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Home My WebLink About125264 \ . 'l \...... ..A C.Department of C Ck\.h./ evenue N hingm.Stare 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.580791.5 ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name 1. Name Rvfield Properties Inc.,a Washington Corporation Name .Jefferson Land Trust,a Washington non profit corporation w O Mailing Address_ 1154 Monroe Rd w Mailing Address 1033 Lawrence Street a >. z ril g City/State/Zip Port Angeles,WA 98362 R g City/State/Zip Port Townsend,WA 98368 c7 Phone No.(including area code) C., Phone No.(including area code) 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 Jefferson Land Trust 902 362 005/22927 ❑ 40,075 Mailing Address 1033 Lawrence Street T ❑ City/State/Zip Port Townsend,WA 98368 ❑ Phone No.(including area code) ❑ tY1410 Street address of property: XX West Uncas Rd,Port Townsend,WA 98363-8000 This Property is located in®unincorporated .Jefferson County OR within E city of Port Townsend ❑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): Ilin List all personal property(tangible and intangible)included in selling 91 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)? YES NO Is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption: RCW? ❑ 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 12,2016 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 $ 65,000.00 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 $ 65,000.00 This land ❑does ❑does not qualify for continuance Excise Tax: State $ 832.00 Local $ 325.00 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 1,1.57.00 NEW OWNER(S): To continue special valuation as historic property, 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 $ 1,162.00 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 d -V" Signature of Grantor or G antor's Agent Grantee or Grantee's Agent Name(print) Rvfield Properties Inc. // Name(print) Jefferson Land Trust Date&city of signing:. 44/4/-/i, Pty-r- '7 /p C Date&city of signing 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(IC). REV 84 0001a(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER 748'7'49 125364 *4/27/2016 00* ttgC.v 12C7.Z(e(4 • Vb&74:h7Ci6 PLEASE TYPE OR PRINT REAL ESTATE EXCISE TAX AFFIDAVIT This tbrm is your receipt when stamped by cashier. CHAPTER 82.45 RCW—CHAPTER 458-6IA WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED (See back of last page for instructions) File No,58079LS 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name 1. Name Ryfield Properties Inc.,a Washington Corporation 2. Name ,jefferson Land Trust,a Washington non profit corporation • Mailing Address 1154 Monroe Rd w. Mailing Address 1033 Lawrence Street z z. u.J < City/State/Zip Port Angeles,WA 98362cg Ity/State/Zip Port Townsend,WA 98368 tt:1:4 Q Phone No.(including area code) L7 Phone No.(including area code) 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 Jefferson Land Trust 902 362 005/22927 0 40,075 Mailing Address 1033 Lawrence Street 0 City/State/Zip Port Townsend,WA 98368 0 Phone No.(including area code) 0 12Utreet address of property: XX West Uncas Rd,Port Townsend,WA 98363-8000 This Property is located in EI unincorporated Jefferson County OR within 0 city of Port Townsend 0 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): LE List all personal property(tangible and intangible)included in selling 91 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. El homeowner with limited income)? A 6. YES NO Is this property designated as forest land per chapter 84.33 If claiming an exemption,list\VAC number reason for exemption: RCW? a Is this property classified as current use(open space,farm and Z agricultural,or timber)land per chapter 84.34? WAC No.(Section/Subsection) Is this property receiving special valuation as historical EJ C property per chapter 84.26 RCW? Reason for exemption If any answers are yes,complete as instructed below. Type of Document Statutory Warranty Deed (I)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S): To continue the current designation as forest land or Date of Document April 12,2016 classification as current use (open space, lam) 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 S 65,000.00 If the land no longer qualifies or you do not wish to continue the designation *Personal Property(deduct) S 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) S 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 S 65,000.00 Excise Tax: State S 832.00 This land 0 does does not qualify for continuance Local S 325.00 *Delinquent Interest: State S Local S DEPUTY ASSESSOR DATE *Delinquent Penalty S (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) NEW OWNER(S): Ti)continue special valuation as historic property, Subtotal S 1,157.00 sign(3)below. If the new owner(s)do not wish to continue,all *State Technology Fee S 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 S (3) OWNER(S)SIGNATURE Total Due S 1,162.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS 1111F— 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 Ser_roLLC_Sea-C-EL, Name(print) Ryfield Properties Inc. Name(print) Jefferson Land Trust Date&city of signing: Date&city of signing Lf Lj(2_0(L, VOL,Ar)SAL-4 (p 41- 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 tine(RCW 9A.20.020(IC). REV 84 0001a(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER 4 EXHIBIT A The North 1/2 of the West 1/2 of the Northwest I A of the Northwest '//4 of Section 36, Township 29 North, Range 2 West, W.M.; EXCEPTING THEREFROM that portion lying within county roads known as Wycoff County Road and West Uncas Road; ALSO EXCEPTING THEREFROM the right of way, if any, of the Port Townsend Southern Railroad. All situate in the County of Jefferson, State of Washington.