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HomeMy WebLinkAbout125231 �' ` � .117 iJLd C r7 . Depadmentof C Revenue Wa;shirrgton State REAL ESTATE EXCISE TAX AFFIDAVIT TPLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC whenhform is stampedouy cashier THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED by cashier (See back of last page for instructions) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. Martha Wyatt and Stephen Beaulieu as Co-Personal Representatives of the Estate of Albert L.Boucher, Name deceased Name Nancy C.Eifert and Larry N.Eifert, x wife and husband w F Mailing Address P.O.Box 1342 a! uw d z ,�� Mailing Address 115 Hilton Avenue c4<City/State/Zip Plaistow,NH 03865 — a City/State/Zip Port Townsend,WA 98368 L Phone No.(including area code) (603)560-4429 Phone No.(including area code) (360)379-0703 II Send all property tax correspondence to:❑Same as Buyer/Grantee List a real and personal property tax parcel account numbers–check box if personal property List assessed value(s) Name Nancy C.Eifert&Larry N.Eifert 962110707 0 $16,000.00 Mailing Address 115 Hilton Avenue 962110708 0 $10,000.00 City/State/Zip Port Townsend,WA 98368 0 Phone No.(including area code) (360)379-0703 0 ®Street address of property: 0 Hilton&9th,Port Townsend,WA 98368 This property is located in 0 unincorporated Jefferson County OR within 0 city of Port Townsend 0 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) Lots 24 through 31 inclusive,Block 107,Irondale Division No.4,as per Plat recorded in Volume 2 of Plats on page 141,records of Jefferson County; Situate in the County of Jefferson,State of Washington. ® Select Land Use Code(s): © List all personal property(tangible and intangible)included in selling 91 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)? IIIYES NO If claiming an exemption,list WAC number and reason for exemption: Is this property designated as forest land per chapter 84.33 RCW? 0 WAC No.(Section/Subsection) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® Reason for exemption Is this property receiving special valuation as historical 0 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 Special Warranty Deed NEW OWNER(S): To continue the current designation as forest land or classification as current use(open space, faun and agriculture,or timber) Date of Document April 13,2016 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 $ 32,500.00 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 $ 32,500.00 to signing(3)below,you may contact your local county assessor for more information. Excise Tax: State $ 416.00 This land ❑does 0 does not qualify for continuance. Local $ 162.50 *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, Subtotal $ 578.50 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) OWNERS)SIGNATURE Total Due $ 583.50 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 FOREGOING IS TRUE AND CORRECT. Signature of Signature of �/ Grantor or Grantor's Agent Q LO Q..17J, Grantee or Grantee's Agent (�� , �Y� Name(print) Martha Wya ,Co-Personal Representative Name(print) Nancy C.Eife(t // -�" Date&city of signing: 0 Lil1(ol!co c- �2( u t AIH Date&city of signing: -(/,-„„7/-/(e p,j�'V��t[�,A 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)). .8 THIS SPACE–TREASURER'S USE ONLY COUNTY TREASURER i FaG i t.-.., .. x t 25VO I