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VeDvenepartmentue of `-
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REAL ESTATE EXCISE TAX AFFIDAVIT ` �.,
PLEASE TYPE OR PRINT This form is yo`y casefpt
CHAPTER 82.45 RCW—CHAPTER 458-6IA 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.58070LS
❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name
1. Name Melissa Nagy and Kenneth R.Slough,wife and Name Bradley Mace and Christina Mace,husband and
husband wife /� 2,
w O Mailing Address 722 58th Street w W Mailing Address 1 Po k 1 4 2.--
>- z
City/State/Zip Port Townsend,WA 98368 City/State/Zip Port Townsend,WA 98368
c7 Phone No.(including area code) (360)344-4411 Phone No.(including area code) (206)963-5271
3. Send all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s)
numbers—check box if personal property
Name Bradley Mace ,i 101 342 012/13193 ❑ $167,992
Mailing Address j I`t'2-- ❑
City/State/Zip Port Townsend,WA98368 k flOt)( "] ❑
Phone No.(including area code) (206)963-5271 ❑ 1 1i/AT
® Street address of property: XX 53rd St,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)
Vacated Lots 1 through 20, Block 3, Seaview Addition to the City of Port Townsend, as per plat recorded in Volume 2
of Plats, page 77, records of Jefferson County, Washington;
Vacated by Ordinance No. 3009 of the City of Port Townsend, recorded April 27, 2009 under Recording No. 542568,
records of Jefferson County, Washington.
Situate in the County of Jefferson, State of Washington.
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 disabledperson,
homeowner with limited income)? ❑ El
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? ❑
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 25,2016
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 $ 110,000.00
If the land no longer qualifies or you do not wish to continue the designation — 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 $ 110,000.00
This land ❑does ❑does not qualify for continuance Excise Tax: State $ 1,408.00
Local $ 550.00
*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 $ 1,958.00
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 $ 1,963.00
PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX
*SEE INSTRUCTIONS
® CERTIFY UNDE PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
Signature of • 'j / Signature of
Grantor or Grantor', A.ent Grantee or Grantee's Agent i
Name(print) Melissa Nary Name(print) Bradley Mace
Date&city of signing: • DY'/—7-6 Date&city of signing .4 11/2-474/4r'.a✓'T 7 ��,,
tgsCY L'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 \`yAr
__0212 125298 *4/29/2016 1 ,963.00# thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(iC).
THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER t,
#151,41.4