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Revenue 11 REAL ESTATE EXCISE TAX AFFIDAVIT V
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This form is your receipt
PLEASE TYPE OR PRINT CHAPTER 82.45 RCW-CHAPTER 458-6)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)
0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name
® Name: Tammy L.Sukert,as her separate estate Name: Tammy L.Sukert and Henry A.Sukert,wife and
husband
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z Mailing Address 2241 Hastings Ave W Mailing Address 2241 Hastings Ave W
vCity/State/Zip Port Townsend,WA 98368 m 4 City/state/zip Port Townsend,WA 98368
Phone No.(including area code) j Phone No.(including area code)
Send all property tax correspondence to: [j Same as Buyer'Grantee List all mat and personal property tax parcel account List assessed value(s)
numbers-check he if persoonaall pro _.r"}
Name 0010540221Ib c rn ✓l s/�1(J�►./1)
Mailing Address -._ x � / n
City/Stata'Zip '„ ...1'".) ,pl`,p n
Phone No.(including area code) /0
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EN Street address of property: 2241 Hastings Ave W,Port Townsend,WA 98368
This property is located in 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)
The land referred to in this Commitment is located in the County of Jefferson,State of WA,and described as follows:A
portion of the Southeast 1/4 of the Northwest 1/4 of the Southeast'/a of Section 5,Township 30 North,Range 1 West,
W.M.,and a portion of Block 23 of the Syndicate Addition to Port Townsend as per Volume 1 of Plats,page 106,
records of Jefferson County,Washington described as follows:Commencing at the Northwest corner of said Southeast
1/4 of the Northwest 1/4 of the Southeast'/.;thence South 2°45'29"West along the West line of said subdivision 55.02
feet to the South right-of-way of West Hastings Avenue;thence South 88°08'03"East along said right-of-way 10.00
feet to the True Point of Beginning for this description;thence continuing along said South right-of-way South 88°08'
03"East 176.14 feet;thence South 3°19'59"East 502.11 feet to a fence line;thence South 28°53'44"West along
said fence line 63.44 feet;thence South 30 10'33"West along said fence 319.11 feet to the South line of said Block
23;thence North 87°18'27"West along said South line 194.13 feet to the Southwest corner of said Block23;thence
North 2°45'29"East along the West line of said Block 23 a distance of 277.01 feet to the Northwest corner of said
Block 23;thence North 87°27'28"West 5.00 feet;thence North 2°45'29"East 595.82 feet to the True Point of
Be•innin'.Situate in the Coun of Jefferson State of Washin•ton
5 Select Land Use Code(s): 7 List all personal property(tangible and intangible)included in selling
11 I price.
enter any additional codes:
(See back of last page of instructions) YES NO
Was the seller receiving a property tax exemption or defenal
under chapters 64.36,84.37,or 84.38 RCW(nonprofit
organization,senior citizen,or disabled person,homeowner with
limited income)?
6 YES NO If claiming an exemption,list WAC number and reason for exerrrption:
Is this property designated as forest land per chapter 84.33 RCW?nLig
Is this property classified as current use(open space,farm and ❑ M WAC No.(Section/Subsection) 458-61A-203(1)
agricultural,or timber)land per Chapter 84.34 RCW?
Is this property receiving special valuation as historical property n 0 Reason for exemption To Create Community Property
per chapter 8426 RCW?
If any answers are yes,complete as instructed below.
(I)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Quit Claim Deed
NEW OWNER(S): To continue the current designation as forest land or
classification as current use(open space,farm and agriculture,or timber)land,you Date of Document May 12,2016
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 land no Gross Selling Price $ 0.00
longer qualifies or you do not wish to continue the designation or classification,it 'Personal Property(deduct) S 0.00
will he removed and the compensating or additional taxes will be due and payable Exemption Claimed(deduct) S 0.00
by the seller or transferor at the time of sale. (RCW 84.33.140 or RCW
84.34.108). Prior to signing(3)below,you may contact your local county assessor Taxable Selling Price S 0.00
for more information. r Excise Tax : State 5 0.00
L__7
This land does does not qualify for continuance. 1 0.00 1 Local S 0.00
*Delinquent Interest: State S 0.00
DEPUTY ASSESSOR DATE Local S 0.00
(2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty S 0.00
NEW OWNER(S):To continue special valuation as historic property,sign(3) Subtotal $ 0.00
below. Rare new owner(s)does not wish to continue,all additional tax calculated
pursuant to chapter 8426 RCW,shall be due and payable by the seller or transferor *State Technology Fee 5 5.00
at the time of sale. *Affidavit Processing Fcc S _ 5.00
(3)OWNER(S)SIGNATURE Total Duc S 10.00
PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX
*SEE INSTRUCTIONS
n t C RTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE�NI)CORRECT.
Signature of Signature of 1.5
Grantor or Grantor's Grantee or Grantee's Agen 4
Name(print) Tammy L Sukert Lr J"Name(print) Henry A.Sukertert
�l e - �^—'�J\
1111
Date&city of signing: S—13 Port Townsend Date&city of signing: J, — L( Port Townsend
Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a rnaxitnum terns 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)).