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Home My WebLink About125357 Department ofre .C'. 0--> Revenue `-bk - Washington 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 PAGES ARE FULLY COMPLETED (See back of last page for instructions) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. flName Platt Irwin Law Firm,Successor Trustee U Name First Federal Savings&Loan Association of Port Angeles al 04 L..L n du . 2i(70, Att'n Jackie Gold a Mailing Address 403 South Peabody w[W' MailingAddress P.O.Box 351 c City/State/Zip Port Angeles,WA 98362 � City/State/Zip Port Anqeles,WA 98362 Phone No.(including area code) (360)457-3327 Phone No.(including area code) (360)417-3237 ® Send all ro List all real and personal property tax parcel account p petty tax correspondence to:®Same as Buyer/Grantee numbers—check box if personal property List assessed vatue(s) Name 502164046 /� r n $23,870 Mailing Address To (1'T LH ( Yi l Q d J n City/State/Zip n Phone No.(including area code) 0 map ✓ ElStreet address of property: /" This property is located in®unincorporated Jefferson County OR within 0 city of 0 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 Exhibit A attached hereto and incorporated by reference. ®Select Land Use Code(s): III List all personal property(tangible and intangible)included in selling 11 -Single Family Household 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 NI chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? ® YES NO If claiming an exemption,list WAC number and reason for exemption: Is this property designated as forest land per chapter84.33RCW? 0 ® WAC No. (Section/Subsection) 458-61A-208(4) Is this property classified as current use(open space,farm and 0 Reason for exemption agricultural,or timber)land per chapter 84.34 RCW? P Is this property receiving special valuation as historical property 0 Foreclosure sale by trustee under deed of trust per chapter 84.26 RCW? DOT AFN#529293,Notice of Sale AFN#597104 If any answers are yes,complete as instructed below. Type of Document Trustee's Deed (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) May6,2016 NEW OWNER(S):To continue the current designation as forest land or Date of Document classification as current use(open space,farm and agriculture,or timber)land, Gross Selling Price $ 44,499.45 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) $ 44,499.45 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. Local $ 0.00 This land 0 does 0 does not qualify for continuance. *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 $ 0.00 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 $ 5.00 (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 ® I CERTIFY UN ER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of itsGrantee Signature of Grantor or Grantor's Agent ' Granor Grantee's Agent /' jJA,............„.-- Name(print) Christopher J.Ri ,Successor Trustee Name(print) Christopher J.Riffle,Agent Date&city of signing: May 6,2016 Port Angeles Date&city of signing: May 6,2016 Port Angeles 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(6/26/14) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER r-- 125357 :53 .ic: 01:- ;i; 3:E 17)77- r M , Exhibit A to Real Estate Excise Tax Affidavit Tax Parcel No. 502164046 THAT PORTION OF THE FOLLOWING DESCRIBED PROPERTY LYING EASTERLY OF MT. JUPITER ROAD: THAT PORTION OF THE NORTHEAST 1/4 OF THE SOUTHEAST 1/4 OF SECTION 16, TOWNSHIP 25 NORTH, RANGE 2 WEST, W.M., DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHEAST CORNER OF SAID SOUTHEAST 1/4 AND RUNNING THENCE NORTH 86°43'10"WEST ALONG THE NORTH LINE OF SAID SOUTHEAST 1/4 1,140.97 FEET TO A POINT 200 FEET EAST OF THE WEST LINE OF SAID NORTHEAST 1/4; THENCE SOUTH 1°24'04"WEST 200 FEET EAST OF AND PARALLEL TO THE WEST LINE OF THE SAID NORTHEAST 1/4 285 FEET; THENCE SOUTH 86°43'19"EAST 1,142.41 FEET TO THE EAST LINE OF SAID SOUTHEAST 1/4; THENCE NORTH 1°06'39"EAST 285 FEET ALONG SAID EAST LINE TO THE POINT OF BEGINNING EXCEPT MT. JUPITER COUNTY ROAD. SITUATE IN THE COUNTY OF JEFFERSON, STATE OF WASHINGTON.