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HomeMy WebLinkAbout125266 t , Department ofzt ` LIO( Revenue Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-6IA 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. Name Susan M Davidson Foley, Personal Representative mu Name Stanley J. DavidsonI kvvnclrrr e( ( oot\l at.S vti.5 o of the Estate of Elizabeth C. Davidson. Deceased 5 0. -t e a z Mailing Address 108 N Maple St 2 Mailing Address 1259 Thoreau Place city/state/zip Ellensburg.WA 98926 m rx City/state/zip Pueblo West, CO 81007 Phone No.(including area code) (425)223-1868 Phone No.(including area code) (71 9)780-0702 ® Send all roe tax correspondence to: List all real and personal property tax parcel account property rty p ®Same as Buyer/Grantee numbers—check box if personal property List assessed value(s) Name 948 304 604 D $209.881 Mailing Address fl City/State/Zip Phone No.(including area code) n 11 Street address of property: 710 18th St This property is located in Port Townsend ❑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) LOTS 3 AND 4,BLOCK 46,SUPPLEMENTARY PLAT OF EISENBEIS ADDITION TO THE CITY OF PORT TOWNSEND,W.T.,AS PER PLAT RECORDED IN VOLUME 2 OF PLATS,PAGE 24,RECORDS OF JEFFERSON COUNTY,WA ® Select Land Use Code(s): III List all personal property(tangible and intangible)included in selling Iii-Household,single family units price. enter any additional codes: NONE (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under 0 ❑✓ 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? ❑ ❑✓ WAC No. (Section/Subsection) 458-61A-202(1) Is this property classified as current use(open space,farm and 0 ❑✓ agricultural,or timber)land per chapter 84.34? Reason for exemption INHERITANCE IN ACCORDANCE WITH THE TERMS OF THE WILL Is this property receiving special valuation as historical property 0 ✓❑ per chapter 84.26 RCW? If any answers are yes,complete as instructed below. Type of Document Personal Representative's 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 4/19/16 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 El does ❑✓ 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 $ 5.00 (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 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORR (Th' Signature of Signature of Grantor or Grantor's Agent j �C1y�8f�46141 Grantee or Grantee's Agent tj�j4 Name(print) Susan M.Davidson Foley,PR Name(print) Mary E Kooistra,Agent f r tanley Day dson Date&city of signing: 4-19-2016 Kirkland Date&city of signing: 4-19-2016 Kirkland 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)). THIS SPACE-TREASURER'S USE ONLY COUNTY ASSESSOR, 7,187;15 .2 5 2; : *4/28/2016 yta '*