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Home My WebLink About125277 Department o Revenuef " a 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. flName Please see attached ■ Name Please see attached - Z Mailing Address PO Box 1342 L's Mailing Address PO Box 1342 N City/State/Zip Plaistow,NH 03865 on a City/State/Zip Plaistow,NH 03865 Phone No.(including area code)(617)748-3186 Phone No.(including area code)(617)748-3186 List all real and personal property tax parcel account ® Send all property tax correspondence to:Q Same as Buyer/Grantee numbers—check box if personal property List assessed value(s) Name 957001301 ❑ $185,486 Mailing Address n City/State/Zip n Phone No.(including area code) n © Street address of property: This property is located in fferst.� � ':iy ❑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 1 in Block 13;Also,all that portion of vacated Ruby Street lying between the North line of Lot 13,Block 13 and the South line of Montgomery Street;in California Subdivision of the Town of Harrisburg,as per Plat recorded in Volume 1 of Plats on page 97,records of Jefferson County;Situated in Jefferson County,Washington. Select Land Use Code(s): 1111 List all personal property(tangible and intangible)included in selling Jia+-Uaee.euced land('and cn,is) J price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter 0 ❑s 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 CI Is this paupc.ty 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? and to correct legal Reason for exemption ,1 Gr7 1�t, p Is this property receiving special valuation as historical property 0 ❑ Distribution of Estate,REETA filing`;IJo 72560�+2d876�AFU 597507 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 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 moreinformation. Excise Tax:State $ 0.00 This land 0 does 0 does not qualify for continuance. 0+0150 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 CERTI; UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND ORRECT. Signature of ' Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) Tracy DiGiovanni,Attorney for G. for Name(print) Tracy DiGiovanni,Attorney for G: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 0001ae(6/28/12) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER // 4, .. s...' 1252'77 /28 - 1 T 10.00* l2 c-21-1 s 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