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Naelrl u Stofe REAL ESTATE EXCISE TAX AFFIDAVIT This form is your ie pt `.
v Chapter 82.45 RCW-Chapter 458-61A WAC when stamped by cashier
PLL E TYPE OR PRINT
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(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.
11111!
Name Martin J.Farrell f S'IlA3\E x
tha ‘ • (�J,
Name Christine E.Farrell .r
x , S%\t\Q, V)0rntaN\
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IX ril gMailing Address 13681 Newport Avenue Suite 8-142 iu Mailing Address 88 Hunters Rd
0 0 City/State/Zip Tustin,CA 92780 w n City/State/Zip Norwich,CT 06360
Phone No.(including area code) 949-584-0218 Phone No.(including area code) 949-292-0198
®Send all property tax correspondence to: 0 Same as Buyer/Grantee List all real and personal property tax parcel account numbers List Assessed value(s)
-check box if personal property
Name y, 95900023x1113900.00
Mailing Address ql Goo 02-3
❑
City/State/Zip a
Phone No.(including area code) ❑
Street address of property: 101 Highland Green,Unit 4,Port Ludlow,WA 98365
This property is located in Jefferson County Required(For Unicorporated locations please select your 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)
Please see Exhibit A attached hereto
Select Land Use Code(s): •List all personal property(tangible and intangible)included in selling price.
14-Residential condominiums
enter any additional codes:
(See back of last page for instructions)
Was the seller receiving a property tax exemption or deferral under YES NO
chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior ❑ O
citizen,or diabled person,homeowner with limited income)? If claiming an exemption,list WAC number and reason for exemption:
YES NO WAC No.(Section/Subsection) WAC 458-61A-203(2)
Is this property designated as forest land per chapter 84.33 RCW? ❑ O
Reason for Exemption Transferred pursuant to Decree of Dissolution
Is this property classified as current use(open space,farm,and
0 0
agricultural,or timber)land per chapter 84.34? entered on June 30,2015
Is this property receiving special valuation as historical property per ❑ 0
chapter 84.26 RCW?
Type of Document Quit Claim Deed
If any answers are yes,complete as instructed below. ,
Date of Document f i r:- 1 / JO IC.,
(1) NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE)
Gross Selling Price $0.00
NEW OWNERS(S): To continue the current designation as forest land or classification as current use
(open space,farm and agriculture,or timber)land,you must sign on(3)below.The county assessor *Personal Property(deduct) $
must then determine if the land transferred continues to qualify and will indicate by signing below.If
the land no longer qualifies or you do not wish to continue the designation or classification,it will be Exemption Claimed(deduct) $
removed and the compensating or additional taxes will be due and payable 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 Taxable Selling Price $0.00
your local county assessor for more information.
This land 0#does 0 does not qualify for continuance. Excise Tax:State $0.00
0.005 Local $0.00
DEPUTY ASSESSOR DATE *Delinquent Interest $
(2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Local$
NEW OWNER(S): To continue special valuation as historic property,sign(3)below.If the new *Delinquent Penalty $
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 at the time of sale. Subtotal$0.00
*State Technology Fee $5.00
(3)OWNER(S)SIGNATURE
*Affidavit Processing Fee $
Total Due $10.00
PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX
*SEE INSTRUCTIONS
11111- I CERTIFY UNDE PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
Si of Signature of Q �(_�---
Grantor or Grantor's Agent: ✓ • Grantee or rantee's Age. : �i� %� "r _
of mac . Ati-e/rir- OK,
ame(Print): Martin J.Farrell Name(Print): stine E.Farrell
jLZuGitp*, 1./.0-
Date&city of signing: April /61 ,2016,Tustin,California Date&city of signing: April/4-1 ,2016,
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(01/05/16) THIS SPACE-TREASURER'S USE ONLY --G647FH PY JREft--
,0(a)p T. p - :ucr Uts
,2.. _ 12 240 *4/2512016 10.00*
EXHIBIT A
Apartment No. 503, in Building No. 5, a residential apartment in Highland Greens according to
survey and set of plans thereof filed under Auditor's File No. 255300, recorded in Volume 1 of
Condominium Plans at page 60 through 81 inclusive,
TOGHETHER WITH 2.378 percentage of undivided interest in the common and limited
common areas and facilities appurtenant as described in the declaration of condominium under
the horizontal property regimes act of the State of Washington, as recorded on the 18th day of
January, 1979, under Auditor's File No. 255301, at Volume 112 of official records, page 683 to
730, records of Jefferson County, Washington, and as amended under Auditor's File No. 292820,
recorded December 20, 1984; and Auditor's File No. 293442, recorded January 30, 1985.
The description of the land, as provided in R.C.W. 64.32.090, is as follows:
That portion of the Southwest V4 of the Northwest '4 of Section 21, Township 28 North, Range 1
East, W.M., described as follows:
Beginning at the Southeast corner of Lot 15 of South Bay 1, as per plat recorded in Volume 6 of
Plats on page 1 to 3 inclusive, records of Jefferson County;
thence South 45°42' 40" West 232.26 feet;
thence South 48° 59' 20" West 289.55 feet;
thence South 59° 51' 27" West 179.21 feet;
thence South 77° 03' 00" West 94.67 feet;
thence North 84° 26' 20" West 142.90 feet;
thence North 19° 00' 46"East 159.30 feet;
thence North 46° 41' 20" East 280.12 feet;
thence North 46° 46' 41"East 162.96 feet;
thence North 20° 25' 13" East 96.33 feet to the Southwest corner of Lot 16 of said plat;
thence along the Southerly limits of said Lot 16, South 82° 01' 52"East 160.46 feet;
thence North 24° 31' 16"East 86.85 feet;
thence South 56° 28' 05"East 50.63 feet;
thence south 24° 31' 16" West 60.29 feet to the Southwest corner of said Lot 15;
thence along the Southerly limits of said Lot 15, South 65° 51' 09"East 168.76 feet to the True
Point of Beginning.
Situate in the county of Jefferson, State of Washington.