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HomeMy WebLinkAbout123072 1c)1 t .O • Department of rell Revenue • REAL ESTATE EXCISE TAX AFFIDAVIT This form is odr{ecet t' l Washington State y p Chapter 82.45 RCW-Chapter 458-61A WAC when stamped by cashier PLEASE TYPE OR PRINT 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. IIIIIName Harvey Gord UName Dan and Caridad Waltz c4 0 a a Mailing Address 665 N.Adams Dr. t4 i- w Mailing Address 1438 Sigsbee Ave. City/State/Zip Idaho Falls,ID 83401 °c D City/State/Zip Salt Lake City,UT 84103 Phone No.(including area code) (208)520-4300 Phone No.(including area code) (801)618-8201 ©Send all property tax correspondence to: 2 Same as Buyer/Grantee List all real and personal property tax parcel account List Assessed value(s) numbers-check box if personal property Name Dan and Caridad Woltz Parcel#962112808 n 4000.00 Mailing Address 1438 Sigsbee Ave. ❑ City/State/Zip Salt Lake City,UT 84103 n Phone No.(including area code) (801)618-8201 0 Street address of property: Southwest corner of Cascade Ave and Duquesne Ave(no street address yet) 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) IRONDALE#5 BLK 128 LOTS 33&34 Select Land Use Code(s): List all personal property(tangible and intangible)included in selling price. 91-Undeveloped land(land only) none enter any additional codes: (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior ❑, 2 citizen,or diabled person,homeowner with limited income)? If claiming an exemption,list WAC number and reason for exemption: YES NO WAC No.(Section/Subsection) Is this property designated as forest land per chapter 84.33 RCW? ❑ 2 Reason for Exemption Is this property classified as current use(open space,farm,and ❑ 0 agricultural,or timber)land per chapter 84.34? Is this property receiving special valuation as historical property per ❑ a chapter 84.26 RCW? �- /� k Type of Document ■ l.N ,� • C If any answers are yes,complete as instructed below. �� Date of Document ` (1) NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Gross Selling Price $ 2,700.00 NEW OWNERS(S): To continue the current designation as forest land or classification as current use(open space,farm and agriculture,or timber)land, you must sign on(3)below.The county *Personal Property(deduct) $ 0.00 assessor must then determine if the land transferred continues to qualify and will indicate by signing below.If the land no longer qualifies or you do not wish to continue the designation or classification, Exemption Claimed(deduct) $ 0.00 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 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you Taxable Selling Price$ 2,700.00 may contact your local county assessor for more information. This land ❑#does ❑does not qualify for continuance. Excise Tax:State$ 34.56 0.005 Local $ 13.50 DEPUTY ASSESSOR DATE *Delinquent Interest Penalty $ (2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Local$ NEW OWNER(S): To continue special valuation as historic property, sign(3)below.If the new *Delinquent Penalty $ owner(s)does not wish to continue,all additional tax calculated pursuant to chapter 84.26 RCW, shall be due and payable by the seller or transferor at the time of sale. Subtotal$ 48.06 *State Technology Fee$ 5.00 (3)OWNER(S)SIGNATURE *Affidavit Processing Fee$ Total Due$ 53.06 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS © I CERTIFY UNDE NALTY OF PERJURY THAT THE FOREGOING IS TRU AND CORRECT Signature of G �,J��/ i Signature of �( _i -� Grantor or Grantor's Agent: � v✓ Grantee or Grantee's Agent: ', Name(Print): Harvey Gord Name(Print): Dan Woltz&Caridad Woltz\ Date&ci ty ofsigning: .7/—,9 .,Z1/ S 1 t)1WD ,),-' A V Date&city of signing: LI—L2..€4-2.0/ 6Y 1 � / Cl r'� 0c-k-, /,V fk 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(02/23/15) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 699395 123072 t I'5 c-r.06* • I •7a"l Z