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HomeMy WebLinkAbout125251 Department ofre, 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 MICHAEI DUANF WEI LS ■ Name_WELLS FAMILY TRUST Ix ESTER WELLS I C1L/ baepu iI'113 f' rcie 1'1764GS --ca z Mailing Address P.O.Box 3141 tO z Mailing Address P.O.Box 3141 % Te C City/State/Zip Shell Beach.CA 93448 t City/State/Zip Shell Beach,CA 93448 Phone No.(including area code)(805)773-4243 Phone No.(including area code)(805)773-4243 ® Send all roe tax correspondence to: List all real and personal property tax parcel account property rtY Po Same as Buyer/Grantee numbers-check box if personal properly List assessed value(s) Name 966100004 ri $152.800 Mailing Address n City/State/Zip n Phone No.(including area code) n © Street address of property:4 Kala I aaoon Court Port Townsend WA 98368 This property is located in Jefferson County El 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) C9,0y 2)-ee--4/ ®Select Land Use Code(s): 1111 List all personal property(tangible and intangible)included in selling 151-Undeveloped land(land only) U price. enter any additional codes: (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under 0 ❑r chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? YES NO If claiming an exemption,list WAC number and reason for exemption: /�� Is this property design[edas forest land per chapter 84.33RCW? 0 ❑ WAC No.(Section/Subsection) `5Jp - '1,4 -49/1 (09J Is this property classified as current use(open space,farm and 0 Q Reason for exemption !!T1�/7 S go ie agricultural,or thnber)land per chapter 84.34? Is this property receiving special valuation as historical ptupc,ty 0 ❑ T/Gl:l1 f per chapter 84.26 RCW? If any answers are yes,complete as iushucted below. Type of Document Gran-e- I)/ed (1)NOTICE OF CONTINUANCE ORESTLAND OR CURRENT USE) /a 1 NEW OWNER(S):To continue the current designation as forest land or Date of Document f! i/ 3, e Q 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 Gross Selling Price $ land transferred continues to qualify and will indicate by signing below.If the *Personal Property(deduct) $ land no longer qualifies or you do not wish to continue the designation or classification,it will be removed and the compensating or additional taxes will Exemption Claimed(deduct) $ 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 Odoes 0 does not qualify for continuance. *Delinquent Interest:State S Local $ DEPUTY ASSESSOR DATE (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ 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 $ (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 „�7 2 - ICE 'fIFY-4 PENAL.001Y 0PERJURY' THAT ORE G ISCORRECT.`)j� Signature ofz / _ lj!`i fJ �/�C//Gc•8trG Grantor or Gra tor's Agent Grantee or Grantee's Agent Name(print) MICHAEL DUANE WELLS Name(print) ESTER WELLS Date&city of signing: 04/20/2016 Shell Beach,CA 93448 Date&city of signing:04/20/2016 Shell Beach,CA 93448 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)). pi() REV 84 0001a(_0004/16), . , _ THIS SPACE-TREASURER'S USE ONLY 747,155`_ t: 5 125251 , ,/;.'o.,'LEIl i'.!_ii_!:#: COUNTY ASSESSOR } y RECORDING REQUESTED BY AND WHEN RECORDED MAIL DOCUMENT AND TAX STATEMENT TO: Michael&Ester Wells,Ttees 1602 Costa Del Eol P O. 60x 3 i A( Shell Beach,California 9-3449.93tfr SPACE ABOVE THIS LINE FOR RECORDER'S USE Tax Account Number: 966100004 GRANT DEED THIS CONVEYANCE TRANSFERS THE GRANTORS' INTEREST INTO HIS/HER/THEIR REVOCABLE LIVING TRUST. THE UNDERSIGNED GRANTOR(s) DECLARES DOCUMENTARY TAX is $0, and FOR NO VALUABLE CONSIDERATION. MICHAEL DUANE WELLS and ESTER WELLS, hereby remises, releases and forever grant their share of the described real property to MICHAEL DUANE WELLS and ESTER WELLS, Trustees of the WELLS FAMILY TRUST, dated May 3, 2006, for the benefit of MICHAEL DUANE WELLS and ESTER WELLS, the following described real property in the County of Jefferson, State of Washington: [ ] See Attachment for Legal Description OR Lots 4 and 5,except the west 30.40 feet of said Lot 5,plat of the lagoon at Kala Point as per plat recorded in Volume 6 of Plats,Pages 181 through 185 records of Jefferson County, Washington. Commonly known as: 5 Kala Lagoon,Port Townsend situated in the County of Jefferson, State of Washington Dated: May 3,2006 AK:Z.!`.! #IP / L _ , Mi• ael Duane Wells,Grantor Dated: May 3,2006 1 / Ester Wells, Grantor STATE OF CALIFORNIA COUNTY OF SAN LUIS OBISPO On May 3, 2006 before me, Dennis James Balsamo, a Notary Public, personally appeared MICHAEL DUANE WELLS and ESTER WELLS . . • . - • : proved to me on the basis of satisfactory evidence to be the persons whose names are subscribed to the within instrument and acknowledge to me that they executed the same in their authorized capacity, and that by their signatures on the instrument the persons,or the entity upon behalf of which the persons acted,executed the .:061101:,vs Comrnlssbli # 1538637 instrument. ,� ;;' Notary PMC California V.1,44) Son t�Obispo County kV Comm Expires Dec 25.201 r,. WITNESS my hand and official seal. \ Signature11140.4! Denni�,.mes Balsamo (This area for official notorial seal) Notary Pu,lie MAIL TAX STATEMENTS AS DIRECTED ABOVE 431557 125251 :.i:4/26,12016 10,00T