HomeMy WebLinkAbout123086 jj `jt
t/L'�4 `167)V
Department of
p (.P2 j(J
Revenue
0/v_.Trgton 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.
e Name Justin J.Bento and Alisha Nicole Bento,husband and Tony L Haddenham and Alyssa C Haddenham,
wife Name husband and wife
x u;
F Mailing Address 25209 Norman Rd NE m F Mailing Address P.O.Box 777
>- z
a <Kingston,WA 98346 a City/State/Zip Port Hadlock,WA 98339
cc c. Phone No.(including area code) (360)535-4912 Phone No.(including area code) (360)774-1279
List all real and personal property tax parcel account
Send all property tax correspondence to:❑Same as Buyer/Grantee numbers-check box if personal properly List assessed value(s)
Name Tony L Haddenham&Alyssa C Haddenham 932300036 ❑ $190,148.00
Mailing Address P.O.Box 777 ❑
City/State/Zip Port Hadlock,WA 98339 -2,45-T1 ❑
Phone No.(including area code) (360)774-1279 ❑
®Street address of property: 83 Fir Circle,Port Hadlock,WA 98339
This property is located in®unincorporated Jefferson County OR within❑city of Port Hadlock
❑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 36 of Bishop Acres,as per plat recorded in Volume 6 of Plats,pages 126 and 127,records of Jefferson County,
Washington.
Situate in the County of Jefferson,State of Washington.
® Select Land Use Code(s): Q List all personal property(tangible and intangible)included in selling
11 price.
enter any additional codes:
(See back of last page for instructions)
YES NO
Is this property exempt from property tax per chapter ❑ El
84.36 RCW(nonprofit organization)?
6 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 ❑ El
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 24,2015
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 $ 194,500.00
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 $ 194,500.00
to signing(3)below,you may contact your local county assessor for more
information. Excise Tax: State $ 2,489.60
This land ❑does ❑does not qualify for continuance. Local $ 972.50
*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 $ 3,462.10
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
andpayable by the seller or transferor at the time of sale. *Affidavit Processing Fee $
(3) OWNER(S)SIGNATURE Total Due $ 3,467.10
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 CO•RECT.
Signature of Signature of
Grantor or Grantor's Agent Y/ .. Grantee or Grantee's Agent -11111111►
t-
Name(print) stin J.Be o Name(print) To enham
Date&city of signing: 11'1.7-!S f,4 Tnans 1, Wet Date&city of signing: A‘, •L _�<
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)).
HIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER
7004;36 1' .3t_I,Y, *41'79/2015 :. ,4A'': ,1u
123040