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HomeMy WebLinkAbout125366 Departptetit ofra -3ktick ' q 'Revenue q53 c. Wash/von Strite REAL ESTATE EXCISE TAX AFFIDAVIT PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC whhe form ouy cashier.eipt THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED n peddby (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. Bobby Briggance,Guardian of Dayle Miye Briggance pursuant to court order dated August 15,2008 in Name Clallam County Guardianship Cause No.07-4-00343-6I Name John Buday and Janet Buday,husband and wife w F Mailing Address 138 Shale Rd. x cc— ; .t7 z Mailing Address P.O.Box 1041 a City/State/Zip Port Angeles,WA 98362 au a City/State/Zip Lake Bay,WA 98349 'Phone No.(including area code) (832)633-0698 (.' Phone No.(including area code) (253)884-9349 ©Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal property tax parcel account numbers–check box if personal property List assessed value(s) Name John Buday&Janet Buday 984902602 0 $52,920.00 Mailing Address P.O.Box 1041 0 City/State/Zip Lake Bay,WA 98349 0 Phone No.(including area code) (253)884-9349 0 0 Street address of property: Lots 2&4,BIk 26,Maple&M Street,Port Townsend,WA 98368 This property is located in 0 unincorporated Jefferson County OR within®city of Port Townsend 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) Lots 2 and 4,Block 26,Pettygrove's First Addition to the City of Port Townsend,as per plat recorded in Volume 1 of Plats, page 36,records of Jefferson County,Washington. Situate in the County of Jefferson,State of Washington. ® Select Land Use Code(s): 8 List all personal property(tangible and intangible)included in selling 91 price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ 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 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 Bargain and Sale 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 2,2016 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 $ 59,500.00 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 $ 59,500.00 to signing(3)below,you may contact your local county assessor for more Excise Tax: State $ 761.60 information. This land 0 does 0 does not qualify for continuance. Local $ 297.50 *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 $ 1,059.10 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 $ 1,064.10 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® I CERTIFY UND r" NALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of t �•- Signature of Grantor or Grantor's Agent ir_ .''' Grantee or Grantee's Agent Name(print) Dayle M It Briggance, Guardian -,A-- , Name(print) John Buday Date&city of signing: �4�%IS �� ate&city of signing: Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional instit!'tion 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)). 44 75 3:; 29- 4 *5 : ,_,,:;u._ ,;.t. i nig SPACE—TREASURER'S USE ONLY COUNTY TREASURER RevDe'ue re) t Washington State REAL.ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 8145 RCW•-CHAPTER 458-61 A 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) I0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. Bobby Briggance,Guardian of Dayle Miye Briggance pursuant to court order dated August 15,2008 in Name Clailam County Cuarditnship Cause No.07-4-00343-6 Name John Buday and Janet Buday,husband and wife .-�g Mailing Address 138 Shale Rd. i Mailing Address P.O.Box 1041 d City/State/Zip Port Angeles,WA 98362 m a City/State/Zip Lake Bay,WA 98349 6 Phone No.(including arca code) (832)633-0698 c.Phone No.(including area code) (253)884-9349 1111 Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) s numbers• check box if personal property ro() Name John Buday&Janet Buday _984902602 0 852,920.00 s' Mailing Address P.O.Box 1041 0 City/State/Zip Lake Bay,WA 98349 0 Phone No.(including area code) (253)884-9349 0 U Street address of property: Lots 2&4,Blk 26,Maple&M Street,Port Townsend,WA 98368 This property is located in 0 unincorporated Jefferson County OR within®city of Port Townsend 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) Lots 2 and 4,Block 26,Pettygrove's First Addition to the City of Port Townsend,as per plat recorded in Volume I of Plats, page 36,records of Jefferson County,Washington. Situate in the Count of Jefferson State of Washin i n. s Select Land Use Code(s): ' List all personal property(tangible and intangible)included in selling 91 price. enter any additional codes: (See back of last page for instructions) Is this property exempt fromtaxYES NO 84.36 RCW(nonprofitproperty perrma ❑ Egl { p organization)? ei YES NO If claiming an exemption,list WAC number and reason for exemption: Is this property designated as forest land per chapter 8433 RCW? 0 0 WAC No.(Section/Subsection) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? 0 ® Reason for exemption Is this property receivingal valuation as historical 0 fa Property ler chapter 84.26 RC If any answers are yes,complete as instructed below. (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Typo of Document Bargain and Sale 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 2,2016 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 $ 59,500.00 sa�ntinthe below. If the land no longer qualifies or you do not wish to *personal Property(deduct) $ 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 $ 59,500.00 to signing(3)below,you may contact your local county assessor for more information. Excise Tax: State S 761.60 This land 0 does 0 does not qualify for continuance. Local $ 297.50 *Delinquent Interest: State $ DEPUTY ASSESSOR DATE Local S (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) 'Delinquent Penalty $ NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 1,059.10 sign(3)below. If the new owner(s)does not wish to continue,all *State Technology5.00 additional tax calculated pursuant to chapter 84.26 RCW.shall be due Fee $and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee S (3)OWNER(S)SIGNATURE Total Due $ 1,064.10 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS a 'CERTIFY UNDER PENALTY OF PERJURY THAT T HE FOREGOING IS TRUE AND CORRECT. Signature of Signature of / Grantor or Grantor's Agent Grantee or Grantee's Agent �/ "y Name(print) Dayle Miyt Brigganec,Guardian Name(print) John Buday /• Date&city of signing: Date&city of signing: s„4-11://7X Lq/1.--1 / 1-4. 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 fate(RCW 9A.20.020(IC)). REV 84 0001a(2/28/13) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER a