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HomeMy WebLinkAbout125411 flonfell . .,, ova '.t I ila4$00:$ . REAL ESTATE EXCISE TAX AFFIDAVIT ,(s y PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC This form is your receipt THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPwhen LETED ped by cashier, (See back of last page for instructions) 0 Check box if•sinal sale of•ro, If multi•Ie owners,list,ercen :_e of ownershi next to name. Jeffrey Lynn Kilpatrick and Denise Marie Kilpatrick, husband and wife,as joint tenants with rights of I Name Steven P.Gross Trustee of the Steven P.Gross Trust 2 Name communi ysurvivorship and not as tenants in common or ty property a aMailing Address 90 Admiralty Lane#346 x w w a City/State/Zip Port Ludlow,WA 98365 Mailing Address 40853 Bucharest Lane an a City/State/Zip Temecula,CA 92591 t? }L L Phone No.(including area code) (360)437-5110 �Phone No.(including area code) (951)704-4111 II 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 val ue(s) Name Jeffrey Lynn Kilpatrick&Denise Marie Kilpatrick 990300216 Mailing Address 40853 Bucharest Lane 0 $264,500.00 City/State/Zip Temecula,CA 92591 0 Phone No.(including area code) (951)704-4111 0 0 ©Street address of property: 90 Admiralty Lane#346,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) FULLY DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. ® Select Land Use Code(s): 0 List all personal 14 property(tangible and intangible)included in selling price. enter any additional codes: (See back of last page for instructions) Is this property exempt from property tax per chapterYES NO Eg 84.36 RCW(nonprofit organization)? ❑ 1111 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 El Is this property classified as current use(open space,farm and WAC No.(Section/Subsection) agricultural,or timber)land per chapter 84.34? ❑ ® Reason for exemption Is this property receiving special valuation as historical 0 181 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 12,2016 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 $ 339 000.00 signing below. Iff the land no longer qualifies 11'byeou do removed not and the to *Personal Property(deduct) $ continue the designation or classification, 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 $ 339 000.00 to signing(3)below,you may contact your local county assessor for more , information. Excise Tax: State $ 4,339.20 This land ❑does 0 does not qualify for continuance. Local $ 1,695.00 *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 $ sign (3) below. If the new owner(s) does not wish to continue, all 6,034.20 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 $ 6,039.20 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® I CERTIFY UNDER P • !i F PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. ►� �� Signature of1 Signature of Grantor or Grantor's Agent i Grantee or Grantee's Agent Steven P.Gr,ss, rust- if the Name(print) Steven P.Gross Trust Name(print) Jeffrey Lynn Kilpatrick Date&city of signing: 5-- 1 1 - 1. V ?o AA-17w Ji iv e Date&city of signing: 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)). 755514 12 4 � _1 E; 2 0 I: �,, .T; 2at , COUNTY TREASURER 12cLlt Depaent of Revenue rea Washington State REAL ESTATE EXCISE TAX AFFIDAVIT PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61 A WAC Thwhe form your cashi hie THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED stampedn cashier. (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. Jeffrey Lynn Kilpatrick and Denise Marie Kilpatrick, husband and wife,as joint tenants with rights of Name Steven P.Gross,Trustee of the Steven P.Gross Trust Name scommunityp and not as tenants in common or ty property w Mailing Address 90 Admiralty Lane#346 -� ° Mailing Address 40853 Bucharest Lane H City/State/Zip Port Ludlow,WA 98365 m City/State/zip Temecula,CA 92591 Phone No.(including area code) (360)437-5110 L Phone No.(including area code) (951)704-4111 Send all property tax correspondence to:0 Same as Buyer/Grantee List all� tonal prop�y�l account List assessed valu numbers-dteck box if personal property efs) Name Jeffrey Lynn Kilpatrick&Denise Marie Kilpatrick 990300216 0 $264,500.00 Mailing Address 40853 Bucharest Lane 0 City/State/Zip Temecula,CA 92591 0 Phone No.(including area code) (951)704-4111 0 •Street address of property: 90 Admiralty Lane#346,Port Ludlow,WA 98365 This property is located in®unincorporated Jefferson County OR within 0 city of Port Ludlow ❑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) FULLY DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. ® Select Land Use Code(s): ® List all personal property(tangible and intangible)included in selling 14 price. enter any additional codes: (See back of lest page for instructions) Is this property exempt from property tax per chapter YES NO Eg 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 1811 property per chapter 84.26 RC 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 12,2016 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 $ 339,000.00 sontingee ellow. If land no longer qualifies or you do not wish to *Personal Property(deduct) $ designation on, 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 8434.108).Prior Taxable Selling Price $ 339,000.00 to signing(3)below,you may contact your local county assessor for more information. Excise Tax: State $ 4,339.20 This land 0 does 0 does not qualify for continuance. Local $ 1,695.00 *Delinquent Interest: State S DEPUTY ASSESSOR DATE Local $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 6,034.20 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) OWNERS)SIGNATURE Total Due $ 6,039.20 PRINT NAME A MINIMUM OF SI0.00 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 Grantee or Grantee's Agent5,Y,--I/ . Steven P.Gross,Trustee of the Name(print) Steven P.Gross Trust Name(print) Jeffrey Lynn Kit.atrick & Datecity of signing: Date&city of signing: �G L✓ s`-�C7 , r' /-/-5,(X. 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)). REV 84 0001a(2/28/13) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER i p EXHIBIT "A" Apartment No.P,a residential apartment of Admiralty No.2,according to survey and set of plans thereof filed under Auditor's File No.229492,recorded in Volume 1 of Condominium Plans,pages 31 through 39 inclusive; TOGETHER WITH 4.64 percentage of undivided interest in common and limited common areas and facilities appurtenant thereto as described in the Declaration of Condominium under the Horizontal Property Condominium Regimes Act of the State of Washington as recorded on the 28th day of July 1975,under Auditor's File No.229492,and as amended by Auditor's File No.235404,both records of Jefferson County,Washington. Situate in the County of Jefferson,State of Washington.