Loading...
HomeMy WebLinkAbout125299 Department of f Revenue WashZ iton State 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('AGES ARE FULLY COMPLETED (See back of last page for instructions) ❑ Check box if partial sale of property If multiple owners,list percentage of ownership next to name. 11111 Name See Attached Exhibit"A" ® Name See Attached Exhibit"A" w z Mailing Address 101 Beverley Ave H Mailing Address 101 Beverley Ave bCity/State/Zip Edgewater,MD 21037-4911 m-Z City/State/Zip Edgewater,MD 21037-4911 Phone No.(including area code) (410)798-5568 Phone No.(including area code) (410)798-5568 © Send all property tax correspondence to: Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers-check box if personal property H Name See Attached Fxhihit"A" 992-600-016 I!tel 10 n 3,51,Le Mailing Address 101 Beverley Ave 0 City/State/Zip Edgewater,MD 21037-4911 n Phone No.(including area code) (410)798-5568 n Street address of property: no known address This property is located in Jefferson County 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) TRACT 10 OF SEAHOME,AS PER PLAT RECORDED IN VOLUME 2 OF PLATS,ON PAGE 124,RECORDS OF JEFFERSON COUNTY,WASHINGTON;EXCEPT THAT PORTION CONVEYED TO JEFFERSON COUNTY FOR RIGHT-OF-WAY BY DEED RECORDED MAY 19, 1965 UNDER RECORDING NO. 183719,RECORDS OF SAID COUNTY;TOGETHER WITH SECOND CLASS TIDELANDS AS CONVEYED BY THE STATE OF WASHINGTON ADJOINING AND ABUTTING THEREON;SITUATE IN THE COUNTY OF JEFFERSON,STATE OF WASHINGTON. Subject to:EASEMENTS,RESTRICTIONS,RESERVATIONS,CONDITIONS,AND COVENANTS OF RECORD © Select Land Use Code(s): 5 List all personal property(tangible and intangible)included in selling 91-Undeveloped land(land Only) 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 0 chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 6 If claiming an exemption, list WAC number and reason for exemption: YES NO Is this property designated as forest land perchapter84.33 RCW? 0 0 WAC No. (Section/Subsection) 458-61A-211(2)(h) Is this property classified as current use(open space,farm and 0 0 agricultural,or timber)land per chapter 84.34? Reason for exemption Transfer FROM a revocable living trust Is this property receiving special valuation as historical property 0 0 per chapter 84.26 RCW? If any answers are yes,complete as instructed below. Type of Document Quit Claim 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 4/6/16 classification as current use(open space,farm and agriculture,or timber)land, Gross Selling Price $ 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 $ 0.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax : State $ 0.00 your local county assessor for more information. 0.0050 Local $ 0.00 This land Does 0 does not qualify for continuance. *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) 0.00 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 $ (3) OWNER(S)SIGNATURE Total Due $ 10.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS 8 1 CE TIFY UNDER PENALTY OF PERJURY TIIAT TME FOREGOING IS TRUE A D CORRECT. Signature of ( ,-_ Signature of /1 f Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) Brittany S.A.Cline,Agent Name(print) Brittany S.A.Cline,Agent Date&city of signing: 4/11/16 Poulsbo,WA Date&city of signing: 4/11/16 Poulsbo,WA 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 live 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)). t? 4 I^ _ *4/29/2016 tmr,00* ASURER'S USE ONLY DEPT. OF REVENU 1► 1252-f,, . EXHIBIT"A" GRANTOR: Eric Warren Arnold, surviving co-trustee and Fred Taylor Arnold, surviving co-trustee of The Helen A.Arnold Trust Agreement, dated August 30, 2006, and any amendments as to a %2 interest, being all of the Trust's interest GRANTEE: Eric Warren Arnold, as his separate estate, as to a% interest and Fred Taylor Arnold, as his separate estate, as to a 1/4 interest, as tenants in common