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HomeMy WebLinkAbout125286 Oepattnnt of I (fes- (-c.r - 7 "5-6C) Revenue, c 5 `✓ Wnshir n Stc to 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. 111 Sarah F.Blossom and James K.Hattrick,wife and M Michael F.Gleeson and Victoria E.Gleeson,husband Name Name husband and wife a w z Mailing Address 181 Quarry Rd x ,� Mailing Address 1229515th Ave SW ala City/State/Zip Port Ludlow,WA 98365 DI a City/State/Zip Burien,WA 98146 L Phone No.(including area code) (360 620-1288 C' Phone No.(including area code) (206)300-2493 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 F.Gleeson&Victoria E.Gleeson 998200130 0 $128,625.00 Mailing Address 12295 15th Ave SW 0 City/State/Zip Burien,WA 98146 0 Phone No.(including area code) (206)300-2493 ❑ ©Street address of property: 234 Tala Shores Drive,Port Ludlow,WA 98365 This property is located in®unincorporated Jefferson County OR within 0 city of Port Ludlow 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) Lot 33,Tala Shores,as per plat recorded in Volume 4 of Plats,page 28,records of Jefferson County, Washington. Situate in the County of Jefferson,State of Washington. Ell Select Land Use Code(s): Q List all personal property(tangible and intangible)included in selling 91 price. enter any additional codes: (See back of last page for instructions) Is this property exem t from propertyYES NO p 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 $ 169,900.00 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 $ 169,900.00 to signing(3)below,you may contact your local county assessor for more Excise Tax: State $ 2,174.72 information. This land 0 does 0 does not qualify for continuance. Local $ 849.50 *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 $ 3,024.22 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 $ 3,029.22 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 of Signature of Grantor or Grantor's Agent d1d7k Grantee or Grantee's Agent Name(print) Sarah F.Blossom Name(print) Michael F.Gleeson Date&city of signing: /'y—a,2•-14, Pa r 4-1-454-1-45%.d Qate&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)). N -. . . .. . COUNTY TREASURER c`),4�r_:f1 1252 :6 i :- _ - - _ .�s D ;rtment Revenue, tic mogoqState= 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. IIIISarah F.Blossom and James K.Hattrick,wife and Michael F.Gleeson and Victoria E.Gleeson,husband Name husband Name and wife a r-Mailing Address 181 QuarryRd x w k Mailing Address 12295 15th Ave SW a City/State/Zip Port Ludlow,WA 98365 a City/State/Zip Burien,WA 98146 ea c Phone No.(including area code) (360)620-1288 Phone No.(including area code) (206)300-2493 III Send all property tax correspondence to:❑Same as Bu er/Grantee List all real and personal property tax parcel account Buyer/Grantee —check box if personal property List assessed value(s) Name Michael F.Gleeson&Victoria E.Gleeson 998200130 0 $128,625.00 Mailing Address 12295 15th Ave SW 0 City/State/Zip Burien,WA 98146 0 Phone No.(including area code) (206)300-2493 ❑ Q Street address of property: 234 Tala Shores Drive,Port Ludlow,WA 98365 This property is located in®unincorporated Jefferson County OR within 0 city of Port Ludlow 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) Lot 33,Tala Shores,as per plat recorded in Volume 4 of Plats,page 28,records of Jefferson County, Washington. Situate in the County of Jefferson,State of Washington. ® Select Land Use Code(s): 0 List all personal property(tangible and intangible)included in selling 91 price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ 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? ❑ ® 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 $ 169,900.00 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 $ 169,900.00 to information. (3)below,you may contact your local county assessor for more Excise Tax: State $ 2,174.72 This land ❑does ❑does not qualify for continuance. Local $ 849.50 *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 $ 3,024.22 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 $ 3,029.22 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. -7 Signature of Signature of /r Grantor or Grantor's Agent Grantee or Grantee's A nt Name(print) Sarah F.Blossom Name(print) Michael F.Glson Date&city of signing: Date&city of signing: 0—z./1/4 Lit r 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