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Home My WebLink About125293 Revenue t 'ti ► C1(-) Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your redeip�� 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) Check box if partial sale of.ro.ert If multi.le owners list percenta_e of ownership next to name. 1 Name Robert E Peterson & Phyllis L Peterson 2 Name Jerome Mylet w Mailing Address / _/ 2.0 L Sp{`eJCe_ Or- yw, Ew-. MailingAddress 20247 NE Interlachen o City/State/Zip [ PpA.10.4 11(i ktiti p co City/State/Zip Fairview,OR el/02,� Phone No.(including area code) (425)238-1439 a;B Phone No.(including area code) (253)686-7874 ill Send all property tax correspondence to: ✓ Same as Buyer/Grantee List all real and personal property tax parcel account p p y p ❑ y numbers—check box if personal property List assessed value(s) Name 965202303 0 3625 Mailing Address n City/State/Zip n Phone No.(including area code) n Street address of property: Kala Point Village Unit 23C(Undiv 1/12th Int) This property is located in Jefferson County 3 0 Check box if any of the listed parcels arc 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) ee 14 • Select Land Use Code(s): ® List all personal property(tangible and intangible)included in selling 19-Vacation and cabin El price. enter any additional codes: (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under 0 4 chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? ® 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 0 ElReason for exemption agricultural,or timber)land per chapter 84.34? p Is this property receiving special valuation as historical property 0 0 per chapter 84.26 RCW? ,l If any answers are yes,complete as instructed below. Type of Document U i c7,, ,,„ (1)NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE) ( NEW OWNER(S):To continue the current designation as forest land or Date of Document ( p classification as current use(open space,farm and agriculture,or timber)land, Gross Selling Price $ 333.00 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.If the *Personal Property(deduct) $ land no longer qualifies or you do not wish to continue the designation or Exemption Claimed(deduct) $ 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 Taxable Selling Price $ 333.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax: State $ 4.26 your local county assessor for more information. 0.0050 Local $ 1.67 This land aloes El does not qualify for continuance. *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) 5.93 NEW OWNER(S):To continue special valuation as historic property, Subtotal $ sign(3)below.If the new owner(s)does 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 $ 0.00 (3) OWNER(S)SIGNATURE Total Due $ 10.93 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® I CERTIFY UNDER PE A, LTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of g / .4ASignature of &-e-214"91 Grantor or Grantor's Agent �. r - Grantee or Grantee's Agent Name(print) Robert E Peterson Name(print) Jerome Mylet Date&city of signing: 4/29/2016 Port Townsend,WA Date&city of signing: 4/29/16 Perjury:Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum tern 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 000Ia(01/04/16) THIS SPACE-TREASURER'S USE ONLY DEPT.OF REVE 12 291 When recorded return to: QUIT CLAIM DEED THE GRANTOR(S)Robert E Peterson&Phyllis L Peterson 201 Spruce Drive Port Townsend,WA 98368 for and in consideration of $333.00 in hand paid,conveys and quit claims to Jerome Mylet 20247 NE Interlachen Fairview,OR,97024 the following described real estate,situated in the County of Jefferson, State of Washington together with all after acquired title of the grantor(s)herein: )(1—t / /3 /7— Abbreviated c1—t / /3 (7Abbreviated Legal: (Required if full legal not inserted above.) KALA POINT VILLAGE UNIT 23 C(UNDIV 1/12 INT) Tax Parcel Number(s): 965202303 LPB 12-05(r)rev 12/2006 Page 1 of 2 Dated: 4 /Z_ ct / Z.ct & "\ r \ '\ (-------_,,,4 r) .,, ,,,,,,,,_._, ,3,0E.__IV. , --------, ..,,,,..1„: ,,,, ,,,, \-.... ,r‘ . ‘ STATE OF l!lD v 11'1)10 ss. COUNTY OFjC,- \ 1 certify that I-know or have satisfactory evidence that V.:69.e4,_)- L3- 611C 1'Yl` AtIlS -L. c- (is/are)the person(s)who appeared before me,and said person(s)acknowledged that (' .' signed this instrument,on oath stated that dY\u...i authorized to execute the instrument and acknowledge it as the of to be the free and voluntary act of such party(ies)for uses and purposes mentioned in this instrument. Dated: ‘"'t 17,41/Ap .,_ Ai i k „willful/0/ Nota r name p "D'T`I ,-d: 7 ,11 r , �� PNY SM/ry , • ary Public m . or . Sta !o , vlr � �C'r••' z \\ Residingr My appointor n ex fres.— (a 4)1 '9vi z•_; liDa z_ ,t,P;;,;•7..,9.,., ,.,,ri.,,...1.•,‘:\•+c, - //of/It:100 LPB 12-05(r)rev 12/2006 Page 2 of 2 EXHIBIT A An undivided 1/12 interest, as a tenant-in-common, with the other fractional owners: Unit No. 23 in Kala Point Village, a condominium, intended for residential and recreational purposes (Post Office address of the Condominium property: P.O. Box 1159, Port Townsend, WA 98368), together with its .2941 percent of undivided interest in the Common Areas and Facilities appertaining to said Unit for Phase 1, 2, 3 & 4, and together with the Limited Common Areas and Facilities so appertaining, all according to Survey Map and Set of Plans delineating said Unit recorded in Volume 1 of Condominiums, pages 46 through 57, records of Jefferson County, Washington, as supplemented by the map and plans recorded in Volume 1 of Condominiums, pages 97 through 101, and according to the Declaration of Condominium recorded on June 5, 1978, under Auditor's File No. 250367, in Volume 102 of Official Records, pages 418 through 478, records of Jefferson County, Washington, as amended by instrument recorded on February 20, 1980 under Auditor's File No. 263587 at pages 66 -73. Including the right of exclusive occupancy and possession for said Unit during Time Sharing Interval C as provided for and defined in said Declaration, as amended. Subject, however, to partial defeasance of the percentage of undivided interest in the Common Areas and Facilities appertaining to said Unit upon inclusion of any subsequent phase(s) to the Condominium by recorded Amendment to the Declaration; and together with that prorata portion of the Declarant's interest in the Common Areas and Facilities of the property in subsequently added phase(s), all as expressly provided for in the Declaration, as amended, upon proper recorded Amendment(s) thereto, and further subject to the terms, covenants and conditions of said Declaration, as amended, and to easements, reservations, restrictions, covenants, conditions and declarations of record. End of EXHIBIT A 00450111.doc