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HomeMy WebLinkAbout123067 Th t 31 ( „:'‘..- , Department of (73 C( Revenue 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. • fl Name L E t 1<0 Li to l 7!i 4,e-pvC2S © Name Ae G. f /T)L L/ / O w a z Mailing Address 'O 4-N.E. &/'r./1 20.6— Mailing Address d=6,4—A 146-144-' :'" g City/State/Zip `J i' L//i(E 1c214 %f5 am R City/State/Zip ,2� JIF W0 ,W/5". `7 Phone No.(including area code) zG�` --T.6.4--4.9 5 c"/ Phone No.(including area code) 2 D6-— /J-4----- List all real and personal property tax parcel account Send all property tax correspondence to0ame as Buyer/Grantee numbers—check box if personal property List assessed value(s) Name qqo '1vv 2 v 2 ❑ --alad Mailing Address n City/State/Zip aCoSr* n Phone No.(including area code) n isStreet address of property: This property is located in Jefferson County ❑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) 5 Select Land Use Code(s): II List all personal property(tangible and intangible)included in selling Select Land Use Codes (.1EIWZIEMPZIMAII price. enter any additional codes: (See back of last page for instructions) YES 14 NO Was the seller receiving a property tax exemption or deferral under ❑ chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? II 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? ❑ WAC No. (Section/Subsection) U lib ' — C,... Is this property classified as current use(open space farm and ❑ Reason for exemption Lk!,( I t/.i,i /•/ IIj ,�.J 1 111 agricultural,or timber)land per chapter 84.3412(.. ? Is this property receiving special valuation as historical property ❑ per chapter 84.26 RC`W? If any answers are yes,complete as instructed below. L..` Type of Document S(Li r et�1'� /�)fir (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) 4-g1-15- NEW OWNER(S):To continue the current designation as forest land or Date of Document classification as current use(open space,farm and agriculture,or timber)land, Gross Selling Price $ you must sign on(3)below.The county assessor must then determine if the 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. y n 0.0050 Local $ 0.00 This land ❑does 4.does not qualify for continuance. *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) NEW OWNER(S):To continue special valuation as historic property, Subtotal $ 0.00 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 RCS',shall be due and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ .) jet Ei(S)SIGNATURE Total Due $ 10.00 l I A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX 4a,t4 E . /.°#)a//PRP�'T NAME *SEE INSTRUCTIONS ® I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CO EC. n Signature of 'i 0 Signature of 4r U,— Grantor or Grantor "Age / Grantee or Grantee's Agent Name(print) Y70v P `t�l17� Name(print) ,WAle c-1 E / /A/bi-/l Date&city of signing: Pr to4-3#f/ 7lt 4/2 (/ Date&city of signing: Pr IL 1 r1FT/t re 7 S 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,0 b av 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(RCM 9A.20.020(1 C)). (O__ REV 84 0001a(03/24/15) THIS SPACE-TREASURER'S USE ONLY COUNTY TEA R U A93779 1'7'3047 1:4/27/2015 10 e 00* \ 122)owc t. When recorded return to: konk-ki PLLJPS j( Li KJ 1J5+12 (Ir JvITE J05 lio i,IK)C j9 C 55- QUIT CLAIM DEED THE GRANTOR(S) Cc166 (AL Pi9 arki ti for and in consideration of )lab Lirrwc,c cF hONT in hand paid,conveys and quit claims to '(fl [K. 9i-IIL1WPi the following described real estate,situated in the County of JEFFErtC)cd , State of Washington together with all after acquired title of the grantor(s)herein: CAT rLrEhl Ab0fUO I GLIB c) LOTS U rn fG JI To ,95 Abbreviated Legal: (Required if full legal not inserted above.) Tax Parcel Number(s): ' 5Q V O cQ Q Q. LPB 12-05(i)rev 12/2006 Page 1 of 2