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HomeMy WebLinkAbout123085 351 y 17 1Li D Iep artmett ut evenue a.Q�>„v ,a„ REAL ESTATE EXC ISE 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) OCheck box if partial sale of property If multiple owners,list percentage of ownership next to name. Name U.S.Bank National Association,as Trustee under the Pooling El Name Phillip Heaward and Annette Heaward, o &Servicing Agreement dated as of 8/1/04.2004-CB6 Trust* w husband and wife ce a F.. Mailing Address 1661 Worthington Road,Ste.100 H Mailing Address 2500 NE Everett c City/State/Zip West Palm Beach,FL 33416 ra City/State/Zip Camas,WA 98607 Phone No.(including area code)Sli I - 334-0 Phone No.(including area code) 360-834-5748 List all real and personal property tax parcel account ® List assessed value(s) Send all property tax correspondence to: Same as Buyer/Grantee numbers—check box if personal property Name 602 234 014 ❑ 194,615.00 Mailing Address 'T�)C 3 _ T E_ n City/State/Zip n Phone No.(including area code) nF✓ ® Street address of property: 304104 Highway 101,Brinnon,WA 98320 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) AS DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. ® Select Land Use Code(s): II List all personal property(tangible and intangible)included in selling Iis-Household,single family units I price. enter any additional codes: none (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ S 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? ❑ L Is this property classified as current use(open space,farm and ❑ is WAC No. (Section/Subsection) agricultural,or timber)land per chapter 84.34? Reason for exemption Is this property receiving special valuation as historical property ❑ 17 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 Special Warranty Deed NEW OWNER(S):To continue the current designation as forest land or — 1 J -- t! S classification as current use(open space,farm and agriculture,or timber) Date of Document t 1 land,you must sign on(3)below.The county assessor must then determine Gross Selling Price $ 106,000.00 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 *Personal Property(deduct) $ or classification,it will be removed and the compensating or additional taxes Exemption Claimed(deduct) $ will be due and payable by the seller or transferor at the time of sale.(RCW 106,000.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Taxable Selling Price $ your local county assessor for snore information. Excise Tax : State $ 1,356.80 This land ID does ❑does not qualify for continuance. I 0.0050 Local $ 530.00 *Delinquent Interest: State $ DEPUTY ASSESSOR DATE Local $ (2)NOTICE OFCOMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ NEW OWNER(S):To continue special valuation as historic property, Subtotal $ 1,886.80 sign(3)below.If the new owner(s)does not wish to continue,all additional tax calculated pursuant to chapter 84.26 RCW,shall be due *State Technology Fee $ 5.00 and payable by the seller or transferor at the time of sale. (3) OWNER(S)SIGNATURE *Affidavit Processing Fee $ Total Due $ 1,891.80 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS © *,C-BASS MO ;age Loa*Ass.• -Balked , OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. . Certificates,Seri•- 004{C)+ / - `_ Z�q. Signature of Signature C _ .... Grantor or Grants}' ep `� Grantee or Grantee's gep ` ', .--�1 � C i '�-- - /JJi� Name(print) -° Name(pant) - 1J Date&city of signing. i`' %-1 z- OaL Date&city of signing: C` - D.�. - ( '6,2_ Ile •1-:e'---- 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)). THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 7004'.7'5 127:0R5 *4 - 9;/.:015 I,891 ,8O* C� ,�t� 1 EXHIBIT A Legal Description That portion of Government Lot 3 in Section 23, Township 26 North, Range 2 West, W.M., described as follows: Beginning at a point 916.3 feet north of the Southwest corner of said Lot 3; Thence North 100 feet along the West line of Government Lot 3; Thence South 77° 30' 15" East to the meander line of said Lot 3; Thence Southerly along said meander line, 100 feet, more or less to a point thereon which is South 77°30' 15" East from the point of beginning; Thence North 77° 30' 15"West to the point of beginning; TOGETHER WITH tidelands of the second class, as conveyed by the State of Washington, situate in front of, adjacent to and abutting thereon; EXCEPT 150 foot wide strip conveyed to the State of Washington for highway purposes by deed dated September 06, 1958 and recorded under Recording No. 159105, records of Jefferson County,Washington. Situate in the County of Jefferson, State of Washington. LPB 16-09(r) Page 3 State of Washington REAL ESTATE EXCISE TAX rip Department of Revenne SUPPLEMENTAL STATEMENT Miscellaneous Tax Section PO Box 47477 Olympia WA 98504-7477 (WAC 458-61A-304) This form must be submitted with the Real Estate Excise Tax Affidavit(FORM REV 84 0001A)for claims of tax exemption as provided below.Completion of this form is required for the types of real property transfers listed in numbers 1-3 below.Only the first page of this form needs original signatures. AUDIT: Information you provide on this form is subject to audit by the Department of Revenue. In the event of an audit,it is the taxpayers'responsibility to provide documentation to support the selling price or any exemption claimed. This documentation must be maintained for a minimum of four years from date of sale.(RCW 82.45.100)Failure to provide supporting documentation when requested may result in the assessment of tax,penalties,and interest. Any filing that is determined to be fraudulent will carry a 50% evasion penalty in addition to any other accrued penalties or interest when the tax is assessed. PERJURY: Perjury is a class C felony which is punishable by imprisonment in a 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 ($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(1C)). The persons signing below do hereby declare under penalty of perjury that the following is true(check appropriate statement): 1. © DATE OF SALE: (WAC 458-61A-306(2)) I, (print name) Tresa Dubuisson certify that the Special Warranty Deed (type of instrument), dated 03/13/2015 ,was delivered to me in escrow by U.S. Bank National Association (seller's name).NOTE:Agent named here must sign below and indicate name of firm.The payment of the tax is considered current if it is not more than 90 days beyond the date shown on the instrument. If it is past 90 days, interest and penalties apply to the date of the instrument. Reams held in escrow: Delay of lender approving loan and providing documents for closing Signature Firm Name 2. GIFTS: (WAC 458-61A-201)The gift of equity is non-taxable; however,any consideration received is not a gift and is taxable. The value exchanged or paid for equity plus the amount of debt equals the taxable amount. One of the boxes below must be checked. Both Grantor(seller)and Grantee(buyer)must sign below. Grantor(seller)gifts equity valued at$ to grantee(buyer). NOTE: Examples of different transfer types are provided on the back.This is to assist you with correctly completing this form and paying your tax. "Consideration" means money or anything of value,either tangible(boats, motor homes, etc)or intangible,paid or delivered,or contracted to be paid or delivered, including performance of services, in return for the transfer of real property. The term includes the amount of any lien,mortgage,contract indebtedness, or other encumbrance, given to secure the purchase price,or any part thereof,or remaining unpaid on the property at the time of sale. "Consideration" includes the assumption of an underlying debt on the property by the buyer at the time of transfer. A: Gifts with consideration 1. LI Grantor(seller)has made and will continue to make all payments after this transfer on the total debt of $ and has received from the grantee(buyer)$ (include in this figure the value of any items received in exchange for property).Any consideration received by grantor is taxable. 2. ❑ Grantee(buyer)will make payments on %of total debt of$ for which grantor (seller)is liable and pay grantor(seller)$ (include in this figure the value of any items received in exchange for property).Any consideration received by grantor is taxable. B: Gifts without consideration 1. ❑ There is no debt on the property; Grantor(seller)has not received any consideration towards equity. No tax is due. 2. ❑ Grantor(seller)has made and will continue to make 100%of the payments on total debt of and has not received any consideration towards equity.No tax is due. 3. ❑ Grantee(buyer)has made and will continue to make 100%of the payments on total debt of and has not paid grantor(seller)any consideration towards equity.No tax is due. 4. ❑ Grantor(seller)and grantee(buyer)have made and will continue to make payments from joint account on total debt before and after the transfer.Grantee(buyer)has not paid grantor(seller)any consideration towards equity.No tax is due. Has there been or will there be a refinance of the debt? ❑ YES 4 NO If grantor(seller)was on title as co-signor only,please see WAC 458-61A-215 for exemption requirements. The undersigned acknowledges this transaction may be subject to audit and have read the above information regarding record-keeping requirements and evasion penalties. . Grantor's Signature Grantee's Signature 3. ❑ IRS "TAX DEFERRED" EXCHANGE (WAC 458-61A-213) I, (print name) , certify that I am acting as an Exchange Facilitator in transferring real property to pursuant to IRC Section 1031, and in accordance with WAC 458-61A-213. NOTE: Exchange Facilitator must sign below. Exchange Facilitator's Signature For tax assistance visit http://dor.wa.gov or call(360)570-3265.To inquire about the availability of this document in an alternate format for the visually impaired, please call(360)705-6715.Teletype(TTY)users may call 1-800-451-7985. REV 84 0002e(a)(06/19/06) COUNTY TREASURER