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REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt -�G 1
PLEASE TYPE OR PRINT when stamped by cashier.
CHAPTER 82,45 RCW—CHAPTER 458-61A WAC
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED
(See back of last page for instructions)
File No.82127,1MM
❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name
I. Name William W.Taylor,as his separate estate and Susan Name Julie Murray and Michael Murray,wife and
D.Grace,as her separate estate,as joint tenants husband
with rights of survivorship and not as tenants in
common
O Mailing Address P.O. Box 817 ce w Mailing Address 5115 Seabeck Hwy.
z
w City/State/Zip Winter Park,FL 32792 ci City/State/Zip Bremerton,WA 98312
cA
t7 Phone No.(including area code) (949)939-8847 t7 Phone No.(including area code) (360)710-7734
3. Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal tax parcel account
numbers—check box if personal property Listed assessed values)
Name Julie Murray and Michael Murray 502 105 030/14349 0 $55,263.00
Mailing Address 5115 Seabeck Hwy. 0
City/State/Zip Bremerton,WA 98312 ❑
Phone No.(including area code) (360)710-7734 0
® Street address of property: Rock Way,Brinnon,WA 98320
This Property is located in
l`unincorporated Jefferson County OR within 0 city of Brinnon
0 Check box if any of the listed parcels are being segregated from a larger parcel,are part of 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)
Tract 23, Canal View too large Lot Subdivision, Division One, as recorded in Volume 1 of Large Lots, pages 50 and
51, records of Jefferson County, Washington.
G Cod 11 )eG ccz
Situate in the County of Jefferson, State of Washington. u
® Select Land Use Code(s): 91 0 List all personal property(tangible and intangible)included in selling
price,
Enter any additional codes:
(See back of last page for instructions)
Was the seller receiving a property tax exemption or YES NO
deferral under chapters 84.36,84.37 or 84.38 RCW
(nonprofit organization,senior citizen,or disabled person,
homeowner with limited income)?
0 E1
® YES NO
Is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption:
RCW? 0 EJ
Is this property classified as current use(open space,farm and
agricultural,or timber)land per chapter 84.34? ❑ ® WAC No.(Section/Subsection)
Is this property receiving special valuation as historical
property per chapter 84.26 RCW? ❑ ® Reason for exemption
If any answers are yes,complete as instructed below.
Type of Document Statutory Warranty 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 April 22,2016
classification as current use (open space, farm and agriculture, or timber)
land,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. Gross Selling Price $ 56,000.00
If the land no longer qualifies or you do not wish to continue the designation — Property(deduct) $
or classification,it will he removed and the compensating or additional taxes
will be due and payable by the seller or transferor at the time of sale. (RCW Exemption Claimed(deduct) $ No
84.33.140 or RCW 84.34.108). Prior to signing(3) below, you may contact
your local county assessor for more information, Taxable Selling Price $ 56,000.00
This land Excise Tax: State $ 716.80
❑does E does not qualify for continuance
Local $ 280.00
*Delinquent Interest: State $
Local $
DEPUTY ASSESSOR DATE *Delinquent Penalty $
(2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 996.80
NEW OWNER(S): To continue special valuation as historic property,
sign(3)below. If the new owner(s)do 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 $
(3) OWNER(S)SIGNATURE Total Due $ 1,001.80
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 of3... p-- Signature of
Grantor or Grantor's Agent Lk.) . I. 01 Grantee or Grantee's Agent
Name(print) William W.Ta Ior Name(print) Julie Murray
Date&city of signing: Cf—A. .. kJ-1%A, ' r•qrt,< PL.. Date&city of signing
Perjury: Perjury is a class C felony which is punishable by imprison ent in the state correctional institution for a maximum term of not more than five years,or by
($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(IC).
URER'S USE ONLY COUNTY TREASURER
enue
REAL ESTATE EXCISE TAX AFFIDAVIT lin,.6.,,,st 41,',ow-wscips
Pi.i.AhE VITT OR PRINT
Cf.IAPTER/52,45 RCA-CIIAPTER.45/Tol A V5 AC
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Tract 23.Canal View too large Lot Subdivision,DivisMn One,as recorded in Volume I oft arge I cots.pages 50 and
51,records of Jefferson County,Washington.
Situate in the t'minty of Jefferion,State of Wasthinaton
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*SEE INSTRUCTIONS
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RI),V 15,4 000 i it(04/30/69) Till S SPACT-TREASI RIR'S I lSil ONLY (01 51,i IRV-1St:R.1:R
LEGAL DESCRIPTION
Tract 23, Canal View too large Lot Subdivision, Division One, as recorded in Volume 1 of Large Lots,
pages 50 and 51, records of Jefferson County, Washington;
TOGETHER WITH an easement for ingress, egress and utilities as conveyed by instrument recorded
under Auditor's File No. 397486.
Situate in the County of Jefferson, State of Washington.