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HomeMy WebLinkAboutBLD2015-00122 - CANCEL THIS BUILDING IS NOT FINALED . THIS IS AN INCOMPLETE BUILDING APPLICATION . THE PERMIT WAS NEVER ISSUED . • BUILDING PERMIT APPLILION BLD15-00122 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 See e) 3 Li Z -1 PERMIT#: BLD15-00122 Received Date: 4/13/2015 SITE ADDRESS: 983 FOUR CORNERS RD PORT TOWNSEND, 98368 OWNER: BARBARAJ HARROLD PHONE: 360-895-8647 8162 SW LOOP DR PORT ORCHARD WA 98367-9221 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001343026 Section: 34 Township: 30 N Range: 1' CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION THIS IS NOT A BUILDING PERMIT - THIS IS FOR TITLE ELIMINATION ONLY! TYPE OF WORK T.E SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 1994 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $78.00 SRE 04/07/15 154280 Permit $0.00 SRE 04/13/15 Permit $0.00 SRE 04/13/15 Total: $78.00 1ltidemark\data\forms\F_BLD_App_Bld.rpt 4/13/2015 • • RETURN RECORDED DOCUMENTTOc gafbet- a 14 v € 1 (e2 Sig) Led DriV2._ 100,-+ o -4--�--d l '� q &34 ? Manufactured Home Please check one: lYllitlltlfletl STATE DEPARTMENT OF • LICENSING Application Tithe Elimination ❑Transfer in Location For full instructions on completing this form,see Manufactured Home Application ❑ Transfer from Real Property Instructions,form TD-420-730. 0 Manufactured Home TPO/Plate number Year Make Length/Width(feel) Vehicle identification number(VIN) / 8-2.04/ a ( moQW,.L I 2,8X VC, / r3 76d0 © Land f/793 Manufactured home will be Real property ��y L^!Affixed ❑Removed 1 Tax parcel no. 0 013 1713 OZ In Legal description on page Block Plat name or Section p/Range Quarter/Quarter section Lot I , Pi)T 3ON, g i W N ltd Q © Grantor(s)Registered/Legal Owner(s)—Additional names on page County number I No.registered owners No.legal owners I Grantee name(f applicable) Name of registered owner Washington driver license or UBI number I;L aa ' -bad' - -5 erg- }-6_w^V`o1.4k vi0i2it0B S4K 78C- Name of adotional registered owner Washington driver license or UBI number Address(Address,City,State,ZIP code) , _�/ Wee_. Cr�{3 6 7 a(e� s.W >^o� C' :t2�, Ido, } prd.V ^P Washington driver license or UBI number Name of legal owner Washington driver license or UBI number Name of atklitiorral legal owner Address(Address,City State,ZIP code) I declare under penalty of perjury under the laws of the state of Washington that I am/we are the registered owner(s)of this manufactured home and the foregoing information is true and correct. X Sidinature of registered owner and title,if applicable Signature of adkfitional registered owner and title,if applicable Notarization Certification State of County of a Signed or attested before me on (Seal or stamp) by by Print registered owner name 5rfnt registered owner name ' Notary printed or stamped name JNCotary signature and Title Dealer/county office number or notary expiration Continued on next page TD-420-729(rvat2)wn Page 1 a3 Manufactured home TPO/Plate num r(from Section 1) • Q Title Company Certification PRINT or TYPE Name of person signing Title company name Position (Area code)Telephone number I certify Mat the legal description of the land and ownership is true and correct according to the real property records. X Signature Date © Building Permit Office Certification I certify that ❑the manufactured home has been affixed to the real property as described. ❑a building permit has been issued for this purpose and the attachment will be inspected upon completion. PRINT orTYPE Name of person signing Bulking permit office Buildng permit number (Area code)Telephone number Position Signature Date Signature of Legal Owners) Signature of legal owner indicates consent for Elimination of Title or Removal from real property. X Signature of legal owner and title,if applicable X Signature of additional legal owner and title,if applicable Notarization/Certification State of County of Signed or attested before me on (Seal or stamp) by by Print registered owner name Print registered owner name Notary printed or stamped name Notary signature and X Title Dealer/county office number or rotary expiration 0 Land Description Legal description of land par-CSI Co as de 12'.c_4td. 6 ^ SKrtJ w-G4eI o ' a o or o-\ -►s.4._ meiikwes+ Q vtAxy -1- or. --1-91,0‘51,-; 30 Nror+ '1 left /s.e I I.Jes4. d�t1. �� +vs �� fl Erg U.K eh e ed. ®r- 1� , VI) l.u-w.e. l © ©-(1 Su�'7ely S� pL I I a, r2c_® S ec ee-t't''`s``_ Continued on next page TD-421i-729(RJ4112)WA Page 2 d 3 • Manufactured homeTPO/Plate number(from Section 1) • Dealer Report of Sale-Selling dealer complete this section Washington dealer number PRINT or TYPE Dealer name Date of sale Purchase price I Tax jurisdiction/Tax rate ❑Sales Tax Exempt-Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). I certify that this information is correct.The manufactured home is clear of encumbrances except as shown. Any required sales tax has been collected. X Dealer authorized signature 0 County Auditor/Agent Licensing Office Approval (not for use by subagents) PRINT or TYPE Name County otfice/VFS operator number 1 certify that the above application appears to be completed correctly,and the applicant has sufficient documentation to proceed with the recording of this form. X Signature Date 10 Title Fees Fling fee I Application I Mobile home fee I Elimination fee Use tax Subagent fees Total fees and tax 0 Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and upon conviction may be punished by a fine,imprisonment,or both.RCW 46.12.750 a We are committed to providing equal access to our services. TD-420-729(R/4/12)WA Page 3 a 3 If you need accommodation,please call(360)902-3600 or TTY(360)664-0116. • Sally Ellis From: Sally Ellis Sent: Tuesday, April 14, 2015 4:24 PM To: 'sharrold@wavecable.com' Subject: Inspection fees for title elimantions Attachments: title elmination -barbara harrold.pdf Dear Barbara Attached are the invoices we discussed on the phone yesterday- You can pay these invoices online-you would go to the following website- http://www.co.jefferson.wa.us/ Then click on Departments- Then select Community Development You should be lead to the below page- Jefferson County Home County Into Departments Search I tomimmunitv� ''' WB1cc►rri tem f?CL orWettspnment ✓t:' Insua Linares •r».rc: R- Ptanninp Cammin>ion 2^12-15 Marijuana Moratorium • PPrtnt( PP PlannirtU rc:n,Gr:(CPP) Orsi-rnrnr2+Ce 01-Q209-1,5 R Consrarh+raaivae Pian Information about taP®naLaatlae 1-50 AMU MARIJUANA Uninged anv�ioPmanz ifi'r � ffq,^rS+Ktn t.:'ObF tv rears Cunt} . ;.. Pvertssit:tnfotmotion siPpriacation corn is Public Records Rants eats ▪ P+crrnit r9xrterbrsa related to I-S02 • rarrlirta cretait Cara a 2014 2015 tRocords Ji.�gaa�st5 eettecrr Pbymanta kForma --m-a- rt- Pttbnc Noticaa--NEwt +a Ca 1b114£ t+ axx f:n.erirIne.roma.. jefY'vrsan County Connrnu ni ty rlevcl op ine nt rmrr ravr.sn.ra,. WA 9gAaPx Planning Manager erraploytnent .r wn.o.. ones,-sw,.Haa rnvr;:ri,o.aau..rzr . l e , rr4L" J*) ; + � e I� �.. :..::. Next on the left hand side of the page-you will see DCD Quick Links- You should select- Online Credit Card & Echeck payments. Then you will simply follow the directions and or steps for paying online. The two attached invoices DCD15-BLD15-00122 This is for the 1994 mobile home and the invoice is for$156.00 $78.00 for inspection fee $78.00 to record a new notice to title saying stair rails is now corrected. The Second Invoice DCD15BLD15-00123 is for the 1987 mobile home-and the invoice is for$78.00 $78.00 for inspection fee 1 • • Once these invoices have been paid-we will then issue you a new permit-and mail those permits to you-you will then be able to call in for inspection on these two new permit. Once those permits have been signed off and final- we can then do the Title Eliminations for both mobiles. Please note you will have to be onsite when the inspections have been schedule-someone has to be present for all final inspections. If you have any questions and or need more information please do not hesitate to contact me. Thank you 4 , `stn nip Sally L Ellis Jefferson County Community Development Permit Technician 621 Sheridan St., Port Townsend,WA 98368 Mon-Thurs 9am- 4:30pm,closed from 12-1 Ph: 360-379-4452 Fax: 360-379-4451 sellis@co.jefferson.wa.us http://www.cmjefferson.wa.us 2 iiNVOICE De 4/13/2015 In ID: DCD15BLD15-00122 1--- 9-3°N O(-. JEFFERSON COUNTY <- DEPARTMENT OF COMMUNITY DEVELOPMENT `' 621 Sheridan Street I Port Townsend, WA 98368 360-379-4450 I email: dcd@co.jefferson.wa.us pi' www.co.jefferson.wa.us/commdevelopment 's7/t]vC`C Date Due: BILLING ADDRESS: 5/13/2015 BARBARA J HARROLD 8162 SW LOOP DR PORT ORCHARD WA 98367-9221 Permit 78.00 Permit 78.00 REMIT TO: Total Amount Due: $156.00 Jefferson County DCD 621 Sheridan St. Port Townsend, WA 98368 Please return the above portion with your payment Permit Number: BLD15-00122 Permit 78.00 Permit 78.00 Total Amount Due: $156.00 Payment is accepted by cash, check, debit or credit card (Visa, Mastercard, Discover, American Express) To pay by credit card, go to www.co.jefferson.wa.us/commdevelopment, and click on the "Online Credit Card & echeck Payments" link on the left side of the page. (questions: call 360-379-4450) • • Gose 'view A.'d Delete Pa.,Fee Hislop., Pent Peturd c s View Case Fee By 14.05 SRE i Fee Type Permit Tran Cade. 2 47 SRE ' Fee Amount S78.00 Amount Due: $78.00 Edit Revenue t(31_Acct: i32210.00 Created -4113120154 ..', By: ISRE Cancel j -_' Notes: NEW OWNER MUST PAY$78.00 FOR JODI TO DO A NEW NOTICE TO TITLE-SAYING THE ( Help HAND RAIL SITUATION HAS BEEN CORRECTED-AND REMOVE THE NOTICE TO TITLE. l ... i iI 9- 'tit Yh Ya( frt g"ir Cx-+aAfl ..wv- u , • . E%ItNew Open Task List QBE GIS ID rii I X Ailitt a X Close View Add Delete Pay Fee History Punt Refund ^T+*44¢ L" f t ew Cdse E' 'A ';''N%' -4" del-etaL€ram - - By U9 05 SRE I Fee Type.'Permit Tran Code ' 7 RE Edit 1 13 45 SRE Fee Amount 1 $78 80 Amount Due., $7800 1 Revenue/ GLAcct 1322 10 00 Created:,4/13`701 By 1SRE �i. _— Cancel Notes_ HIS TITLE ELIMINATION IS FOR A MOBILE HOME THAT WAS PERMITTED BUT THAT PERMIT Help AS NEVER FINAL AND WAS CANCELED- PAY 1 HR FOR BUILDING INSPECTOR TO GO • AND INSPECT THE MOBILE AND HAND RAILS- IN ORDER TO COMPLETE THE TITLE ELIMINATION 1 t• Associated fees ,_ Paid history Totals: $234.00 $156.44 , ; I . ..., ' ..2--• -. . . ..-- - -.4- '61 -411111"11111111...."•22.- 7 .-- f-: T r". re. .. 1 P — _., -I- , —12.2....24 . .t,„. .,, ..,, . , _ . . _ 0 . - - .....--em _ '...' t-- '` i I . a WNW r A l , I a . I I ...,... - 't --. , . . , Ste A. .1'.._ - - -- - 41, pr-1-4......... . . , - 'III, \ ' It 'ta # ... At......, ..,,....7.,.....: ....,10. . ,4...-..,.• —T. t•Oki',7 .4titt.., . ',t.:"0".".44 '..,..4•70' .10.0‘,7,.,- riVir-ft'''' '''tt: ',.,,--'., Tder." - • ...,.. '''•..ret, * 'tot.k... -'''- '1" '449,Y 4. "'''' .-144.. '....La.lifft "?' ,,-..1..,; '.4.4.4 .:.„ -,,T., ' .,,. . - ., • .. ........;"„ . / . API ......, _ A . a . 981 4 Corners , . . - • • RETURN RECORDED DOCUMENT TO: 1-34Lr, bet_ I !e_ 5 ) I-- off' D�iv� AWASHINGTON STATE DEPARTMENT OF Manufactured Home Please check one: i LICENSING Application ETitleElimination For full instructions on completing this form,see Manufactured Home Application ❑Transfer in Location Instructions,form TD-420-730. ❑Removal from Real Property Manufactured Home TPO/Plate number Year Make Length/Width(feet) Vehicle identification number(VIN) IFS_2o( , i99V ft)0OK;L. 2(x yn / / 3 ?&'O? © Land r/ 793 �yM�anufactured home will be Real property L'9 Affixed LI Removed Tax parcel no. 0 013/-3 0-Z Legal description on page Lot Block Plat name or Section/Township/Range Quarter/Quarter section � 3y,T3ONJ I k) NVQ © Grantor(s) Registered/Legal Owner(s)-Additional names on page County number No registered owners No.legal owners Grantee name(if applicable) Name of registered owner Washington driver license or UBI number FL a- }Ace_ v-0 1d Ht11Z20E33`M76C__ Name of adctitional registered owner Washington driver license or UBI number Address(Address,City,State,ZIP code) $I (P 111 VC— I901#01-e--1-42-.43.-0 L2&. Cf g''3 �v 7 Name of legal owner Washington driver license or UBI number Name of additional legal owner Washington driver license or UBI number Address(Address,City State,ZIP code) /declare under penalty of perjury under the laws of the state of Washington that 1 am/we are the registered owner(s)of this manufactured home and the foregoing information is true and correct. x Signature of registered owner and title,if applicable Signature of additional registered owner and title,if applicable Notarization/Certification State of -- County of Signed or attestiYd before me on (Seal or stamp) by by Print registered owner name Xnt registered owner name Notary printed or stamped name Notary signature and Title Dealer/county office number or notary expiration TD-420-729(R/4/12)WA Pagel of a Continued on next page Manufactured homeTPO/Plateber(from Section 1) Q Title Company Certification PRINT orTYPE Name of person signing Title company name Position (Area code)Telephone number I certify that the legal description of the land and ownership is true and correct according to the real property records. X Signature Date © Building Permit Office Certification t certify that ❑the manufactured home has been affixed to the real property as described. ❑a building permit has been issued for this purpose and the attachment will be inspected upon completion- PRINT or TYPE Name of person signing Building permit office Building permit number Position (Area code)Telephone number X Signature Date DSignature of Legal Owner(s) Signature of legal owner indicates consent for Elimination of Title or Removal from real property. X Signature of legal owner and title,if applicable X Signature of additional legal owner and title,if applicable Notarization)Certification State of County of Signed or attested before me on (Seal or stamp) by by Print registered owner name Print registered owner name Notary printed or stamped name Notary signature • and X The Dealer/county office number or notary expiration Q Land Description �/� Legal description of land pa.,--celGCS dep c#ec ^ S"� - — e/ D a F r-}- OP p.('• 14-� hlor-}).t,9es+- a„t,�r�2r' o h �� Secy+ ov. I pi.oKsk, p 30 Nor+h) R e S& I L4) w. ,11 . •/ uLv^�e S ►� 1 1 z, i^ec,d.ds ��s C9"--4 / TD-420-729(want)WA Page 2 of 3 Continued on next page Manufactured homeTPO/Plate tuber(from Section 1) 0 QDealer Report of Sale—Selling dealer complete this section PRINT orTYPE Dealer name Washington dealer number Date of sale Purchase price Tax jurisdiction/Tax rate ❑Sales Tax Exempt—Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). I certify that this information is correct.The manufactured home is clear of encumbrances except as shown. Any required sales tax has been collected. X Dealer authorized signature 0 County Auditor/Agent Licensing Office Approval (not for use by subagents) PRINT orTYPE Name County office/VFS operator number I certify that the above application appears to be completed correctly,and the applicant has sufficient documentation to proceed with the recording of this form. X Signature Date 10 Title Fees Fling fee Application Mobile home fee Elimination fee Use tax Subagent fees Total fees and tax 0 Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and upon conviction may be punished by a fine,imprisonment, or both. RCW 46.12.750 a We are committed to providing equal access to our services. I 7D-420.729(R/4f12)WA Page 3 of 3 If you need accommodation,please call(360)902-3600 or TTY(360)664-0116. NOTICE TO TITLE 27818.Q . '��rPJI DI• 378401 OUST 0 ..�,, . 2$ Filed for the record at the request of: OO - ... .' 4f !Ur SON COU Y AUDITOR Jefferson County Permit Center . , 621 Sheridan g A. I.‘.41Z ga OCPUTY Port Townsend, Washington 98368 When recorded, return to: E R TICS a•K 11cE 312 LANGCOK ET m8I FOur2 CcRR S RD. PORT TOWNSEND WA 98368 NOTICE IS HEREBY GIVEN .EK TICE, their heirs and a$eiggs, a d the general public. /r--� C/'//''i DESCRIPTION OF REAL PROPERTY AFFECTED: Parcel Not2Ob33sY3 26 Section 34, Township 30, Range 01 West, WM. STRUCTURE TYPE INVOLVED: # BLD93-0747 mobile eta ation ADDRESS OF STRUCTURE: 983 FOUR CORNERSl7PO_P�TQWI,➢SEND, WA 98368 NOTICE IS HEREBY GIVEN THAT i / due to the construction of a handraillta�t do of meet building code requirements, the Jefferson County Pe 1 Cents Building Division will no and cannot attest that the constructs was cofisistent with the requirement of the 1991 Uniform Building Code and R l27. Datedrfhi- ,• ' i' da of-Pc_vityl K. 'n•' ', Dfl.c or 3 f r9e Bounty Pe it Center ) AcKnow3e gement s .� /I .•sciibed and sworn to 4efore me this .301-4- 00.. lv• �.�cambar I / C b5Y p . IC 0 + a y public in and for the State of Washington, Oh u�• �Pe�s;•ing at NORDi_AKID a,9 • OFppy� • _ commission expires /0-,5-9g ase — HAL R v,a_. DAG I I Ft IAL RE U WEST OF I��JA m- PITY\8 C / UVA41�Y )$TERSONCOUNTY AUDITOR 3Y DEPUTY JaN - 3 voc 520 PA.1518 vn 5 JANI21995 ii T NOTICE TO TITLE 29818046 IfIgru �{ REOUESI OF ��, 25 Filed for the record at the request of: DOq, ���' :SC 1EFFCR SON COUNTY AUDITOR Jefferson County Permit Center , 621 Sheridan 3Y I \LO S11 rl DEPUTY Port Townsend, Washington 98368 When recorded, return to: E R TICE 312 HANCOCK STREET PORT TOWNSEND WA 98368 NOTICE IS HEREBY GIVEN E R TICE, their heirs and assigns, general public. ,� , II \ !J DESCRIPTION OF REAL PROPERTY AFFECTED: Parcel No. 0013 302 Section 34, Township 30, Range 01 West, WM. STRUCTURE TYPE INVOLVED: # BLD93-0747 mobile home�,ns\b�iOn ADDRESS OF STRUCTURE: 983 FOUR CORNERS RD, PORT /�OS�NS�N(D, WA 98368 NOTICE IS HEREBY GIVEN THAT \ —� due to the construction of a handrail th 't does o' meet building code requirements, the Jefferson County Permi nter, )Building Division will not and cannot attest that the construction s oi tent with the requirements of the 1991 Uniform Building Code and &RCW 12/ ', ,\, j\ Dated thi--7? da of,Pc ., S X= ' t.e -o', •i71'c or Jeffers/o Co. ty Pe it Center Ac) :lC;Rent tea.. ������ Ag" 1 �'�,P�s�R � /�.fi�- r, ed and sworn to �efore me this 3o "olN �,.; o ► - /u ,.r 1 • 4 e 1 �a�- Nay public ,n and for the State of Washington, c ,..,,,7,,,,,, ,,;i, __ g ' .ing at AJo .DI...AM I4,r; l' commission expires ,D-Y5-9 \ s CI 4iiibl _ JAN-3E5 VOL520 YA.c 19 41 I s REPORT OF SALE If you are the seller: You must release interest in the vehicle by signing below on the Vehicle Certificate of Ownership(Title)and give it to the buyer. The report of sale is considered properly tiled if it is received by the department or a local vehicle licensing office within five (5) business days after the sale of the vehicle and includes all information requested in the following boxes: NAME OF SEL LERARANSFEROR(CURRENT REGISTERED OWNER) NAME OF PURCHASER/TRANSFEREE COMPLETE ADDRESS OF SELLFRRRANSFEROR COMPLETE ADDRESS OF PURCHASER/TRANSFEREE STATE ZIP CODE CITY STATE ZIP CODE CITY PATE VEHICLE SOLD I TODAY'S DArE I SALE PRICE PURCHASER/TRANSFEREE'S DRIVER LICENSE NUMBER(IF AVAILABLE) III. I(CENSE NUMBER VEHICLE IDENTIFICATION NUMBER(VIN) YEAR MAKE MODEL CERTIFICATE NUMBER &182016 113760 1994 MODUL 28/40 0731010207 For additional information regarding Reports of Sale visit the DOL Website at: 11111111111111111111111111 11II ll 11 www.dol.wa.gov You may complete your Report of Sale online at www.InternetTabs.wa.gov OR at your local vehicle licensing office (there is a fee for this option). A person who files a vehicle report of sale without the knowledge of the transferee is guilty of fraudulent filing and may be punished under state law 9.45 RCW. O5(06 The Department of Licensing has a policy o1 providing equal access to its services. If you need special accommodation.please call(360)902-3600 or TTY(360)664-8885.. .C------111) am ,y .� �, L --Lt-----1-:-.1-,A:',------"_____— -,r-,�- 4- , :�� L ,• ' ,n �� — jr".;. 1 r Wt dfNtr r., q c , t , i +Cr . ', .574 L�+tp '/ T / y pI 0' Y i '').1°':' ti roti Q 'VY, ,?0,';, .i Y 'x',.h I+Yf piii., if I, r s t �A)s,�11,.':�r I Cw.:v".:2>::... ya,.,,tl S dH., f .0v r. STATE OF WASHINGTON ? VEHICLE CERTIFICATE OF OWNERSHIP(TITLE) CERTIFICATE NUMBER :4 ;":. ti* -; 0731010207 tt;, LICENSE VEHICLE IDENTIFICATION SERIES }• �} NUMBER NUMBER(VIN) YEAR MAKE MODEL STYLE BODY 3C" &182016 113760 1994 MODUL 28140 -' FLEET EQUIP FUEL �` (s '0. ODOMETER NUMBER NUMBER TYPE :t1\ s a DATE ISSUED MILES ODOMETER STATUS c 11/06/2007 0000000 UNPOWERED � .:- EXEMPT GROSS PRIOR TITLE - PRIOR TITLE 1,, C` USE SCALE STATE NUMBER iz- ,_J CLASS WEIGHT WEIGHT VEHICLE COLOR 0024312503 _ „. MOB 00000 000000 GRY WA 0.'•-•i: sr, "E' COMMENTS -;a� I , :;;,..E,,... 35670-1993 , +r i BRANDS ;" ,a ti S c eft=i 47 '- __ -- 1•.1 s`i't '-k:,-. r;•` SALE PRICE $DATE OF SALE — rA LEGAL OWNER:When lien is satisfied, release interest by signing below and Transmit this document to County Auditor or a Agent with proper fee. Failure to properly release artd t ansmit the document within 10 days after lien is satisfied may result I n monetary penalty to the debtor, pursuant to RCW 46.12.170.TRANSFEREE/BUYER MUST APPLY FOR TRANSFER OF OWNERSHIP WITHIN 15 DAYS FROM DATE OF DELIVERY TO AVOID PENALTY. ,�. REGISTERED OWNER ' , 7 EGAL OWNERw r' - HARROLD,BARBARA JEAN SAME AS LEGAL OWNER ?• IE x2 s- 8162 SW LOOP DR yarn r:'4_, PORT ORCHARD WA 98367-9221 ta 3 c Ej I SIGNATURE OF LEGAL OWNER HEREBY DATE SIGNATURE OF REGISTERED OWNER DALE " RELEASES ALL INTEREST IN VEHICLE AS HEREBY RELEASES ALL INTEREST IN €°= q DESCRIBED ABOVE VEHICLE DESCRIBED ABOVE SIGNATURE OF LEGAL OWNER HEREBY DATE SIGNATURE OF REGISTERED OWNER DATE RELEASES ALL INTEREST IN VEHICLE AS HEREBY RELEASES ALL INTEREST IN I DESCRIBED ABOVE VEHICLE DESCRIBED ABOVE ( a. 0017131 01 AV '''' t Jrt.- /HOW PERSONSTHATTHE RECORDS OP THE DEPARTMENT OF LICENSING 0017131 01 AV 3 i' S SHOW NAMED HEREON AS REGISTERED OWNERS AND RECTOR DEPARTMEN70P LICENSING .., LEGAL OWNERS OF 1 HE VEHICLE DESCRIREO. _..____....___ i j oe/Ny,to.the Best of my knowledge,that the ODOMETER RFAOlNG es shown below:(CHECK ONE) s 4 1 t'' 1. is the ACTUAL MILEAGE of the vehicle L,.IF ce � �� ( TENTHS t 02 is In EXCESS OF ITS MECHANICAL LIMITS -sit�' Jl r Iy LLLJJJ3- is NOT THE ACTUAL MILEAGE Y ODOMETER READING an miles) I Date of Transfer 1 1 t0 p II TRANSFEREE/BUYER:sinless lice sed� eab�r�must transfer Mk vtithin t 5 da a of sale. i F W 0 • I/we warrant this Tale andce that the vlilT desrn'W herefn�s been cold to the following: z�,,_ t— `FEREE ISIGNATURE OF TRANSFEROR/SELLER .r 1)1 . 2� 4SIGNATURE OF TRANSFEREE/BUYER I Gf �. I. _ _.. _ ,��,, 13,1' — — -- -- NAME OF TRANSFEROR I SELLER i`�5, QO �/LgplppRINTFQNAMEOFTRANSFEREE/BUYER HdCtQP$d7F� ) A '?'L:t ADDRESS OF TRANSFEREE!BUYER — T�— -`ADDRESS OF TRANSFEROR/SELLER O partmed of Cevenue c 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. 57353RW 0 Check box if partial sale of property If multiple owners, list percentage of ownership next to name I. Name Barbara J. Harrold, a married woman as herName Justin Rankin,an unmarried individual and separate estate Chasina McGee, an unmarried individual Cd 0 Mailing Address 8162 SW Loop Dr 41 Mailing Address PO Box 329 Lu z City/State/Zip Port Orchard,WA 98367 City/State/Zip Port Hadlock, WA 98339 0 Phone No. (including area code) (360)895-8647 t7 Phone No.(including area code) (360)385-3312 3. 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 Justin Rankin 001 343 026 0 192,857.00 Mailing Address PO Box 329 ❑ City/State/Zip Port Hadlock, WA 98339 0 Phone No.(including area code) (360)385-3312 0 0 Street address of property: 981 & 983 Four Corners Rd,Port Townsend,WA 98368 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 5. Select Land Use Code(s): 11 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)? 0 El tT• YES NO Is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption: RCW? ❑ 10 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? ID ® Reason for exemption If any answers are yes,complete as instructed below. Type of Document Statutory Warranty Deed (i)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S): To continue the current designation as forest land or Date of Document August 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 $ 200,000.00 If the land no longer qualifies or you do not wish to continue the designation *personal Property(deduct) $ or classification, 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 $ 200,000.00 Excise Tax: State $ 2,560.00 This land ❑ does 0 does not qualify for continuance Local $ 1,000.00 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 3,560.00 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 $ 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 $ (3) OWNER(S)SIGNATURE Total Due $ 3,565.00 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 FOR GOING IS TRU AND CORRECT Signature of `, A . Signature of Grantor or Grantor's Agent rL� Grantee or Grantee's Agent Name(print) Barbara J.Harrold Name(print) Justin Ran nn Date&city of signing:�-'3 j- j ,�y f (r7�.✓y�L-L Date&city of signing g/ ( � oi(r• To: • yngt 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 1238E7 ::9., 1 5, EXHIBIT A Parcel 6, as depicted on Survey map being a portion of the Northwest 'V4 of the Southwest Y4, Section 34, Township 30 North, Range 1 West, W.M., recorded on July 11, 1989, under Auditor's File No. 322962, in Volume 10 of Surveys, page 112, records of Jefferson County, Washington. Situate in the County of Jefferson, State of Washington. Together with a 1987 AMEST 48 / 28 Mobile Home VIN # 01910561 WAB &15230 & a 1994 MODUL 28/40 Vin # 113760 &182016