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tfP REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt t(S 7
PLE SE 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.58135LS
❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name
1. Name Alison Kaplan,as her separate estate and Sidney Name Bess A.Jennings and Randall S.Morehouse,
Kaplan,a married man as his separate estate Trustees of the Bess A.Jennings Living Trust,dated
September 16,2010 and Randall S.Morehouse and
Bess A.Jennings as Trustees of the Randall S.
Morehouse Living Trust,dated September 16,2010
x O Mailing Address 810 Polk St a w Mailing Address 80A Kaiwiki Rd
� z z
iii City/State/Zip Port Townsend,WA 98368-6535 m City/State/Zip Hilo,HI 96720
t7 Phone No.(including area code) (360)379-4714 c7 Phone No.(including area code) (808)938-6219
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
Randall S.Morehouse Living Trust,dated September 349,331.00
Name 16,2010 975 300 005/35302 0
Mailing Address 80A Kaiwiki Rd 0
City/State/Zip Hilo,HI 96720 ❑
Phone No.(including area code) (808)938-6219 0
® Street address of property: 810 Polk St,Port Townsend,WA 98368-6535
This Property is located in 0 unincorporated Jefferson County OR within®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): 11 0 List all personal property(tangible and intangible)included in selling
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)? 0 Ni
6. YES NO
Is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption:
RCW? 0 ®"
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
El
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 $ 375,000.00
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 $ 375,000.00
This land ❑does ❑does not qualify for continuance Excise Tax: State $ 4,800.00
Local $ 1,875.00
*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 $ 6,675.00
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 $ 6,680.00
PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX
*SEE INSTRUCTIONS
® I CER IFY UNDER PEN,LTY OF PERJURY THAT THE FOREGOING IS TRUE = D CORRECT
Signature of -- — Signature of i ~
ii
Grantor or raptor's •,_• t 4.40k6f,„,il/ `L--- Grantee or antee's —nfr ,„fr/ ,G— S —
= ''i re o r • ' ust,dated
Name(print) , '•: ii A. .,_ I l t�� Name(print) Sep er 16,2010 14,/-1, i:—.. ,0 ,
Date&city of signing: 2ir� lirM , Date&city of signing 1'7-6)1 4 ?o { -"11 J r.(4,4..
Perjury: Perjury is a class C felony which is punishable by imprisonme tin 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).
COUNTY TREASURER �(r
748251 125265 *4/27/2016 6,6;,'- ,i iO.7.
EXHIBIT A
Lot 8,Nolton's First Addition to Port Townsend, as per plat recorded in Volume 2 of Plats, page 25, records of
Jefferson County, Washington.
Situate in the County of Jefferson, State of Washington.