years,or by a fine in an amount fixed by the court of not more than five thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(IC)). REV 84 0001a(04/16/15) THIS SPACE-TREASURER'S USE ONLY COUNTY A SSESS t OR 69414 1230,4:5 : 1 4.2015 10.00* \/)I