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HomeMy WebLinkAbout125242 k kLi �' Department of S L 1 euenue REAL ESTATE EXCISE TAX AFFIDAVIT washrn�;con StateThis form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-6IA 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. ISName Daryl P.Finley 1111 Name Mary L.Finley,a married woman,but as to her sole and O separate estate a Mailing Address 1430 West Casino Road#314 c4Z Mailing Address 1430 West Casino Road#314 C4 tt City/State/Zip Everett,WA 98204 a City/State/Zip Everett,WA 98204 Phone No.(including area code) (425)347-0450 Phone No.(including area code) (425)347-0405 List all real and personal property tax parcel account ® Send all property tax correspondence to:❑✓ Same as Buyer/Grantee numbers-ch/eck box if personal property List assessed value(s) Name 979500101 ?»atl5 0 $600 Mailing Address n City/State/Zip Phone No.(including area code) n © Street address of property: This property is located in Jefferson County ❑Check box if any of the listed parcels are being segregated from a larger parcel. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) Lot 1 of Block 1,First Addition to the Townsite of Oil City as per map recorded in Volume 3 of Plats,Page 15 thereof,Records of said County. Situate in the County of Jefferson,State of Washington. Subject to covenants,conditions,easements,restrictions,reservations,a record,if any. ®Select Land Use Code(s): 0 List all personal property(tangible and intangible)included in selling 191-Undeveloped land(land only) I price. enter any additional codes: NnnP (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter 0 0 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? 0 El Is this property classified as current use(open space,farm and 0 0 WAC No.(Section/Subsection) 458-61A-203(1) agricultural,ortimber)land per chapter 84.34? Reason for exemption Is this property receiving special valuation as historical property 0 0 To convert from community property to separate property per chapter 8426 RCW? If any answers are yes,complete as instructed below. (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Quit Claim Deed NEW OWNER(S):To continue the current designation as forest land or _ q60 classification as current use(open space,faun and agriculture,or timber) Date of Document r�5 land,you must sign on(3)below.The county assessor must then determine Gross Selling Price $0.00 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 *Personal Property(deduct) $0.00 or classification,it will be removed and the compensating or additional taxes Exemption Claimed(deduct) $0.00 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. Excise Tax:State $ 0.00 This land 0 does 0 does not qualify for continuance. 0.0050 Local $ 0.00 *Delinquent Interest: State $0.00 DEPUTY ASSESSOR DATE Local $ 0.00 (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $0.00 NEW OWNER(S):To continue special valuation as historic property, sign(3)below.If the new owners)does not wish to continue,all Subtotal $ 0.00 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. (3) OWNERS)SIGNATURE *Affidavit Processing Fee $0.00 Total Due $10.00 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 FOREGOING IS TRUE AND CORRECT. Signature of i)a-rF'n Signature of k . Grantor or Grantor's Agent orm ai�./Qo� Grantee or Grantee's Agent Name(print) Daryl P.Finley� gytre+yn hats .vl Oi'I/IF1 U Name(print) Mary L.Finley Date&city of signing: 1/-0- "w,`Cf S Date&city of signing:in : L 45)(a Ed in0/248 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(1C)). REV 84 0001a(11/19/08) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER t - L 2Zf-I2-