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HomeMy WebLinkAbout123096 Detivrtment of �i� Venue t sccre 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. S Name Vernon Ray Welsh and Penny Sue Welsh,husband and wife Name Stephen Van Long,an unmarried individual a u: w F Mailing Address 4200 Bainbridge Ct NE x Mailing Address 580 Saddle Dr. aCity/State/Zip Lacey,WA 98516 c City/State/Zip Port Townsend,WA 98368 �'Phone No.(including area code) (360)878-8082 ` Phone No.(including area code) (360)301-3676 List all real and personal property tax parcel account ©Send all property tax correspondence to:❑Same as Buyer/Grantee numbers-check box if personal property List assessed value(s) Name Stephen Van Long 947300031 ❑ $321,597.00 Mailing Address 580 Saddle Dr. ❑ City/State/Zip Port Townsend,WA 98368 ❑ Phone No.(including area code) (360)301-3676 ❑ ®Street address of property: 72 Olympic Blvd,Port Townsend,WA 98368-9651 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 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) FULLY DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. BE Select Land Use Code(s): 0 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 ❑ 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? ❑ ® WAC No.(Section/Subsection) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ 0 Reason for exemption Is this property receiving special valuation as historical ❑ 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 28,2015 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 $ 379,000.00 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 $ 379,000.00 to signing(3)below,you may contact your local county assessor for more information. Excise Tax: State $ 4,851.20 This land ❑does El does not qualify for continuance. Local $ 1,895.00 *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 $ 6,746.20 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. *Affidavit Processing Fee $ (3) OWNER(S)SIGNATURE Total Due $ 6,751.20 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ICI1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Grantor of ) r , �, n /� Signature of Grantor or Grantor's Agent tJ{J�.Xp.�,� Grantee or Grantee's Agent Name(print) Vernon Ra Welsh) Name(print) Ste•hen Van Lon Date&city of signing: 2-V I c} . • Date&city of signing: "Lo''/ - w 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)). 701259 y 096 .1.4,,_ r,y�0�1 k __i THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER EXHIBIT "A" Lot 31, Discovery Bay Heights,Division No. 1,as per plat recorded in Volume 6 of Plats,pages 75 and 76,records of Jefferson County, Washington. TOGETHER WITH a non-exclusive pedestrian easement across the following described real property; That portion of Government Lot 2,Section 32,Township 30 North,Range 1 West, W.M., in Jefferson County,Washington,described as follows: Beginning at the intersection of the West line of said Government Lot 2,with the South margin of the County Road; Thence southeasterly along said South margin a distance of 1,075 feet, more or less,to a point which lies 330 feet west of the East line of said Government Lot 2; Thence South 00°52' 10"West.Parallel with the aforesaid East line of Government Lot 2,a distance of 182 feet,more or less,to the line of ordinary high tide of Port Discovery; Thence Northwesterly along said line of ordinary high tide a distance of 1,075 feet,more or less to the West line of said Government Lot2; Thence North 00°36' 48"East a distance of 174 feet,more or less,to the point of beginning; EXCEPT the Easterly 90 feet thereof; TOGETHER WITH tidelands of the second class as conveyed by the State of Washington, situated in front of,adjacent to,and abutting upon the above described tract. Situate in the County of Jefferson, State of Washington.