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Home My WebLink About125294 Department 3f �' venue _C�, 'l 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.82134JMM 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name I. Name Barber Family Associates L.P.,a Washington Name Marcia S.Kelbon and Richard G.Kelbon,wife and Corporation husband w O Mailing Address 8129 Lake Ballinger Way,Ste. 104 x H Mailing Address 9981 Kingston Farm Rd F. .azz r a City/State/Zip Edmonds,WA 98026 R City/State/Zip Kingston,WA 98346 `" 0 Phone No.(including area code) (206)817-7013 0 Phone No.(including area code) (360)908-5165 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 Marcia S.Kelbon and Richard G.Kelbon 702 034 004/17959 0 273,076.00 Mailing Address 9981 Kingston Farm Rd 'r0A X _' ❑ City/State/Zip Kingston,WA 98346 0 Phone No.(including area code) (360)908-5165 0 m rkp ✓ MIStreet address of property: 273 River Ridge Drive,Quilcene,WA 98376 This Property is located in rp unincorporated Jefferson County OR within 0 city of Quilcene ❑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) SEE EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF FOR COMPLETE LEGAL DESCRIPTION ® Select Land Use Code(s): 91 7. 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, ❑ x homeowners with limited income)? ® YES NO Is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption: RCW? x 0 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 20,2016 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 $ 320,000.00 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 $ 320,000.00 This land [k does 0 does not qualify for continuance Excise Tax: State $ 4,096.00 / Local $ 1,600.00 Sask-2 � �Za 1 i tO *Delinquent Interest: State $ el Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 5,696.00 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 $ 5,701.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX Marcia S.Kelbon Richard G.Kelbon *SEE INSTRUCTIONS ® I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Signature of �{ Signature of Grantor or Grantor's Agent 1/IA i 1(/ Grantee or Grantee's Agent Name(print) Barber Family + 1 iates L.P. Name(print) Marcia S.Kelbon Date&city of signing: £pc" 0.--4.0 (A.mt • 11/9+-t/ t 4' 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). REV 84 0001a(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER 750193 125294 *4,129/2016 '5,70i :00* 1 7 2�2�� r Levefk•{mnmer+nueni REAL ESTATE EXCISE TAX AFFIDAVIT This titan 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 instmctions) File No.82134.IMM ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name Name Barber Family Associates L.P..a Washington Name Marcia S.Kelbon and Richard G.Kelbon,wife and Corporation husband z Mailing Address 8129 Lake Ballinger Way,Ste.104 z`' Mailing Address 9981 Kingston Farm Rd -= N Cit /State/Zi Kinston,WA 98346 n Z City/State/Zip Edmonds,WA 98026 7"- P g % Phone No.(including area code) (206)817-7013 z1 Phone No.(including area code) (360)908-5165 Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal tax parcel account Li);ted a>sessed valuers) numbers—check box if personal property 273,076.00 Name Marcia S.Kelbon and Richard G.Kelbon 702 034 004/17959 0 Mailing Address 9981 Kingston Farm Rd 0 City/StateiZip Kingston.WA 98346 0 Phone No.1.including area code) (360)908-5165 0 0 Street address of property: 273 River Ridge Drive,Quilcene,WA 98376 This Property is located in�unincorporated Jefferson County OR within❑city of Quilcene 0 Check box if any of the 1 sted parcels are being segregated from a larger pared,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) SEE EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF FOR COMPLETE LEGAL DESCRIPTION ® Select Land Use Code(s): 91 am 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, ❑ homeowners with limited income)? x 6. YES NO Is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption: RCW? x 0 Is this property classified as current use(open space.farm and 0 x „ agricultural.or timber)land per chapter 84.34? 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 (I)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S): To continue the current designation as forest land or Date of Document April 20,2016 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 5 320,000.00 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 84.33.14(1 or RCW84.34.108).Prior to signing(3)below,you may contact your local county assessor for more informTaxable Selling Price $ 320,000.00 Excise Tax: State 5 4,096.00 ' This land does 0 does not ualify for continuance Local $ 1,600.00 1 � . *Delinquent Interest: State $ . i A A 4 VI Local $ I DEPUTY ASSE'SOR DATE *Delinquent Penalty $ (2)N TICE OF COM' .NCE(HISTORIC PROPERTY) WNER(S): To continue special valuation as historic property. Subtotal $ 5,696.00 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 $ X (3) OWNER(S)SIGNATU�� Total Due $ 5,701.00 ,f '— am" .X 1!�"" ,&�Z;t,G"�w PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX Marcia S.Kelbon Richard G.Kelbon *SEE INSTRUCTIONS ICII CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Signature of Signature of —.��— Grantor or Grantor's Agent Grantee or Grantee's Agent X Name(print) Barber Family Associates L.P. Name(print) Marcia S.Kelbon J , Date&city of signing: Date&city of signing x ,/2V/ hw)„5,4d.i i . 4 Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum tem of not more than five years.or by a tine in an amount fixed by the court of not more than five thousand dollars(S5.0(.10.00),or by both imprisonment arid fine(RCW 9A20.020(IC). REV 84 0001a(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER EXHIBIT A Tract 6 of Survey recorded in Volume 25 of Surveys, pages 117-120, under Auditor's File No. 466733, records of Jefferson County, Washington, together with that portion of Tract 7 of said survey described as follows: Beginning at the Northeast corner of the Southeast '/4 of Section 3, Township 27, Range 2 West, W.M., Jefferson County, Washington; thence South 01°51'25" West along the East line of said Southeast 1/4, a distance of 697.14 feet to the true point of beginning; thence continuing South 01°51'25"West along the East line of said Southeast 1/4, a distance of 806.17 feet to the centerline of Little Quil Road; thence North 71°48'00"East along said centerline, a distance of 192.98 feet to a curve to the left having a radius of 170.00 feet through a central angle of 41°31'24"; thence along said curve a distance of 123.20 feet; thence North 30°16'37" East, a distance of 51.69 feet to a curve to the left having a radius of 200.00 feet through a central angle of 58°55'13"; thence along said curve a distance of 205.68 feet; thence North 28°38'37" West, a distance of 407.82 feet to a curve to the left having a radius of 150.00 feet through a central angle of 42°57'24"; thence along said curve a distance of 112.46 feet to a point on the East line of said Southeast 1/4 and the true point of beginning. Less that portion of said Tract 6 described as follows: Beginning at the Southeast corner of the Northeast 1/4 of said Section 3; thence North 01°51'25"East along the East line of said Northeast 1/4, a distance of 617.25 feet to the true point of beginning; thence North 46°40'02"West, a distance of 736.34 feet to the centerline of Little Quil Road; thence North 73°05'15" East along said centerline, a distance of 169.36 feet to a curve to the right having a radius of 630.00 feet through a central angle of 25°51'22"; thence along said curve a distance of 284.30 feet; thence South 81°03'23"East, a distance of 79.46 feet to a curve to the left having a radius of 150.00 feet through a central angle of 12°16'00"; thence along said curve a distance of 32.11 feet to a point on the East line of said Northeast 1/4; thence South 01°51'25"West, a distance of 560.56 feet to the true point of beginning. Situate in the County of Jefferson, State of Washington.