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Home My WebLink About125282 7 �� D^ourtment of ��t v\ :7 LC. e: nue REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt + 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.82057.1MM 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name I. Name Miller Family Trust,dated November 21, 1996, Name Dan Ginther and Diane Ginther,husband and wife Fred Miller and Nancy B.Miller,Co-Trustees w O Mailing Address 411 Poppinga Way m H Mailing Address 445 Snagstead Way w City/State/Zip Santa Maria,CA 93455 City/State/Zip Port Townsend,WA 98368 C7 Phone No.(including area code) (805)937-3561 Phone No.(including area code) (360)385-5188 3. Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s) numbers—check box if personal property Name Dan Ginther and Diane Ginther 001 295 006/11355 0 168,685.00 Mailing Address 445 Snagstead Way 0 City/State/Zip Port Townsend,WA 98368 0 Phone No.(including area code) (360)385-5188 0 ® Street address of property: 3,Doe Run,Port Townsend,WA 98368 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 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) Lot 3, of Doe Run, a survey recorded March 6, 1990 in Volume 11 of Surveys, page 49, under Auditor's File No. 328862, records of Jefferson County, Washington, being a portion of Section 29, Township 30 North, Range 1 West, W.M., Jefferson County, Washington. Situate in the County of Jefferson, State of Washington. 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)? ❑ x ® 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 x Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ x WAC No.(Section/Subsection) Is this property receiving special valuation as historical property per chapter 84.26 RCW? ❑ x 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 21,2016 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 $ 215,000.00 If the land no longer qualifies or you do not wish to continue the designation *personal Property(deduct) $ or classification,it will be 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 $ 215,000.00 Excise Tax: State $ 2,752.00 This land 0 does 0 does not qualify for continuance Local $ 1,075.00 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 3,827.00 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 $ 3,832.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS I CERTIFY UNDER PE ALTY 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) Miller Family rust ated N rember 21, 1996 Name(print) Dan Ginther Date&city of signing: /d (/ /� t Z ;� Date&city of signing Perjury: Perjury is a class C felonylwhich is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years,or by a fine �� or by both imprisonment and fine(RCW 9A.20.020(IC). JRER'S USE ONLY COUNTY TREASURER 749:340 40 _5.22 /:29/2016 .00 35032 :} L�CVCI iue Waslon irate PLEASE TYPE OR PRINT REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt CHAPTER 82.45 RCW—CHAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED (See back of last page for instructions) File No.82057.1MM ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name I. Name Miller Family Trust,dated November 21, 1996, Name Dan Ginther and Diane Ginther,husband and wife Fred Miller and Nancy 13.Miller,Co-Trustees ee O Mailing Address 411 Poppinga Way xitj Mailing Address 445 Snagstead Way Z m City/State/Zip Santa Maria,CA 93455 City/State/Zip Port Townsend,WA 98368 " 0 Phone No.(including area code) (805)937-3561 Phone No.(including area code) (360)385-5188 3. Send all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal tax parcel account numbers—check box if personal property Listed assessed value(s) Name Dan Ginther and Diane Ginther 001 295 006/11355 1:1168,685,00 Mailing Address 445 Snagstead Way El City/State/Zip Port Townsend,WA 98368 Phone No.(including area code) (360)385-5188 ❑ MIStreet address of property: 3,Doe Run,Port Townsend,WA 98368 This Property is located in❑unincorporated Jefferson County OR within❑city of Port Townsend ❑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) Lot 3, of Doe Run, a survey recorded March 6, 1990 in Volume 11 of Surveys, page 49, under Auditor's File No. 328862, records of Jefferson County, Washington, being a portion of Section 29, Township 30 North, Range 1 West, W.M., Jefferson County, Washington. Situate in the County of Jefferson, State of Washington. ® Select Land Use Code(s): 91 RN List all personal property(tangible and intangible)included in selling price. Enter any additional codes: (See hack 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)? ❑ x ® YES NO Ts this property designated as forest land per chapter 84.33 if claiming an exemption,list WAC'.number reason for exemption: RCW? a is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ x WAC No.(Section/Subsection) is this property receiving special valuation as historical ❑ x 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 21,2016 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 $ 215 000.00 if the land no longer qualifies or you do not wish to continue the designation *Personal Property(deduct) $ ' or classification, it will be 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 $ 215,000.00 This land ❑does Excise Tax: State $ ❑does not qualify for continuance 2,752.00 Local $ 1,075.00 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 3,827.00 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 $ 3,832.00 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 C I RRE T Signature of Signature of ) t� Grantor or Grantor's Agent Grantee or Grantee's At ent 46, 1>lr ' Name(print) Miller Family Trust,dated November 21, 1996 Name(print) Dan Gi th4 �I Date&cityof signing: Date&city of signing f „J(i 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 0001 a(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER