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Home My WebLink About125275 ckDepartment of tx j Revenue r@ Washington State C? C is 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. Name Please see attached A Name Please see attached Z Mailing Address PO Box 1342 r z Mailing Address PO Box 1342 h n City/State/Zip Plaistow,NH 03865 m v City/State/Zip Plaistow,NH 03865 Phone No.(including area code)(617)748-3186 Phone No.(including area code)(617)748-3186 ® Send all property tax correspondence to: Same as Buyer/Grantee List all real and personal property tax parcel account p y p ❑ y numbers—check box if personal property List assessed value(s) Name 957001302 0 $34,320 Mailing Address n City/State/Zip n Phone No.(including area code) III Street address of property: This property is located in ,dffe sQ': ❑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 2 through 4 and 7 through 9 inclusive and Lots 5 and 6 less the North 90 feet in Block 13;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): II List all personal property(tangible and intangible)included in selling 19'- land i ani a?!y) price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter 0 El 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 Q WAC No.(Section/Subsection) 458-61A-217 re-record to correct legal agricultural,or timber)land per chapter 84.34? description. Reason for exemption Is this property receiving special valuation as historical property 0 ❑Q Distribution of Estate,REETA filing No.729607 124874,AFN 597505 per chapter 84.26 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,farm 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 0.00 land transferred continues to qualify and will indicate by signing below.If the Gross Selling Price $ 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 Odoes ❑does not qualify for continuance. € 0,arth.-) 1 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 $ 10.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS © I CERTIFY UNDER P NALTY OF PERJURY THAT THE FOREGOING IS TRUE CORRECT. Signature of & Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent �_ Name(print) Tracy DiGiovanni,Attorney f Grantor Name(print) Tracy DiGiovanni,Attorney for rantee 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(I C)). REV 84 0001a(6/28/12) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER , 7- 749205 1 25275 *4/.23 If`.. _I.__ 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