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Home My WebLink About125249 Der' enl.of V ( q�V Pe " venue q WrnhoRron Stein, REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRiNT when stamped by cashier. CHAPTER 82.45 RCW—CHAPTER 458-61A WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED (See back of last page for instructions) File No.57946RW ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name 1. Name Jaromir Belie and Lanie Belic,husband and wife Name Susan Ehrlich and Michele A.Rabey,a married couple ce O Mailing Address_ 2023 E Sims Way #316 cG w Mailing Address 360 Cleveland St H z d•'S City/State/Zip Port Townsend,WA 98368 City/State/Zip Port Hadlock,WA 98339 Phone No.(including area code) (360)379-9770 Phone No.(including area code) (252)717-1539 3. Send all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s) numbers-check box if personal property Name Susan Ehrlich 962 700 085/32099 ❑ 323,481 Mailing Address 360 Cleveland St 962 700 088/32100 ❑ 40,000 City/State/Zip Port Hadlock,WA 98339 trona(a (-e A C -frca.G--.� ❑ Phone No.(including area code) (252)717-1539 (L-{ g I (leo,z 9) 17'04 ai'JD map 0 Street address of property: 360 Cleveland St,Port Hadlock,WA 98339 This Property is located in El unincorporated Jefferson County OR within❑city of Port Hadlock ❑Check box if any of the listed parcels are being segregated from a larger parcel,are part of 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) SEE EXHIBIT"A" ATTACHED HERETO AND MADE A PART HEREOF FOR COMPLETE LEGAL DESCRIPTION ® Select Land Use Code(s): 0 List all personal property(tangible and intangible)included in selling 11,9] price. Enter any additional codes: (See back of last page for instructions) Was the seller receiving a property tax exemption or YES NO Deferral under chapters 84.36,84.37 or 84.38 RCW (nonprofit organization,senior citizen,or disabled person, ❑ homeowner with limited income)? 6. YES NO is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption: RCW? ❑ Ei Is this property classified as current use(open space,farm and ❑ agricultural,or timber)land per chapter 84.34? WAC No.(Section/Subsection) Is this property receiving special valuation as historical property per chapter 84.26 RCW? ❑ Reason for exemption If any answers are yes,complete as instructed below. Type of Document Statutory Warranty Deed (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S): To continue the current designation as forest land or Date of Document April 19,2016 classification as current use (open space, farm and agriculture, or timber) land,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. Gross Selling Price $ 396,000.00 if the land no longer qualifies or you do not wish to continue the designation *Personal Property(deduct) $ or 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 Exemption Claimed(deduct) $ No 84.33.140 or RCW 84.34.108). Prior to signing(3) below, you may contact your local county assessor for more information. Taxable Selling Price $ 396,000.00 This land 1=1does Eldoes not qualify for continuance Excise Tax: State $ 5,068.80 Local $ 1,980.00 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 7,048.80 sign(3)below. if the new owner(s)do 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 $ (3) OWNER(S)SIGNATURE Total Due $ 7,053.80 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS 111111-- I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Signature of - .� Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) Jaromir Belie Name(print) Susan Ehrlich Date&city of signing:„( Z t f4 pUl nU/y` �- Date&cityof signing �' �- � � � Ate:.Z - (�+ 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(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER 74:T. .e 125249 .. -;s EXHIBIT A Parcel A: The South 100 feet of Tract 81; also the North 10 feet of Tract 82, except the West 300 feet thereof, all in Irondale Acre Tracts, as recorded in Volume 2 of plats, page 145, records of Jefferson County Washington, and including, that portion of Tract 82 of Irondale Acre Tracts, as recorded in Volume 2 of plats, page 145, records of Jefferson County, Washington, lying Northerly of the following described line: Commencing as the Northwest corner of said Tract 82; thence South 1°26'45" West along the West line of said Tract 82 a distance of 10.00 feet; thence South 88°10'00"East parallel with the North line of said Tract 82 a distance of 614.14 feet to the true point of beginning; thence South 24°31'15"East 22.32 feet;thence South 88°10'60" East 100.66 feet; thence North 46°50'00"East 28.28 feet to the South line of the North 10.00 feet to said Tract 82; thence South 88°10'00"East along said South line a distance of 233.89 feet more or less to a point of intersection with the balanced government meander line and terminus of said line. Parcel B: The West 300 feet of the following described property: The South 100 feet of Tract 81; also the North 10 feet of Tract 82, all the lrondale Acre Tracts, as recorded in volume 2 of plats, page 145, records of Jefferson County, Washington. All situate in the County of Jefferson, State of Washington.