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HomeMy WebLinkAbout125272 Revenue Uk.-- G� :)`�tC.� r@i Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61 A 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. ElName Please see attached a Name Please see attached L.1 a z Mailing Address PO Box 1342 }U.7 Mailing Address PO Box 1342 v v City/State/Zip Plaistow,NH 03865 m ce City/State/Zip Plaistow,NH 03865 U Phone No.(including area code)(617)748-3186 Phone No.(including area code)(617)748-3186 ® El ail property tax correspondence to:❑� Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers-check box if personal property Name 957001306 n $27,588 Mailing Address n City/State/Zip n Phone No.(including area code) El © Street address of property: This property is located in ,uf1e: ol?C vi??Py ❑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) Lot 13 in Block 13;Also,all that portion of vacated Ruby Street lying between the North line of Stevens Street and the Northerly line said lot;in California Subdivision of the Town of Harrisburg,as per Plat recorded in Volume 1 of Plats on page 97,records of Jefferson County;Together with that portion of Stevens Street as vacated by Jefferson County Ordinance 10095 that would normally pass by operation of Law.Situated in Jefferson County,Washington. ®Select Land Use Code(s): ® List all personal property(tangible and intangible)included in selling J91 Unce, ,;,ed ant ian'only) price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ ❑2 84.36 RCW(nonprofit organization)? © 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 Is this property classified as current use(open space,farm and 0 ❑ WAC No.(Section Subsection) 458-61A-217 re-record to add Notary Seal agricultural,or timber)land per chapter 84.34? (land to correct legal Reason for 0exemptiontgS Is this property receiving special valuation as historical property 0 Distribution of Estate,REETA filing o.729 61 1g 1 4S 82 A FN 597515 per chapter 8426 RCW? If any answers are yes,complete as instructed below. (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Personal Representative's Deed NEW OWNER(S):To continue the current designation as forest land or classification as current use(open space,faint and agriculture,or timber)land Date of Document 2/1/16 you must sign on(3)below.The county assessor must then determine if the Gross Selling Price $ 0.00 land transferred continues to qualify and will indicate by signing below.If the land no longer qualifies or you do not wish to continue the designation or *Personal Property(deduct) $ 0.00 classification.it will be removed and the compensating or additional taxes will Exemption Claimed(deduct) $ 0.00 be due and payable by the seller or transferor at the time of sale.(RCW 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Taxable Selling Price $ 0.00 your local county assessor for more information. Excise Tax:State $ 0.00 This land 0 does ['does not qualify for continuance. € ).t)�.i' 7 Local $ 0.00 *Delinquent Interest:State $ 0.00 DEPUTY ASSESSOR DATE Local $ 0.00 (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ 0.00 NEW OWNER(S):To continue special valuation as historic property, sign(3)below.If the new owner(s)does not wish to continue,all Subtotal $ 0.00 additional tax calculated pursuant to chapter 84.26 RCW,shall be due and *State Technology Fee $ 5.00 payable by the seller or transferor at the time of sale. (3) OWNER(S)SIGNATURE *Affidavit Processing Fee $ 5.00 Total Due 5 10.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® I CERTI UNDER PE: 'LTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of / Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) Tracy DiGiovanni,Attorney for I rantor Name(print) Tracy DiGiovanni,Attorney for e.ntee Date&city of signing: 4-21-16.Port Orchard.WA Date&city of signing: 4-21-16,Port Orchard,WA 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 84 000 lae(6/28/12) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER +'T__.._ 12 ?, :,22/ is 10_ _ I Z52-12 Attachment to REETA Box #1 Name of Grantor: Martha Wyatt and Stephen Beaulieu,as Co-Personal Representatives of the Estates of Albert L. Boucher and Vada Boucher, deceased, each Estate as to an undivided one-half interest Box#2 Name of Grantee: Martha Wyatt and Stephen Beaulieu, as Co-Personal Representatives of the Estate of Albert L. Boucher