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HomeMy WebLinkAbout123078 Department of ,f, 1" � '1. ,� Revenue �- ` S 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. James M.Foster and Sharon L.Foster,husband and Name wife Name Frank H.C.Kam and Diane D.Kam,husband and wife cc u.: l rw F Mailing Address 24 Blueberry Hill Road w H Mailing Address 166 Pinana St. zCity/State/Zip Port Ludlow,WA 98365-8765 a City/State/Zip Kailua,HI 96734 c. Phone No.(including area code) (360)821-8352 L Phone No.(including area code) .),k---)-{i2 List all real and personal property tax parcel account Send all property tax correspordence to:❑Same as Buyer/Grantee numbers—check box if personal property List assessed value(s) Name Frank H.C.Kam&Diane D. Kam 821334060 ❑ $243,467.00 Mailing Address 166 Pinana St. T& 12a ❑ City/State/Zip Kailua, HI 96734 ❑ Phone No.(including area code) ❑ 1`/AAP ✓ ®Street address of property: 24 Blueberry Hill Road,Port Ludlow,WA 98365-8765 This property is located in®unincorporated Jefferson County OR within❑city of Port Ludlow ❑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) FULLY DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. ® Select Land Use Code(s): Q List all personal property(tangible and intangible)included in selling I I price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ 84.36 RCW(nonprofit organization)? © 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) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® Reason for exemption Is this property receiving special valuation as historical ❑ property per chapter 84.26 RCW? If any answers are yes,complete as instructed below. (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Statutory Warranty Deed NEW OWNER(S): To continue the current designation as forest land or classification as current use(open space, farm and agriculture,or timber) Date of Document April 18,2015 I land, you must sign on (3) below. The county assessor must then determine if the land transferred continues to qualify and will indicate by Gross Selling Price $ 315,000.00 signing below. If the land no longer qualifies or you do not wish to *personal Property(deduct) $ continue the designation or classification, it will be removed and the compensating or additional taxes will be due and payable by the seller or Exemption Claimed(deduct) $ No transferor at the time of sale. (RCW 84.33.140 or RCW 84.34.108).Prior Taxable Selling Price $ 315,000.00 to signing(3)below,you may contact your local county assessor for more Excise Tax: State $ 4,032.00 information. This land ❑does ❑does not qualify for continuance. Local $ 1,575.00 *Delinquent Interest: State $ DEPUTY ASSESSOR DATE Local $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 5,607.00 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 $ (3) OWNER(S)SIGNATURE Total Due $ . '5,612.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of �/ Signature of Grantor or Grantor's Agent "LC Grantee or Grantee's Agent Name(print) James M.Foster Name(print) Frank H.C.Kam Date&city of signing: S� u-61//6W/ /i, Date&city of signing: 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($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(1C)). Y 700077 t2307R *4139/2015 5,61 ,00*. '? 0 CE—TREASURER'S USE ONLY COUNTY TREASURER • Revenue rek Washington State REAL ESTATE EXCISE TAX AFFIDAVIT �,ter ,,is PLEASE TYPE OR ma CHAPTER 82.45 RCW-CHAPTER 458-61A WAC rut in' by aehia. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPUTED (Sec back of lot pose far betuafens) 0 Check box if medal snit of property If multiple owners,list pamet i of Owntabip nett ID amts. James M.Foster and Sharon L.Foster,disband and ME Name wife Name Frank H.C.Kam and Diane D.Kam,basbmnd and wife frp Mail' Address 24 Bla a mi eberry Hill Rid Mr7ing Address 166 Plasma St. JChy/Stae/Zip Port Ludlow,WA 98365-8765 1 ay/Stile/4 Kailas,HI 96734` o Plane No.(bndudmg area code) (360)821-8352 Phone No.fad area code) rib Y-2(,L— �/S't'a -';-r i Send all property tax eoe aspmdence to:O Same as DuyerlOramee Lin all nd and puaaerpreputyten pima rowan Lbt MINIM vsloe(s) Cl�J 1 nu des-drodt box Owed property Name Frank H.C.Kam&Diane D.Kam 821334060 0 5243.467.110 Mailing Address 166 Pianos St Q City/State/Zip Kailas,HI 96734 t� Q Phone No.(including area code) 'b$-24:2--$ i 7-G O Q Street address of property: 24 Blueberry HIE Road,Port Ludlow,WA 98365.8765 This ptopaly is located in®unincorporated Jefferson County OR within O city of Port Ludlow 0 Check box if any of the listed parcels are beingsegregaed Aim another are pan Ma boundary line adjmtateat or preach being merged Legal description of property(if more space is needed,you may dada a separate sheet to cads page of the affidavit) FULLY DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. ®Select Land Use Code(s): gm List all personal property(tangble and )intdoded in selfing II Pry enter any additional codes: (See back of last page Dr instructions) YES NO la skis propaty eawapt Sam property tax pa dspter ❑ Ei *4.36 RCW(nonproftorpoiaation)7 ® YES NO If claiming an exemption,list WAC number and reason for=molar is this property designated as fiat land per dopes 8433 RCW7 ❑ 0 WAC No.(Section/Subsection) a this or classified aspoa (o space.farm and Q ®chsprat 8434? Re exon property receiving special vitiation m historical O pope y Per dicier$4426 El If any answers are yes,complete as irartruc ed below. (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Doasaeat Statutory Warranty Deed NEW OWNER(S):To continue the current designation as forest Lod or dassificarion as cured use(open space,farm and agriculture,or timber) Dale of Docanan April 18,2115 land,you must sign is (3) below. The openly assessor mast then determine if the land tra sfaned caotimmes to qui and will indicate by Gross Selling Price S 315,11M.S0 signing below. If the land no qualifies or you do not wish to *pawns!Ptopati,(deduct) $ continue the designation or d�ioo,it will be removed and the compensating or additional taxes will be due and payable by the seller or Exemption Claimed(deduct) S No transferor at the time ofsak. (RCW 14.33.140 or RCW*4.34.10*).Prior Taxable Selling Price S 315,008 11 to )below,you may contact your local county assessor for more Excise Tax: State S 4,I132.00 Tbis land❑does 0 does not qualify ter continuance. Local S 1,575.11 *Delinquent Interest: State S DEPUTY ASSESSOR DATE Local S (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) •Delinquent Penalty S ssNEW OWNER(S): To condom special vahwion as historic property, Subtotal S 5,607.10 (3)below. If the additloonsl calculated punt tto s chapter 14.26 RCW,shall be due 'State Technology Fee $ 5.00 and payable by the seller or trausfaroe at the time of sale. 'Affidavit Processing Fee S (3)OWNER(S)SIGNATURE Total Due S 5.612.10 PRINT NAME A MINIMUM OF$10.10 IS DUE IN FEE{S)AND/OR TAX *SEE INSTRUCTIONS ® I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRE Signature of Signature of Grantor or Granter's Agent Grantee or Grantee's Agent Name(print) James M.Foster Name(print) Fiaak Kam � Date&city of signing: Dark d city ofsitah Kitt W Perjury:Perjury is a dos C felony which is punishable by imprboaraeat in the state correctional fastiaaioa Ter a aundmom term of ace nano then five yeas,err by a fine in an mom fixed by the noun of not more dun five thousand dollars($5,000.10),or by both imprisoaroeot and fix(RCW 9A.20.020(IC)). REV 840.001a(212S/13) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER EXHIBIT "A" Commencing at the Northwest corner of Government Lot 2,as said corner is depicted upon Volume 25 of Surveys,pages 97 through 99, records of Jefferson County, Washington; thence South 01°16'41"West,along the Westerly Limits of said Government Lot,a distance of 60.80 feet to a point on the Southerly margin of the Teal Lake County Road; thence continuing South 01°16'41"West,along said Westerly limits of said Government Lot 2,a distance of 131.85 feet; thence North 84°49'31"East,a distance of 121.38 feet,to the TRUE POINT OF BEGINNING;thence North 14°55'17"East,a distance of 79.89 feet,to a 30 feet distant and South 64°06'06"West, (perpendicular) from a point on the centerline of the road traversing the Erving Johnson Properties in Section 33,as depicted upon said Volume 25 of Surveys,page 97-99,also known as the Blueberry Hill Road; Thence North 64°06'06"East,a distance of 30 feet to a point on said road centerline and point of curve to the Southeast; thence along the arc of said curve of said road,counter-clockwise to the Southeast, the center of which bears North 64°06'06"East,and lies 93.50 distant,through a central angle of 56°01'35",a distance of 91.43 feet,to the Northwesterly corner of Jefferson County Assessor's Tax Number 59(Parcel 22 of the Erving Johnson Properties)as same is described in Volume 638,at page 866,records of Jefferson County, Washington,under Jefferson County Auditor's File Number 420987; thence South 01°49'06" West,along the westerly of limits of said Assessor's Tax Number 59,a distance of 206.95 feet to the centerline of the southerly road traversing the Erving Johnson Properties in Section 33,as depicted upon said Volume 25 of Surveys,page 97-99; Thence South 78°24'16"West,along said road centerline,a distance of 38.36 feet; Thence South 80°33'02"West,along said road centerline,a distance of 81.51 feet,to a point that bears South 01°49'06"East,from the TRUE POINT OF BEGINNING; Thence North 01°49'06"East,a distance of 189.46 feet,to the TRUE POINT OF BEGINNING. Being shown as Parcel"B"of Survey recorded in Volume 32 of Surveys,page 170, under Recording No.529260, records of Jefferson County, Washington. Situate in the County of Jefferson,State of Washington.