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REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt
PLEASE TYPE OR PRINT t 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 hack of last page for instructions)
File No.82146.iMM
❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name
I. Name Angela R.Lawson,also shown of record as Angela Name Taran M.Minnihan and Lisa Minnihan,husband.
R. Breitwegr,as Personal Representative of The and wife
Estate of Alan Breitweg,deceased
uMailing Address P.O.Box 1331 m F Mailing Address 91 C St
E=
aCity/State/Zip Port Hadlock,WA 98339 City/State/Zip Port Hadlock,WA 98339
Phone No_(including area code) (361))53141094 Phone No.(including area code) (360)774-1649
3. Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal tax parcel account
numbers-check box if personal property Listed assessed values}
Name Taran M.Minnihan and Lisa Minnihan 996 400 706/42828 0 118,994.00
Mailing Address 91 C St
City/State/Zip Port Hadlock,WA 98339 ❑
Phone No.(including area code) (360)774-1649 0
® Street address of property. 91 C St,Port Hadlock,WA 98339
This Property is located in unincorporated Jefferson County OR within❑city of Port Hadlock
❑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 de cription of property(if more space is needed,you may attach a separate sheet to each page of the affidavit)
Lots 13 and 14, Block 7, South Port Townsend,as per the plat thereof,recorded in Volume 1 of Plats,page 10, records
of Jefferson County, Washington.
Situate in the County of Jefferson, State of Washington.
ix Select Land Use C'odc(s): 11 ® List all personal property(tangible and intangible)included in selling
price.
I.nter arts-additional codes:
>"c`pack of last)late 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,
homeowner with limited income)?
❑ x
® YES NO
Is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption:
RCIN"? ❑ x
Is this property classified as current use(open space,farm and
x
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? ❑ 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 May 6,2016
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 S 172,500.00
It'the land no longer qualities or you do not wish to continue the designation *Personal Property(deduct) S
or classification,it will he 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) S 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 S 172,500.00
This land ❑does ❑does not qualify for continuance Excise Tax: State S 2,208.00
Local S 862.50
*Delinquent interest: State S
Local S
DEPUTY ASSESSOR DATE *Delinquent Penalty S
(2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY)
NEW OWNER(S): To continue special valuation as historic property, Subtotal S 3,070.50
sign(3)below. If the new owner(s)do not wish to continue,all *State Technology Fee S 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 S
(3) OWNER(S)SIGNATURE Total Due S 3,07530
PRINT NAME A;MINIMUM OF S10.00 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 �r �� Y ��,� Signature of / a /
Grantor or Grantor's Agent �} Q �J� J V 1J /,EXC'1;rantee or Granter's Age _____K,:,..4,4_'�/fi/�.�( j/�jl(/�i(�
Name(print) Angela R.Lawso t7 Name(print) Lisa Minnihan �� 6`
Date&city of signing: 5 /1 T I Date&city of signing Lo
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
H",'in an amount fixed by the court of not more than five thousand dollars(S5,000.00).or by both imprisonment and fine(RCW 9A,20.020(IC).
81 v 84 0001a (()4/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER
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