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Home My WebLink About123092 `' R�n�rrmeM � evenue nt REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT when stamped by cashier. CHAPTER 82.45 RCW-CHAPTER 458-61A WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED (Sec back of last page for instructions) File No.80990.1MM ❑Check box if partial sale of property if multiple owners,list percentage of ownership next to name 1. Name Dorothy E.Hopkins,Trustee of the Lucille Ni, Name Kenneth Brooks,Sr.Family LLC,a Washington Brown Trust,dated July 23.1990 limited liability company Mailing Address P.O.Box 927 ct ti Mailing Address 644 Old Eaglemount Road � F L } r City/State/Zip Chimacum,WA 98325 m a City/State/Zip Port Townsend,WA 98368 sa Phone No.(including area code) (360)373-6312 Phone No.(including area code) 360-531-4668 3. Send all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal tax parcel account numbers-check box if personal property Listed assessed value(s) Name Kenneth Brooks,Sr.Family I,LC 901 313 006 88,060.00 Mailing Address 644 Old Eaglemount Road ❑ city/State/'Lip Port Townsend.WA 98368 �'�Z�� ❑ Phone No.(including area code) 360-531-4668 ❑ ® Street address of property: 735 Lind Road,Port Townsend,WA 98368 This Property is located in a unincorporated Jefferson County OR within❑city of Port Townsend ❑Check box if any of the listed parcels are being segregated from a larger parcel,are part of 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) Government Lot 3 in Section 31,Township 29 North,Range 1 West, W.M.; EXCEPTING therefrom Lind Road along the North boundary thereof; ALSO EXCEPT a strip of land conveyed to the City of Port Townsend by instrument recorded February 21, 1 929 under Auditor's File No. 60452. Situate in the County of Jefferson, State of Washington. 5. Select Land Use Code(s): 88 7. List all personal property(tangible and intangible)included in selling price. Enter any additional codes: (See back of last page for instructions) Is this property exempt from property tax per YES NO chapter 84.36 RCW(nonprofit organization)? ❑ x 6. YES NO Is this property designated as forest land per chapter 84.33 If claiming an exemption.list WAC number reason for exemption: RCW? X ❑ Is this property classified as current use(open space.farm and x agricultural.or timber)land per chapter 84.34? ❑ WAC No.(Section/Subsection) Is this property receiving special valuation as historical property per chapter 84.26 RCW? ❑ X Reason for exemption If any answers are yes,complete as instructed below. Type of Document Statutory Warranty Deed (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S): To continue the current designation as forest land or Date of Document April 28,2015 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 land transferred continues to qualify and will indicate by signing below, Gross Selling Price S 67,500.00 If the land no longer qualifies or you do not wish to continue the designation *Personal Property(deduct) S or classification,it will be removed and the compensating or additional taxes st=ill be due and payable by the seller or transferor at the time of sale. (RCW Exemption Claimed(deduct) S No 84.33.140 or RCW 8434.108). Prior to signing(3)below,you may contact your local county assessor for more information. Taxable Selling Price S 67,500.00 Excise Tax: State S 864.00 This land does ❑does not qualify for continuance Local S 337.50 r �'7/ *Delinquent Interest: State S \` i r, f��i�_tL �� / 36-15 Local S DEPUTY ASSESSOR DATE *Delinquent Penalty S (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal S 1,201.50 NEW OWNER(S): To continue special valuation as historic property, sign(3)below. if the new owner(s)do not wish to continue,all *State Technology Fee S 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 S (3) OW"NER(S)�S �'ATURE Total Due S 1,206.50 1_ "� - PRINT NIAME A MINIMUM OF$10.00 IS DUE iN FEE(S)AND/OR'TAX Kenneth M.Brooks,Sr. *SEE INSTRUCTIONS ® 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING iS TRUE AND CORRECT Signature of Signature of i Grantor or Grantor's A.ent �+ �L1� !,�;,L � Grantee or Grantee's Agent {i,t 9<, Name(print) Lucille NI. 'rown Trust, ated Jul/23,199 Name(print) Kenneth Broo s,Sr.Family L ,C. Date&city of signing: 4(gr �� • • 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(IC). REV 84 0001a(04/30/09) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 701007 123092 092 :*4/.--`r't1,?201S 14;20A,51t:8 12j27V°V2—.