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HomeMy WebLinkAbout125241 of fre Revenue � Washington State 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) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. 0 Name William H.Aker and Helen J.Aker.\Trustees of t e © NameWilliam H.Aker and Helen J.Aker, o William and Helen Aker L ivinS7 Trust1 ata \I\as' aoQO w husband and wife ti F Mailing Address 303 N Webster Lane c44.1 z Mailing Address 303 N Webster Lane in 0 City/State/ZipLilliwauD.WA 98555 m x city/state/zipLilliwaup,WA 98555 Phone No.(including area code)(360)877-5563 Phone No.(including area code)(360)877-5563 ® Send all property tax correspondence to:0 Same as Buyer/GranteeList all real and personal property tax parcel account List assessed value(s) numbers—check box if personal property Name 502 313 045 n 34,960 Mailing Address n City/State/Zip n Phone No.(including area code) n 0 Street address of property:Maple Avenue,Brinnon,Washington This property is located in Jefferson County 3 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) Lot 4,Aker Short Plat Recorded November 21,1998,Volume 2 of Plats,Pge 122,Records of Jefferson County. Subject to protective covenants of Triton Cove Estates,Marshall Addition,Recorded November 6,1967,Volume 176 of Deeds,Pages 125 through 131,File Numer 194129 Select Land Use Code(s): ®List all personal property(tangible and intangible)included in selling 1-Undeveloped land(land only) ® price. enter any additional codes: N/A (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under 0 9 chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 111 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? 0 9 WAC No.(Section/Subsection) WAC 458-61a-211 Is this property classified as current use(open space,farm and 0 agricultural,or timber)land per chapter 84.34 RCW? Reason for exemption Is this property receiving special valuation as historical property 0 0 Mere change in identity or form;family corporations and partnerships. per chapter 8426 RCW? If any answers are yes,complete as instructed below. Type of Document Quit Claim Deed q (1)NOTICE OF CONTINUANCE(FOREST LAND ORCURRENT USE) Date of Document I�1� a.� NEW OWNER(S):To continue the current designation as forest land or i classification as current use(open space,farm and agriculture,or timber)land, Gross Selli g Price $ 0.00 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.If the *Personal Property(deduct) $ 0.00 land no longer qualifies or you do not wish to continue the designation or Exemption Claimed(deduct) $ 0.00 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 Taxable Selling Price $ 0.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax:State $ 0.00 your local county assessor for more information. 0.0050 Local $ 0.00 This land 0 does 0 does not qualify for continuance. *Delinquent Interest:State $ 0.00 Local $ 0.00 DEPUTY ASSESSOR DATE *Delinquent Penalty $ 0.00 (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) NEW OWNER(S):To continue special valuation as historic property, Subtotal $ 0.00 sign(3)below.If the new owner(s)does 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 $ 5.00 (3) OWNER(S)SIGNATURE Total Due $ 10.00 • PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® I CERTI UNDER PENALTY OF P RJURY THAT THE FOREGOING IS TRUE CORRECT. Signature of rtere of i -- .97 104/17 Grantor or Grantor's Agent C . / I[_ Grantee or Grantee's Agen d Name(print) William H.Aker n�-" Name(print) William H.Aker Date&city of signing: LI Li--(4 S'^l- '1 Date&city of signing: 1-4--LI'1U , ine n 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)). 74.1)a.?-< 125241 .x.ct/2'5/2016 10.00* THIS SPACE-TREASURER'S USE ONLYe�r•-• pc'OT