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Home My WebLink About123094 %venue l ' q357.-4 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 ARE FULLY COMPLETED (See back of last page for instructions) File No.57016RW ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name I. Name Paul George Rogers.as his separate estate Name Jay Hagar.an unmarried man as his separate estate w Address O Mailing Add 1801 N.Flagler 1C#539 Wit Mailing Address Po Box 1352 z to City/State/Zip West Palm Beach,FL 33407 City/State/Zip Port Townsend,WA 98368 C7 Phone No.(including area code) (817)253-7003 Phone No.(including area code) (360)986-1020 Send all property tax correspondence to:®Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s) numbers—check box if personal property Name Jay Hagar 996 700 204 ❑ 213 375.00 Mailing Address Po Box 1352 ❑ City/State/Zip Port Townsend,WA 98368 ❑ Phone No.(including area code) (360)986-1020 ❑ ® Street address of property: 181 Quincy St#204,Port Townsend,WA 98368-5762 This Property is located in❑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) SEE EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF FOR COMPLETE LEGAL DESCRIPTION Select Land Use Code(s): 14 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)? ❑ El ® YES NO Is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption: RCW? ❑ El Is this property classified as current use(open space,farm and 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? ❑ 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 23,2015 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 $ 275,000.00 If the land no longer qualifies or you do not wish to continue the designation *personal Property(deduct) $ or classiftcation,.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 Exemption Claimed(deduct) $ No 84.33.140 or RCW 84.34.108). Prior to signing(3)below, you may contact your local county assessor for more information. Taxable Selling Price $ 275,000.00 This land ID does ❑does not qualify for continuance Excise Tax: State $ 3,520.00 Local $ 1,375.00 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 4,895.00 sign(3)below. If the new owner(s)do 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 $ OWNER(S)SIGNATURE Total Due $ 4,900.00 L+ P\ 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 zid4 Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent W Name(print) Paul Geor a Ro ers Name(print) Ja Haar _, _ �► Date&city of signing: .' (a t GztUf+ 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 :01132 123094 44/30/2015 4,90n.0 lf: 'i7,. 4 EXHIBIT A Unit 204,Waterman-Katz Building Condominium, a condominium recorded in Volume 2 of Condominiums, pages 177 through 182,according to the declaration thereof,recorded under Jefferson County Recording No. 514706 and any amendments thereto. Situate in the County of Jefferson, State of Washington.