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Home My WebLink About123095 Department of P k ' Revenue WaaIhin star ' REAL ESTATE EXCISE TAX AFFIDAVIT 7(,1( 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) n Check box if partial sale of property If multiple owners,list percentage of ownership next to name. IIIName: Juana Tingdale,a married woman,as her Name: Warren Grondahl and Jean Grondahi, husband and separate estate wife x w o4 0 a Mailing Address 472 S. State St. #103 W z Mailing Address 24 Smith Road a V City/state/zip Bellingham,WA 98225 m g City/State/Zip Nordland,WA 98358 o Phone No.(including area code) (360)933-1267 Phone No.(including area code) (360)385-6289 Send all property tax correspondence to: X Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers-check box if personal property Name 921 051 018 30,000.00 Mailing Address PID# 23051 6..c ., i 1 City/State/Zip 0... TLt}C I F3 I 1 Phone No.(including area code) T14 R l3 T/l �' z9) I I M.AP V ® Street address of property: Vacant Land,Jefferson County,WA 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) See Exhibit"A",attached. 111O! Select Land Use Code(s): Q List all personal property(tangible and intangible)included in selling 91 price. enter any additional codes: (See back of last page of instructions) YES NO Was the seller receiving a property tax exemption or deferral I X under chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 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? I I I XI Is this property classified as current use(open space,farm and I I X WAC No.(Section/Subsection) agricultural,or timber)land per Chapter 84.34 RCW? Is this property receiving special valuation as historical property 1 I X Reason for exemption 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)land,you Date of Document April 24, 2015 must sign on (3) below. The county assessor must then determine if the land transferred continues to qualify and will indicate by signing below. If the land no Gross Selling Price $ 21,500.00 longer qualifies or you do not wish to continue the designation or classification,it *Personal Property(deduct) $ will be removed and the compensating or additional taxes will be due and payable Exemption Claimed(deduct) $ by the seller or transferor at the time of sale. (RCW 84.33.140 or RCW 84.34.108). Prior to signing(3)below,you may contact your local county assessor Taxable Selling Price $ 21,500.00 for more information. Excise Tax : State $ 275.20 This land does I I does not qualify for continuance. 0.0050 Local $ 107.50 *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,sign(3) Subtotal $ 382.70 below. If the new owner(s)does not wish to continue,all additional tax calculated pursuant to chapter 84.26 RCW,shall be due and payable by the seller or transferor *State Technology Fee $ 5.00 at the time of sale. *Affidavit Processing Fee $ (3)OWNER(S)SIGNATURE Total Due $ 387.70 A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX PRINT NAME *SEE INSTRUCTIONS 8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. -: e of \ 1 Signature of �\ rantor o Grantor's Agent 'N.') -`�+�v•o,5� �� i�3C-V..�`�-- Grantee.' Grantee's •gents •Name(print) Juana Tingdale Name(print) Warren-Gtrmdahl c _ '. • Date&city of signing: 4/27/15 Bellingham Date&city of signing: � —��-\�j Port Teh..s.ntl__ 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(I C)). REV 84 0001a(6/26/14) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 0 701253 123095 *4/30/2015 387,70* 1 2 1 D i S- EXHIBIT A LEGAL DESCRIPTION: Real property in the County of Jefferson, State of Washington, described as follows: That portion of Government Lot 3, Section 5,Township 29 North, Range 1 East, W.M., in Jefferson County, Washington,described as follows: Beginning at a point on the east line of said Government lot,South 0°44'30"West 730.00 feet from the Northeast corner of thereof; Thence North 0°44'30" East 730.00 feet; Thence North 89°15'30"West along the North line of said Government lot, 902.60 feet; Thence South 07°47'00"East 739.13 feet in intersect a line drawn parallel with the North line of said Government lot, North 89°15'30"West from the point of beginning; Thence South 89°15'30"East 794.60 feet, more or less,to the point of beginning; EXCEPT the East 30 feet thereof for county road known as Ness to Flagler Road CR#4 (SR116); The above described property being SUBJECT TO AND TOGETHER WITH an easement being 60 feet wide parallel to and lying east and north of the following described line: Starting at a point on the North line of said Lot 3, 903.54 feet from the Northeast corner thereof; thence South 7°44'03" East 1,073.51 feet to the point of curvature of a curve, having a central angle of 95°33'and a radius of 200 feet; Thence along said curve a distance of 333.53 feet to the point of tangency of said curve; Thence North 76°42'57"East 508.95 feet to the west margin of county road and end of easement; ALSO SUBJECT TO an easement for road over the North 30 feet in width of said Government Lot 3; except the West 650 feet thereof; AND EXCEPTING THEREFROM those portions conveyed as follows: To Herbert M. Welch by deed recorded under Auditor's File No. 219265; to R.James Mason recorded under Auditor's File No. 302885; to William W. Verd under Auditor's File No. 232838; to William C. Barnard under Auditor's File No. 239013; to Ross E. Brown under Auditor's File No. 240543; to John A. Schmidt under Auditor's File No. 243300 to James Little under Auditor's File No. 198977; to A. William Nelson under Auditor's File No. 217598; to Norman M. Wells under Auditor's File No. 230271; to Richard C. Stuckenschneider under Auditor's File No. 286485 and to Kenneth Edward Corkum under Auditor's File No. 296955; ALSO EXCEPT that portion as conveyed to the County of Jefferson for right-of-way purposes by deed recorded August 23, 1967 under Recording No. 193239, records of said county. All situate in the County of Jefferson, State of Washington. Tax Parcel ID No. 921 051 018 ■ A B !Page C D E 1 AFN Book Parcel No. Tax No. 2 243300 88 245 921051026 Tax 24 3 240523 83 152 921051022 Tax 21 4 239013 80 160 921051021 Tax 20 5 232838 68 449 921051023 Tax 22 6 219265 43 589 921051020 Tax 19 7 217598 40 589 921051025 Tax 42 (S 1/2) 8 198977 8 152 921051025 Tax 42 (Mid) 9 302885 224 414 921051019 Tax 18 10 286485 181 364 921051025 Tax 42 (N 1/2) 11 296955 207 588 921051030 Tax 28&29 12 230571 64 22 921051028 Tax 26 13 14 For future use-All of these AFN documents are in the history/folder drawer