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Home My WebLink About125257 1Peneverieunte Li)( 1 K 3 475- _ t- Washirron State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt c` , PLEASE TYPE OR PRINT when stamped by cashier. CHAPTER 82.45 RCW—CHAPTER 458-61 WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS 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 1. Name Aaron Williamson and Christina Williamson, Name Jamie Walker and Mary Childs,Husband and Wife husband and wife w O Mailing Address 3 I ISO l_O._4'jt'I l to r� Do j ,4v.. NE. L8 Mailing Address 3616 Densmore Ave N Z J L14 City/State/Zip Paw)sbo 1 W/ 9 8370 City/State/Zip Seattle,WA 98103 co Phone No.(including area code) (360)821-1968 c7 Phone No.(including area code) (206)605-2451 3. Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s) numbers—check box if personal property Name Jamie Walker 801-035-006 PIM-194-334, ❑ $353,466.00 Mailing Address 3616 Densmore Ave N \°l 33( 0 City/State/Zip Seattle,WA 98103 0 Phone No.(with area code) (206)605-2451 Levy Code- 0 ® Street address of property: 251 Center Cemetery Rd,Chimacum,WA 98325 This Property is located in El unincorporated Jefferson County OR within 0 city of Chimacum 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) SEE ATTACHED EXHIBIT"A" ® Enter Abstract Use Categories 11 ® List all personal property(tangible and intangible)included in selling (See back of last page for instructions) price. NONE Seller's Exempt Reg.No.: Is this property exempt from property tax per YES NO chapter 84.36 RCW(nonprofit organization)? 0 El YES NO Is this property designated as forest land chapter 84.33 RCW? 0 ® If claiming an exemption,list WAC number reason for exemption: Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ z 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 21,2016 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 $ 280,000.00 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 $ 280,000.00 This land 0 does 0 does not qualify for continuance Excise Tax: State $ 3,584.00 Local $ 1,400.00 *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 $ 4,984.00 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 $ 4,989.00 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 Grantori naafi re If t rantee or Grantor's Agent: " "� or Granter' :gent: Name(print) Aaron Williamson Name(print) � Jr Date&city of signing: t4.4 Date&city of signing Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum to m 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(IC). REV 84 0001a(09/01/06) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER 747453 125'257 ./ -- _I1^ 4 9:739 00 /�/�2 Exhibit "A" THE LAND REFERRED TO HEREIN IS DESCRIBED AS FOLLOWS: Parcel 14 of Mt. Townsend Vista,a Survey recorded June 2, 1989,in Volume 10 of Surveys,page 91,under Auditor's File No. 322120,records of Jefferson County,Washington,being a portion of the following described property: The Southwest quarter of the Southeast quarter in Section 3,Township 28 North,Range 1 West, W.M.; EXCEPT right of way for county road as conveyed to Jefferson County by instrument recorded in Volume 1 of Road Waivers,page 239,records of Jefferson County,Washington; ALSO EXCEPT that portion lying Easterly and Northerly of said county road right of way; ALSO EXCEPT right of way of Center Cemetery Road; and the Southwest quarter of the Northeast quarter, lying West of Larson Lake Road,as conveyed to Jefferson County in Deed recorded September 7, 1927,Volume 94 of Deeds,page 517,records of Jefferson County,Washington; and the West half of the Northeast quarter of the Northeast quarter; and the Northwest quarter of the Northeast quarter; EXCEPT right of way of Larson Lake Road,as conveyed to Jefferson County in Deed recorded September 7, 1927, in Volume 94 of Deeds,page 517,records of Jefferson County, Washington,all in Section 10,Township 28 North,Range 1 West,W.M., in Jefferson County, Washington. Situate in the County of Jefferson, State of Washington.