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HomeMy WebLinkAbout125352 fre. •�+2 evenue REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt cO 1>f.r.nSE TYPE OR PRINT CHAPTER 82.45 RCW-CHAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALLAREAS ON ALL PAGES ARE FULLY COMPLETED (See hack of last page for instructions) Check box if partial sale of property If multiple owners,list percentage of ownership next to name. Name George D. Tracy and Lisa K. Siu, husband and wife II Name Jason J. Bennett and Crissa K. Bennett, husband and Mailing Address 3772 29th Ave W wife City/State/Zip Seattle, WA 98199 F- Mailing Address 10917 28th Ave SW : 'hone No. (including area code -2.,„6,c) City/State/Zip Seattle, WA 98146 Phone No.(including area code) 3Lb ----7 7 ' j S�d all property tax correspondence to: ❑ Same as Buyer/Grantee List all real and personal property tax parcel account 1 numbers-check box if personal property List assessed value(s) Name Jason J. Bennett 997 200 008 ❑ $318,265.00 Mailing Address 20 Sunny Slope Road Property ID No. 42927 ❑ City/State/'Lip Brinnon, WA 98320 0 Phone No. (including area code) ❑ El Street address of property 20 Sunny Slope Road, Brinnon, WA 98320 This property is located in 0 unincorporated County OR within ©city of Brinnon Check box if any of the listed parcels are 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) SEE ATTACHED EXHIBITA Scicci Land Use Code(s): © List all personal property(tangible and intangible) included in selling 11 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 [�] chapters 84.36,84.37.or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 6 YES NO Is this property designated as forest land per chapter 84.33 RCW? 0 If claiming an exemption, list WAC number and reason for exemption: Is this property classified as current use(open space,farm and 0 121 WAC No, (Section/Subsection) Zvi icultural.or timber)land per chapter 84.34 RCW? Reason for exemption: his property receiving special valuation as historical property ❑ [JJ pc, chapter 81.26 RCW? I f am answers arc yes. complete as instructed below. y'O"1I(:1" OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Statutory Warranty Deed NI \\I OWNI:R(S): To continue the current designation as forest land or classification as current use(open space, farm and agriculture,or timber) Date of Document 5/3/2016 land.you must sign on (3)below. The county assessor must then determine i f the land transferred continues to qualify and will indicate by signing below. If the land no longer qualifies or you do not wish to continue the designation or classification, it will he removed and the compensating or additional taxes Gross Selling Price $332,000.00 will be due and payable by the seller or transferor at the time of sale. (RCW *Personal Property (deduct) 81.33.140 or RCW 84.34.108). Prior to signing(3)below,you may contact your local county assessor for more information, Exemption Claimed (deduct) Taxable Selling Price $332,000.00 This land does 0 does not qualify for continuance. Excise Tax: State $4,249.60 DEPUTY ASSESSOR DATE Local $1,660.00 *Delinquent Interest: State (2) No-riCl OF COMPLIANCE(HISTORIC PROPERTY) Local NI:A\ OWNIlR(S): To continue special valuation as historic property, rin (3) heir)W. If the new owner(s)does not wish to continue,all `Delinquent Penalty .1,I(liuonal tax calculated pursuant to chapter 84.26 RCW,shall be due and Subtotal $5,909.60 i,ar able by the seller or transferor at the time of sale. *State Technology Fee $5.00 (3)OWNER(S)SIGNATURE *Affidavit Processing Fee Total Due $5,914.60 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS I C 'UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of Grantor or Grantor's Agen � Grantee or Grantee's Agent Name(print) Car &It Name(print) Jason J. Benne Data&city of signing: CI Le SC CL- (/ r Date&city of signing: 0 7 140 P(irjury: Periur) 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 .1 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)). It) V 8,1 0001a(09/22/15) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 755274 125:352 i.5 1 1 205 914.r, :1: i f EXHIBIT "A" LEGAL DESCRIPTION Lot 11 of Sunny Slope Plat, as per plat recorded in Volume 3 of Plats, page 33, records of Jefferson County, Washington. TOGETHER WITH all tidelands of the second class as conveyed by the State of Washington, situate in front of, adjacent to an abutting upon the above described uplands. Situate in the County of Jefferson, State of Washington. Streamline Legal Description-Exhibit"A"Rev.2/4/2006 8:58:00 PM