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Revenue
Wat-rungton State
REAL ESTA IL EXCISE TAX AFFIDAVIT This fonn is your receipt
PLEASE TYPE OR PRINT C-I-LAP i ttt 8245 RCW-CHAPTER 458-61A WAC When stamped by cashier,
TIM At 1-10.4INIT%SILL NOT RE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(See back of lam page for rintrintions)
27 Check n box dpartsal sale of priserter _ Ifmultriple ownere,het perces:item of owner-JIM next t. ./.1.-ron scrrerl lel Name bOAV ei• 0 StLX 04/14tV A.be+-Itle-P.,s . . .. ,....i.
i .. . . _
/Oft, 297A A-141 1070/ 443 0 /au_ rufe.br.s ...________,
Mattson Addiess_. 1--• Nladieg Address
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N 1 corswazip bib/47iftor 1A44., #*--6- - -r- ..„.,„ , citv•stezipraiottAtAi'en.WA*,, .18-50 1
i I phoDeNo.(ineudin.area.code) .w(:-R.VT:7825_ __,......., . i tn.No.6.4....6 al1ea code)(-360)784211-)42-1-6-----=,--••----J.
0 ,_, . ______,_ ,,, ,,,._ _.. Lin all real and persona/property not parcel income
..cu a au property MX correspoenonec to: rime as enner...name= - -
earthen--check box epersonal property List&messed valuer,$) ,
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i 5.(e_51,41-0..1.q0 .3 • --0 I 3 aac)
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, Qtystatezip SAAre.,...a,eltAft.KM,.4.161w.,f ,
— 0 ,
Phone No (moluding area code) I _Vta.044.e...,..CMA/114 iii;) i 0 1
Iii 71Atee DV t4444,y- iy.r.)
ii Street address of property:,_ ,Zp., „ , .„„,„ ,, , „ ,,,,,,.„,„
This property is located Au g(tmintsaporated e„feiiteP,N _ _County OR:Within 0 cits-of
0 Check box slimy of the luted parcels are being segregated from another parcel,are part ole boundary line adjustment or parcels being merged.
Lentl description of proper. i. y( more space is needed,you mar attach a separate sheet to each page ofaffidavit)
i it Lir (14 N lt)1/iti /0111 TNT
)
/04-(,44 alni. V)/ 141-0.
5E Ak-ko.(\i\ Ar
laSelect Land Use Code(s): I,...y.2,...e) III List alt personal property(tangible and intangible)included in setting
_
enter any ad/intone!codes: '
(See back of last page for inetructions)
YES NO 1
Was the seller montane a property Mx exerognion or&finnan:aim 0 0 1
chapters 5436,54.37,or 8438 RCW(nonprofit arganization,senior
i
citizen or dimbled.person Instnemenernitit hunted
a' income)" l
„._ --,--- —
yEs N70 I If Maiming an exemption,hat WAC number and reason for exempts n:
c r-s
Is thitPrOPera.9 dreallInaft51 as totesd-Per chapter 5433 RCA?" 0 0 1 WAC No.(Section'Subeection) iii)15- \A_-af.DA 110 (k)
1.this pcoperty ciassified as=mat use(open space,fatm areS 0 £3 t
/Reason for exemption A.,C\
'minmitural,or timber)land pm chapter 8434 ROW"
per chapter 8426 ROW"
Marty answers are ye.t,'complete al illStiliCeed below 1 Type of Document ad ,,, I A 1 I"IN bper
a)NOTICE OFCONTENRIANCE(FOREST LA....-smoacuRfrecrusE) i
. .
NEW OWNER(S):To continue the current designation as forest land or V
classification as current use(open space,fann and agriculture,or tenter)Land, i
you
Gross Selling Price S „_ _ _most sign on(3)below The county assessor must then detention ifthe I
land transferred continues to Testify and will Indicate by signing below.If the iePeraonal Property(deduct) S,,
'hold no longer qualifies or you do not nidi to continue the doncit 1, Exemption Claimed 0 d .0 S
classification an
it will be removed d the compensating or addinorial team will !
be due and payable by the seller or transferee at the time of sale(RCW i Taxable SellIng Price S ,
8433,141)or ROW 8434.108).Prior to sinning(3)below,you*nay contact ; Excise Tax:State 5
your local county animism for more irSOMIZI10/1. I
I Local 9
This land 0 does 0 does not qualify for continuance. i
*Delinquent Interest:State $_ ,
Local S
_
DEPL'TY ASSESSOR DATE 1
*Delinquent Penalty S
(2)NOTICE OF COMPLLANCIE MOSTORIC PROPERTY) I
,
NEW OWNER(S):To continue special valuation as historic property_ Subtotal S
sign(3)below_If the new earnes(s)deers not wish to continue_all 1
*State Technology Fee S _ ..... ........5.00 _
additional tax calculated pursuant to chapter 84.26 ROW,shall be due and 1
/ St_Qp_
payable by the setter or transferor at the tune of sale, i *Affidavit Processing Pee 5
(3) OWNER(S)SIGNATURE 1 Total Due S 10-e0ID
< /
PREST NAME 1 A MINIMUM OF$10.00 IS DUE IN TEE(S)ANDIOR TAX
*SEE INSTRUCTIONS
I CE'Ri tr a UNDER PENALES OF PERJURE THAT THE FOREGOLNG LS iRtE AND CORRECT.
..„. Signature ofAegx,12._ Signature of ..jtive,4(:& tk._ f::sCc:;?x.t.t..___
NGrantor or Grantor's Agent / AT 4 , __ Grantee or Grxtautee,s Agent t.i =
4
Date di city of signing: .s...//ri 1 10
- C.;C Ace-12-0."---44 Date fir cite of signing: ..,,Y41-.1/10,4,,„21/11/40,Nler Wit ..585-0/.....
Perjury:Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a r"term of riat mare than five years,or by
_a fine in on amount fixed Iiij-_the court of not moire than five tbousand_dirDars(55,000,82),or_ltiv bottAissajnisoortanalt ar.d fine(LIC,W,A.2.0.02()(MI,_ ,._,.„, ,
' REV 24 iltOnla(922.15) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER
--.•,,.„:„.„ ,:f5.17.::-..7 C.,''i l'•:.'2D..,v... 1C.,C;C_.,:-' /a535
reea, State of Waskiageoga
==eons"TRa.n=1". REAL ESTATE EXCISE TAX
Scx 4,4-7 SUPPLEMENTAL STATEMENT
Of,,,•=pa 935C4-74-7
(W.4.0 45841A 304)
This form roust be submitted with the Real Estate Excise Tax Affidavit(FORM REV St C.1{301.A for deeded transfers and
Farm REV 34 000113 for controlling interest transfers)for claims of tax exemption as provided below.Completion of this form is
required for the types of real property transfers listed in numbers 1-3 below.Only the Ern page of this form needs original signatures.
AL-DIE Information you provide on this form is subject to audit by the Department of Revenue, in the event of an audit,it is the
taxpayers'responsibility to provide documentation to support the selling price or any exemption claimed. This documentation
must be maintained for a minimum of four years from date of sale.(RCW 82.45.100)Failure to provide supporting documentation
when requested may tenth in the assessment of tax,penalties,and interest Any filing that is determined to be franibilent will cany a.
50%evasion penalty in addition to arty other accrued penalties or interest when the tax is assessed.
PERTER.Y.Perjury is a class C felony which is punishable by imprisonment in a 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
(55,000.00),or by both itemnsoatnent end fine(P.CW 9A.20.020(IC)).
The persons signing below do hereby declare under penalty of perjury that the following is true(check enproprine statement):
1.0 DATE OF SA t,F:(WAC 45S-6/A-306(2))
(type of instrument),dated _,was delivered r' to me in escrowby(seller's name).NOTE:Agent named here must sign below and indicate name of firm.The payment of the tax is considered current if
it is not more than 90 days beyond the date shown on the instrument If it is past 90 days,interest and penalties apply to the date of the
instrument.
ReaS0115 held in escrow
Signature Firm Name
2. GIFTS;(WAC 453-61A-201)The gift of equity is non-taxable;however,any consideration received is not a gift and is taxable.The
value eitrbeneed or paid for equity plus the amount of debt equals the taxable amount.One of the boxes below must be checked
Both Grantor(seller)and Grantee(buyer)must sign below.
Grantor(seller)gifts equity valued at S to grantee(buyer).
NOTE:Examples of different transfer types are presided on the bark-This is to assist you with correctly completing
this form and paying your tax.
"Consideration"means money or anything value,either tangible(boats.motor homes,etc)or intangible,paid or delivered,or
contracted to be paid or delivered,including performance of unlaces,in return for the transfer of real property.The term inchides the
amount of any lien,mortgage,contract indebtedness,or other encumbrance,given to secure the purchase price,or any part thereof,or
reeneining unpaid on the property at the time of sale,"Consideration"includes the assumption of an underlying debt on the property
by the buyer at the time of transfer.
A, Gifts with consideration
1. 0 Grantor(seller)has made and will continue to make all payments after this transfer on the total debt of
(include in this figure the vahw of any items received in exchange for property).Arty consideration received by
grantor is taxable.
2. Li Grantee(buyer)will nuke payments on _nee of total debt of$ for which grantor(seller)
is liable and pay grantor(seller)S (include in this figure the value of any items received in
exchange for property).Any consideration received by grantor is taxable
B. Gifts without consideration
1. There is no debt on the property;Grantor(seller)has not received any consideration towards equity.
0- No tax is due.
2. 0 Grantor(seller)has made and will continue to make 100%of the payments on the total debt of S
and has not received any consideration towards equity.No tax is due.
3. 0 Grantee(buyer)has made and will continue to make 100%of the palm-lents on total debt of S
and has not paid grantor(seller)any consideration towards equity.No tax is due,
4. 0 Grantor(seller)and grantee(buyer)have made and will continue to metre payments from joint account on total
debt before and after the transfer,Grantee(buyer)has not paid grantor(seller)any consideration towards equity.
No tax is due,
Has there been or will there be a refinance of the debt? 0 YES 0 NO(If yes,please call(360)534-1503 to see if-this transfer is
taxable).If grantor(seller)was on title as co-signor only,please see WAC 45S-61A-21e for exemption requirements.
The undersigned acknowledge this transaction may be subject to audit and have read the above information regarding
record-keeping requirements and evasion penalties.
K . -de
14‘4"a- tLD41.41.1.7‘ —K11 *14.:1314714
Grantor's . 1 Grantee's Signature Date
eir Ai 6 f",,
, -
Grantor's Name(print) )(% ir iP Grantee's Name(prim) X • •
__Fee° fwv4,
3. 0 IRS"TAX DEFERRED"EX .'CEIA..'S'GE(A AC 455-61A-213) '14rite X 1:1:21 -SOLA4-11.10.I,(print(prim name) ,certify that lain acting as an Exchange Facilitator in transferring' real property
to
— pursuant to TRC Section 1031,and in accordance with WAC 458-61 A- /3.NOTE:Exchange
Facilitator must sign below.
Exchange Facilitator's Sienature
FOT ta5aztistano&contact your local County Treatureraecorder or visit Intp:-daraya.gover call(360)334-1303.To Inquire about the avaRabilny of the document in
an alternate lomat,please'call 1-800-647-7`706.Teletype(FTV)users may me the Washington Relay Serace by calling 7.1L
REV 8. tb it COUNTY ASSESSOR
a
The following undivided fractional interest being identified as the named Tenancy in Common
Interest in the herein described Time Share Unit(TSU)apartment(s),as a tenant-in-common
with the other fractional owners of the said TSU of the named condominium, intended only for
the stated use,according to Survey Map and Set of Plans recorded as noted(said Survey Map
setting forth delineating a description of the/and as provided in RCW 64.32.090(l)),and
according to Condominium Declaration recorded as noted;
TOGETHER WITH the stated Unit Percentage of undivided interest in the common areas and
facilities appertaining to said TSU Apartment(s)for the Phase noted;
SUBJECT TO,however,possible partial defeasance of this undivided interest upon inclusion of
any subject phase(s)(to the Condominium by recorded Amendment to the Declaration; and
together with that pro-rata portion of the Declarant's interest in the common areas and facilities
of the Property in any subsequently added phase(s)), if any;
All as expressly provided for in the Declaration,as it may be so amended or record;said Tenancy
in Common interest having a fractional percentage of undivided interest in the Common Area and
Facilities identified as the TSU Percentage;
INCLUDING the right to exclude occupancy and possession of said Apartment during the stated
Time Sharing pertod(s)(to the exclusion of all other tenants-in-common)as provided for and
defined in said declaration;
AND"IOGETHER WITH the use of those Limited Common Areas and Facilities, it any,
appertaining to said Apartment(s);
Condominium: Kala Point Village
Volume/Page: Volume 1 of Condominiums,pages 46 through 57, and Volume I, paces
97 through 101,and pages 119 through 121.
Records of: Jefferson County, Washington
Declaration and
Amendments Recorded on: June 5, 1978 and February 20, 1980
Recording Nos.: 250367,263587 and 275985, respectively
TSU Apartment No.: 14
Building No.: Building 13, Phase 2
Unit Percentage: 2.552%
Tenancy in Common: 11,2th Interest
Time Share Period:
TSU Percentage: .2127%