HomeMy WebLinkAbout125243 evenueDepartment of
Wehngo„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)
['Check box if partial sale of property If multiple owners,list percentage of ownership next to name.
aName Daryl P.Finley Name Mary L.Finley,a married woman,but as to her sole and
separate estate
Waa Mailing Address 1430 West Casino Road#314 Mailing Address 1430 West Casino Road#314
frjA City/State/Zip Everett,WA 98204 oa g City/State/Zip Everett,WA 98204
Phone No.(including area code) (425)347-0450 Phone No.(including area code) (425)347-0405
® Send all property tax correspondence to:❑✓ Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s)
numbers—check box if personal property
Name 979505302 /'21(¢te to 5 ❑ $550
Mailing Address f n
City/State/Zip n
Phone No.(including area code) n
Street address of property:
This property is located in Jefferson County
0 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 2 of Block 53,First Addition to the Townsite of Oil City as per map recorded in Volume 3 of Plats,Page 15 thereof,Records of Jeffersor
County,Washington. Subject to covenants,conditions,easements,restrictions,reservations,of record,if any.
IISelect Land Use Code(s): 11 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)?
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? ❑ ❑
Is this property classified as current use(open space,farm and 0 Q WAC No. (Section/Subsection) 458-61A-203(1)
agricultural,or timber)land per chapter 84.34?
Reason for exemption
Is this property receiving special valuation as historical property ❑ 0 To convert from community property to separate property
per chapter 84.26 RCW?
If any answers are yes,complete as instructed below.
(1)NOTICE OFCONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Quit Claim Deed
NEW OWNER(S):To continue the current designation as forest land or f_�r1_l/
classification as current use(open space,farm and agriculture,or timber) Date of Document /1' J S"
land,you must sign on(3)below.The county assessor must then determine 0.00
if the land transferred continues to qualify and will indicate by signing below. Gross Selling Price $
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 owner(s)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) OWNER(S)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 .Da 1 P r n I Signature of / 4
Grantor or Grantor's Agent ;� %` �p / ie.oct Grantee or Grantee's Agent)
Daryl P.Finley _pry
Name(print) ry y wee, I I � „✓1,f��(t19 Name(print) Mary L.Finley
Date&city of signing: '))/L F�,Gt//G,D/Cd / / I
Date&city of signing: `I / f Ed'/yyaDt
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
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