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HomeMy WebLinkAbout125255 s t re. g*' Department of 6-15Q(71 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) ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name. 1111 Name STFPHFN THOMAS FRFNCH Name DONITA FERN FRENCH xx w z Mailing Address P.O. BOX 248 Z Mailing Address P.O. BOX 305 gCity/State/zip OUILCFNF.WA 98376 m a City/State/Zip 01111 CFNF WA 96376 Phone No.(including area code) (360)301-1609 Phone No.(including area code) (360) 765-3619 © Send all ro ert tax corres ondence to: Same as Bu er/Grantee List all real and personal property tax parcel account p p y p ® y numbers-check box if personal property List assessed value(s) Name 802234006 n $244.614.00 Mailing Address ❑ City/State/Zip n Phone No.(including area code) n Street address of property: 1350 Snnw CrAPk Road 0uilrAne Washington 98376 This property is located in Jefferson County ❑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) THE SOUTHWEST QUARTER OF THE SOUTHEAST QUARTER OF SECTION 23,TOWNSHIP 28 NORTH,RANGE 2 W.W.M., EXCEPT THE WEST 310 FEET THEREOF AND EXCEPT A STRIP OF LAND 50 FEET IN WIDTH CONVEYED TO JEFFERSON COUNTY FOR COUNTY ROAD BY DEED DATED JUNE 10, 1952 AND RECORDED UNDER AUDITOR'S FILE NO. 132532, RECORDS OF JEFFERSON COUNTY. 1 �. ® Select Land Use Code(s): 1111 List all personal property(tangible and intangible)included in selling 11-Household,single family units price. enter any additional codes: All personal property on premises • (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under ❑ ❑✓ 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 designated as forest land per chapter 84.33 RCW? 0 ❑✓ WAC No. (Section/Subsection) 458-61A-203 Is this property classified as current use(open space,farm and 0 ❑✓ Reason for exemption agricultural,or timber)land per chapter 84.34? p Is this property receiving special valuation as historical property ❑ ❑✓ Pursuant to Decree of Dissolution per chapter 84.26 RCW? If any answers are yes,complete as instructed below. Type of Document Quit Claim Deed (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) ,.�// //(P NEW OWNER(S):To continue the current designation as forest land or Date of Document 7 l classification as current use(open space,farm and agriculture,or timber)land, Gross Selling Price $ 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.If the *Personal Property (deduct) $ land no longer qualifies or you do not wish to continue the designation or Exemption Claimed(deduct) $ 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 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 ❑does not qualify for continuance. *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) 0.00 NEW OWNER(S):To continue special valuation as historic property, Subtotal $ 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 OI CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of " Signature of .- Grantor or Grantor's Agent.2 �� Grantee or Grantee's Agent �� Name(print) Stephen Thomas Fren h (p ) Name(print) Donita Fern French Date&city of signing: Y / 1/0 RV# AA5isDate&city of signing: /- /Milt 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(01/04/16) THIS SPACE-TREASURER'S USE ONLY COUNTY ASSES eR ic„,_ 747379 125255 *4/26/2016 10.00* �Z�ZtiS A