HomeMy WebLinkAbout125359 Nt I
Department of
Revenue 6)S 3 5
Washington State C
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.
111 Port Ludlow Associates,LLC,a Washington limited
Name liability company Name Robert Davis IV and Larina Davis,husband and wife
wC Mailing Address 70 Breaker Lane Mailing Address 2339 Fairview Ave East
44't City/State/Zip Port Ludlow,WA 98365 a City/State/Zip Seattle,WA 98102
ea Phone No.(including area code) (360)437-2101
Phone No.(including area code) (206)860-3131
II Send all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal property tax parcel account
numbers—check box if personal property List assessed value(s)
Name Robert Davis IV&Larina Davis 968900014 ❑ $185,000.00
Mailing Address 2339 Fairview Ave East ❑
City/State/Zip Seattle,WA 98102 0
Phone No.(including area code) (206)860-3131 ❑
0 Street address of property: 194 Anchor Ln,Port Ludlow,WA 98365
This property is located in®unincorporated Jefferson County OR within 0 city of Port Ludlow
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)
Lot 14 of Ludlow Cove Division 2,as per plat recorded in Volume 8 of Plats,pages 112 through 116,records of Jefferson
County,Washington.
Situate in the County of Jefferson,State of Washington.
® Select Land Use Code(s): 0 List all personal property(tangible and intangible)included in selling
10 price.
enter any additional codes:
(See back of last page for instructions)
YES NO
Is this property exempt from property tax per chapter ❑
El
84.36 RCW(nonprofit organization)?
0 YES NO If claiming an exemption,list WAC number and reason for exemption:
Is this property designated as forest land per chapter 84.33 RCW? 0 ® WAC No.(Section/Subsection)
Is this property classified as current use(open space,farm and
agricultural,or timber)land per chapter 84.34? Reason for exemption
Is this property receiving special valuation as historical 0 IZ
property per chapter 84.26 RCW?
If any answers are yes,complete as instructed below.
(1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Statutory Warranty Deed
NEW OWNER(S): To continue the current designation as forest land or
classification as current use(open space,farm and agriculture,or timber) Date of Document May 9,2016
land, you must sign on (3) below. The county assessor must then
determine if the land transferred continues to qualify and will indicate by Gross Selling Price $ 537,000.00
signing below. If the land no longer qualifies or you do not wish to *personal Property(deduct) $
continue the designation or classification, it will be removed and the
compensating or additional taxes will be due and payable by the seller or Exemption Claimed(deduct) $ No
transferor at the time of sale. (RCW 84.33.140 or RCW 84.34.108).Prior Taxable Selling Price $ 537,000.00
to signing(3)below,you may contact your local county assessor for more Excise Tax: State $ 6,873.60
information.
This land ❑does ❑does not qualify for continuance. Local $ 2,685.00
*Delinquent Interest: State $
DEPUTY ASSESSOR DATE Local $
(2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $
NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 9,558.60
sign (3) below. If the new owner(s) does not wish to continue, all
additional tax calculated pursuant to chapter 84.26 RCW,shall be due *State Technology Fee $ 5.00
and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $
(3) OWNER(S)SIGNATURE Total Due $ 9,563.60
PRINT NAME A MINIMUM OF$10.00 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 Signature of �' ��
Grantor or Grantor's Agent �Z'I4 bt.4 4
Grantee or Grantee's Agent
Name(print) Diana Smeland,President Name(print) S fv S a..ppK,
Date&city of signing: 5--(/— 7 1 tT £ / diAr Date&city of signing: 05 • (1• 20
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(IC)).
75t:;290 ± COUNTY TR
EASURER
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