The URL can be used to link to this page

Home My WebLink About123080 • Department of u{a t,t!`1 Lk)1 Revenue , Washington State ��O 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. 0 Name Peter V.Ciani and Deborah P.Ciani ® Name Peter V.Ciani and Deborah P.Ciani,Trustees or any successors x w in trust under the Peter V.and Deborah P.Ciani Family Trust aZ Mailing Address 16206 Orchard Hills Drive H Mailing Address 16206 Orchard Hills Drive un LI City/State/Zip Sun City,AZ 85351 City/State/Zip Sun City.AZ 85351 Phone No.(including area code) (406)451-5876 Phone No.(including area code) (406)451-5876 © Send all property tax correspondence to:D Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers—check box if personal property Name 942300057 n 43615700 Mailing Address C A E' ouvt V l ❑ `/L5-Cci 3 1p O City/State/Zip -(""; S,SL t ( n Phone No.(including area code) n t1/44.,0 ' V © Street address of property: 3796 Thorndvke Road.Ludlow SV. 19- 2.-7 ` I This property is located in Jefferson County El 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) see attached ® Select Land Use Code(s): ® List all personal property(tangible and intangible)included in selling 111-Household,single family units I price. enter any additional codes: N/A (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under ❑ r chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? ® 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? ❑ Fl WAC No. (Section/Subsection) 458-61A-211(2o) Is this property classified as current use(open space,farm and ❑ 0 agricultural,or timber)land per chapter 84.34? Reason for exemption transfer to revocable trust without consideration Is this property receiving special valuation as historical property ❑ p per chapter 84.26 RCW? If any answers are yes,complete as instructed below. Type of Document Bargain and I Deems (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) / I NEW OWNER(S):To continue the current designation as forest land or Date of Document S classification as current use(open space,farm and agriculture,or timber)land, 0.00 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 0 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 $ (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 f?�-- ++ Signature of Grantor or Grantor's Agent C,L l' �� Grantee or Grantee's Agents Name(print) Peter V.Ciani Name(print) Deborah P.Ciani Date&city of signing: tit//r5 (47 a Date&city of signing: 1 I 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)). REV 84 0001a(6/26/14) THIS SPACE-TREASURER'S USE ONLY COUNTY ASSESSOR 00087 123080 *4/29/2015 10.00* 12.720 00 0 EXHIBIT A [Legal Description] %re Wast 320 fast of TErts 99 artl 100, imk i as ply i n la 2 P° 119, of , IMMO,WM Its et Torts 1€1 103,E Wean pEr plat mousalerl in wee 2 of , Ptap 119, Ctuity, tai t> it. -. Lb. 9 c# Niey dallzdtoJeffenam 11, 1 4"I rthr Palitres File to. 199579. 15-35429(cmm) 3