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Home My WebLink About125254 Department of rat. n , r Reuenue 111) A i -- • Washington State 9.S Q- c� i REAL ESTATE EXCISE TAX AFFIDAVIT l PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC This form is your receipt THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED ped by cashier. (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. Marjorie Jane Pearson-Olason,as her separate estate, Peter Douglas Pearson,as his separate estate,John Alfred Pearson,as his separate estate,and Mark Herman Pearson,as his separate estate as tenants in common,being the sole heirs of Marjorie J.Pearson, Elizabeth Rose Richter and Neal John Richter,wife and 1 Name deceased. husband Mailing Address 8709 137 St NW !Mailing Address 1010 Fairmount Rd City/State/Zip Gig Harbor,WA 98329 City/State/Zip Port Townsend,WA 98368 Phone No.(including area code) (253)225-5700 Phone No.(including area code) , 31,Q O L27 S3t l 3 Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal property tax parcel account numbers—check box if personal property List assessed value(s) Name Elizabeth Rose Richter&Neal John Richter 902241015 0 $151,702.00 Mailing Address 1010 Fairmount Rd T-,x 17 ❑ City/State/Zip Port Townsend,WA 98368 �` 0 Phone No.(including area code) ❑ m �, En Street address of property: 1010 Fairmount Rd,Port Townsend,WA 98368 !��J This property is located in®unincorporated Jefferson County OR within 0 city of Port Townsend 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 atach a separate sheet to each page of the affidavit) FULLY DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. ® Select Land Use Code(s): Q List all personal property(tangible and intangible)included in selling II price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter 0 El 84.36 RCW(nonprofit organization)? 0 YES NO If claiming an exemption,list WAC number and reason for exemption: Is this property designated as forest land per chapter 8433 RCW? 0 WAC No.(Section/Subsection) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® Reason for exemption Is this property receiving special valuation as historical 0 property per chapter 84.26 RCW? If any answers are yes,complete as instructed below. (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Statutory Warranty Deed NEW OWNER(S): To continue the current designation as forest land or classification as current use(open space,farm and agriculture,or timber) Date of Document April 6,2016 land, you must sign on (3) below. The county assessor must then determine if the land transferred continues to qualify and will indicate by Gross Selling Price $ 205 000.00 signing below. If the land no longer qualifies or you do not wish to *Personal Property(deduct) $ continue the designation or classification, it will be removed and the compensating or additional taxes will be due and payable by the seller or Exemption Claimed(deduct) $ No transferor at the time of sale. (RCW 84.33.140 or RCW-84.34.108).Prior Taxable Selling Price $ 205 000.00 to signing(3)below,you may contact your local county assessor for more information. Excise Tax: State $ 2,624.00 This land 0 does 0 does not qualify for continuance. Local $ 1,025.00 *Delinquent Interest: State $ DEPUTY ASSESSOR 'DATE Local $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 3,649.00 sign (3) below. If the new owner(s) does not wish to continue, all 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. *Affidavit Processing Fee $ (3) OWNER(S)SIGNATURE Total Due $ 3,654.00 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 `` . / Signature of Grantor or Grantor's Agent 4t.L ��l Grantee or Grantee's AgentUilikb " Name(print) Marj ie Ja Pearson-Olason Name(print)(p ) Elizabeth Rose Richter Date&city of signing: ct ft/icf '7' � S,(,�Ci Date&city of signing: Perjury: Perjury is a class C felony which is punishable by imprisonmert 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)). 7.4367.7' 175'254 *4/26/2016 r 4, * ASURER'S USE ONLY COUNTY TREASURER ON. . 1Ztii EXHIBIT"A" LEGAL DESCRIPTION That portion of John F.Tukey Donation Claim No.39 in Section 24,Township 29 North,Range 2 West,W.M.,described as follows: Commencing at stake at the intersection of the South line of the county road,with the East line of Charles Lambert's land described in deed recorded in Volume 11 of Deeds,page 322,(Tax No.5); thence Southeast along Lambert's line 220 feet;thence East Northeast 141.5 feet;thence North Northwest,220 feet,to the Southerly side of the county road;thence along the Southerly side of the county road to the Place of Beginning;said tract being designated on the County Assessor's Plat and Description Book as Tax No. 17 in said Section 24. Situate in the County of Jefferson, State of Washington.