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HomeMy WebLinkAbout125279 Revenue cis-3 CC/ Woshirigtan;State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A 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) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. INPatrick R.DeMars and Dee Ann DeMars,husband and © Michael J.Stelzner and Aline M.Stelzner,husband and Name wife Name wife a _ w F Mailing Address PO Box 536 41 x F Mailing Address 5925 Cape George Road w a City/State/Zip Port Hadlock,WA 98339 a v,a co a City/State/Zip. Port Townsend,WA 98368 L Phone No.(including area code) (360)774-0190 c Phone No.(including area code) (360)378-2040 III Send all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal property tax parcel account numbers—check box if personal property List assessed value(s) Name Michael J Stelzner&Aline M.Stelzner 001195009 0 $59,565.00 Mailing Address 5925 Cape George Road ,0)5(6t/P1,ti( 1 i" fl' t I ❑ City/State/Zip Port Townsend,WA 98368 PQ rce I C JJe 74 q CTA. s..)0 Phone No.(including area code) (360)378-2040 0 t�1'1 t2.f) -/" ©Street address of property: 5925 Cape George Road,Port Townsend,WA 98368 / �" 1' This property is located in 'unincorporated Jefferson County OR within 0 city of Port Townsend 0 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) FULLY DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. ® Select Land Use Code(s): W�,( t WM Listall personal property(tangible and intangible)included in selling 98 '�T�OL`- 1 tQ price. enter any additional codes: Y (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ El 84.36 RCW(nonprofit organization)? 0 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 ® WAC No.(Section/Subsection) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® Reason for exemption Is this property receiving special valuation as historical 0 property 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 Statutory Warranty Deed NEW OWNER(S): To continue the current designation as forest land or classification as current use(open space, farm and agriculture,or timber) Date of Document April 18,2016 land, you must sign on (3) below. The county assessor must then determine if the land transferred continues to qualify and will indicate by Gross Selling Price $ 170,000.00 signing below. If the land no longer qualifies or you do not wish to *personal Property(deduct) $ continue the designation or classification, it will be removed and the compensating or additional taxes will be due and payable by the seller or Exemption Claimed(deduct) $ No transferor at the time of sale. (RCW 84.33.140 or RCW 84.34.108).Prior Taxable Selling Price $ 170,000.00 to signing(3)below,you may contact your local county assessor for more Excise Tax: State $ 2,176.00 information. This land 0 does 0 does not qualify for continuance. Local $ 850.00 *Delinquent Interest: State $ DEPUTY ASSESSOR DATE Local $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 3,026.00 sign (3) below. If the new owner(s) does not wish to continue, all additional tax calculated pursuant to chapter 84.26 RCW,shall be due *State Technology Fee $ 5.00 and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ (3) OWNER(S)SIGNATURE Total Due $ 3,031.00 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 CORRECT. Signature �L "'" "'� Q�, Signature of Grantor orr Grantor's Agent entQ� Grantee or Grantee's Agent Name(print) Patrick R.DeMars Name(print) Michael J.Stelzner Date&city of signing: 407//i Roar re 4,1 4 s cob Date&city of signing: 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)). i& fgrA iA: 7:- i?t J. -" .t. JRER'S USE ONLY COUNTY TREASURER v �.t,: 9?36 12 9 ,20 i rentb*gue-,' : ' REAL ESTATE EXCISE TAX AFFIDAVIT PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC This form is your receipt when THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED stamped by cashier. (See back of last page for instructions) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. Patrick R.DeMars and Dee Ann DeMars,husband and II Name wife Michael J.Stelzner and Aline M.Stelzner,husband and Name wife a w C Mailing Address PO Box 536 n t" a ` Mailing Address 5925 Cape George Road rn a City/State/Zip Port Hadlock,WA 98339 a City/State/Zip Port Townsend,WA 98368 ol c,Phone No.(including area code) (360)774-0190 c Phone No.(including area code) (360)378-2040 111 Send all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal property tax parcel account numbers—check box if personal property List assessed value(s) Name Michael J.Stelzner&Aline M.Stelzner 001195009 0 $59,565.00 Mailing Address 5925 Cape George Road 0 City/State/Zip Port Townsend,WA 98368 0 Phone No.(including area code) (360)378-2040 0 ©Street address of property: 5925 Cape George Road,Port Townsend,WA 98368 This property is located inunincorporated Jefferson County OR within 0 city of Port Townsend 0 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) FULLY DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. ® Select Land Use Code(s): Q List all personal property(tangible and intangible)included in selling 98 price. enter any additional codes: (See back of last page for instructions) Is this property exempt from property tax per chapter YES NO 84.36 RCW(nonprofit organization)? ❑ 1111 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 WAC No.(Section/Subsection) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® Reason for exemption Is this property receiving special valuation as historical 0 El property 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 Statutory Warranty Deed NEW OWNER(S): To continue the current designation as forest land or classification as current use(open space,farm and agriculture,or timber) Date of Document April 18,2016 land, you must sign on (3) below. The county assessor must then determine if the land transferred continues to qualify and will indicate by Gross Selling Price $ 170 000.00 continuesignibelow. If the eland no or classification,qualifies or you do not wish to *personal Property(deduct) $ designationtheon, it will be removed and the compensating or additional taxes will be due and payable by the seller or Exemption Claimed(deduct) $ No transferor at the time of sale. (RCW 84.33.140 or RCW 84.34.108).Prior Taxable Selling Price $ 170,000.00 to signing(3)below,you may contact your local county assessor for more information. Excise Tax: State $ 2,176.00 This land 0 does 0 does not qualify for continuance. Local $ 850.00 *Delinquent Interest: State $ DEPUTY ASSESSOR DATE Local $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 3,026.00 sign (3) below. If the new owner(s) does not wish to continue, all additional tax calculated pursuant to chapter 84.26 RCW,shall be due *State Technology Fee $ 5.00 and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ (3) OWNER(S)SIGNATURE Total Due $ 3,031.00 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 CORRE . Signature of Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) Patrick R.DeMars Name(print) Michael J.Stelzner Date&city of signing: Date&city of signing: 7 /2o//i / 1i/-/, )34"< , 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)). REV 84 0001a(2/28/13) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER • EXHIBIT "A" Those portions of Parcels 8 and 9 of that large lot subdivision known as Discovery Ridge Division No.2,recorded in Volume 10 of Surveys,Page 57,situated in the South half of Section 19,Township 30 North,Range 1 West,W.M. in Jefferson County,Washington, described as follows: Commencing at the Southwest corner of said Parcel 8 of the Plat of Discovery Ridge Division No.2; thence N 01°32'35"E,a distance of 1046.07 feet to the Northwest corner of said Parcel 8; thence,S 60°16'55"E,a distance of 232.56 feet to the Northeast corner of said Parcel 8; said corner also being the Northwest corner of Parcel 9 of said plat; thence,S 37°12'56"E,a distance of 327.45 feet to the Northeast corner of said Parcel 9; thence,S 01°32'35"W,a distance of 282.42 feet to a point on the East line of said Parcel 9 and the point of beginning of this description; thence, S 01032'35"W,a distance of 769.09 feet to the Southeast corner of said Parcel 9, being a point on the Northerly margin of a county road known as Chevy Chase Road,said point being on a curve,concave to the Southwest and having a central point which bears S 54°04'20"W, 1530.00 feet; thence,Northwesterly along said curve through a central angle of 18°11'39",a distance of 485.85 feet to a point of compound curve of said northerly margin,said point of compound curve having a central point which bears S 35°52'41"W, 1405.00 feet; thence,Northwesterly along said curve through a central angle of 01°24'14",a distance of 34.43 feet; thence,N 01°32'35"E,a distance of 417.41 feet; thence, S 88°27'25"E,a distance of 380.00 feet to the point of beginning. Situate in the County of Jefferson,State of Washington.