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HomeMy WebLinkAbout123075 Department of rea z,,,-(ct ci 3 Revenue Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61 A 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. 0 Name Reverse Mortaaae Solutions. Inc. ® NameJohn Resek Jr. &Sharon Reseck as Trustees x e4 w John Resek Jr. and Sharon Resek Joint Livina Trust g 14 a z Mailing Address2727 Spring Creek Drive Mailing Address 631 MontaomelyLane City/State/ZipSSrina. TX 77373 m g City/State/Zip Port Ludlow,WA 98365 Phone No.(including area code) Phone No.(including area code) © Send all property tax correspondence to: 12 Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers—check box if personal property Name 990-400-253 ❑ %'- (�(.-cl�,.�y�I ` (AD Mailing Address 940-400-254 f-1 e 1 !17 v' C� City/State/Zip P- O'.L4(`Xf2 n Phone No.(including area code) e-Dirt: i{ a n iiiStreet address of property: 631 Montgomery Lane,Port Ludlow,WA 98365 This property is located in Jefferson County d ❑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) LOT FIFTY-THREE(53)AREA TWO(2)PORT LUDLOW NO.ONE(1)ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 5 OF PLATS,PAGES 26 TO 32 INCLUSIVE,RECORDS OF JEFFERSON COUNTY,WASHINGTON;LOT FIFTY-FOUR(54) AREA TWO(2)PORT LUDLOW NO.ONE(1)ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 5 OF PLATS,PAGES 26 TO 32 INCLUSIVE,RECORDS OF JEFFERSON COUNTY,WASHINGTON. SITUATE IN THE COUNTY OF JEFFERSON,STATE OF WASHINGTON. DISelect Land Use Code(s): all personal property(tangible and intangible)included in selling III 11-Household,single family units 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 ❑ 12 chapters 84.30,84 37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 1111 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? ❑ CV WAC No. (Section/Subsection) 458-61A-209 Is this property classified as current use(open space,farm and ❑ 12 Reason for exemption agricultural,or timber)land per chapter 84.34 RCW? p Is this property receiving special valuation as historical property ❑ 0 RESCISSION OF DEED IN LIEU RECORDED FEBRUARY 3,2015 UNDER per chapter 84.20 RCW? JEFFERSON COUNTY RECORDING NUMBER 589090 If any answers are yes,complete as instructed below. Type of Document RESCISSION (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S):To continue the current designation as forest land or Date of Document 4/20/15 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 84,33.14))or RCW 8-1.34.108).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 ❑does ❑does not qualify for continuance. *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE (2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ 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 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 Grew4er-or Grantor's Ag- 11 '/, _ Ci Grantee's Agent Name(print) Ta) 5ev ,/ lwa /%.u1 a ��� Name(print) `y� k)ca-nt/ Date&city of signing: 04/24/2015 KIRKLAND, WA Date&city of signing: 04/24/2015 KIRKLAND 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 21)020(I C)). REV 84 0001a(04/16/15) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 699442 12-075 *4/28/2015 1000* 1PCV-