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HomeMy WebLinkAbout125412 Department of evenue et'S 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) ['Check box if partial sale of property If multiple owners,list percentage of ownership next to name. II Name Quality Loan Service Corp.of Washington © Name CITIGROUP MORTGAGE LOAN TRUST INC.ASSET-BACKED x o 5kvei /�?�tey Ref hQ/Z7 w c/o CitiMortgage, Inc az Mailing Address 108 1st Ave.South,Suite 202 z Mailing Address 1000 Technology Drive MS 92 VA City/State/Zip Seattle,WA 98104 City/State/Zip O'Fallon,MO 63368 -1?1-)4:'\ Phone No.(including area code) Phone No.(including area code) ® Send all property tax correspondence to:❑✓ Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value numbers-check box if personal property Name A.P.N.: 43686/999003602 Uyrc� Mailing Address n City/State/Zip n Phone No.(including area code) n © Street address of property: 65 ELM STREET PORT TOWNSEND.WA 98368 This property is located in Jefferson County 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 NORTH 100 FEET OF LOTS 1,2 AND 3 IN BLOCK 36 OF CAPTAIN TIBBAL'S LAKE PARK,AS PER PLAT RECORDED IN VOLUME 2 OF PLATS,PAGE 3, RECORDS OF JEFFERSON COUNTY,WASHINGTON; TOGETHER WITH THAT PORTION OF VACATED MAPLE STREET ADJOINING,PURSUANT TO ORDINANCE RECORDED AUGUST 31, 1992,UNDER AUDITOR'S FILE NO.352880,WHICH,UPON VACATED,ATTACHED TO SAID PROPERTY BY OPERATION OF LAW.SITUATE IN THE COUNTY OF JEFFERSON,STATE OF WASHINGTON:*PASS-THROUGH CERTIFICATES,SERIES 2007-AMC4,U.S BANK NATIONAL ASSOCIATION AS TRUSTEE ASelect Land Use Code(s): List all personal property(tangible and intangible)included in selling 11-Household,single family units price. enter any additional codes: -0- (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ 0 84.36 RCW(nonprofit organization)? © 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 Is this property classified as current use(open space,farm and ❑ ❑✓ WAC No. (Section/Subsection) 458-61A-208(4) agricultural,or timber)land per chapter 84.34? Reason for exemption Is this property receiving special valuation as historical property ❑ ❑✓ Foreclosure of Deed of Trust-519608 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 Trustees Deed Upon Sale 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 5/4/16 land,you must sign on(3)below.The county assessor must then determine 179,200.00 if the land transferred continues to qualify and will indicate by signing below. Gross Selling Price $ If the land no longer qualifies or you do not wish to continue the designation *Personal Property (deduct) $ or classification,it will be removed and the compensating or additional taxes Exemption Claimed(deduct) $ 179,200.00 will be due and payable 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 Taxable Selling Price $ 0.00 your local county assessor for more information. Excise Tax : State $ 0.00 This land 0 does ❑does not qualify for continuance. 0.0050 Local $ 0.00 *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, sign(3)below.If the new owner(s)does not wish to continue,all Subtotal $ 0.00 additional tax calculated pursuant to chapter 84.26 RCW,shall be due *State TechnologyFee $ 5.00 and payable by the seller or transferor at the time of sale. (3) OWNER(S)SIGNATURE *Affidavit Processing Fee $ Total Due $ 10.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS I CERT UNDER PENALTY F PERJURY THAT THE FOREGOING IS TRUE AN P CORRECT. Signature of • Signature of Grantor or Grantor's Agent ` _ Grantee or Grantee's Agent . . L'di• Name(print) Janice Stavee Name(print) SIERRA HERBERT WEST Date&city of signing: 5/4/16 Seattle Date&city of signing: 5/4/16 SEATTLE 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)). REV 84 0001ae(5/31/11) THIS SPACE-TREASURER'S USE ONLY DEPT. OF REVENUE "755515 .2_'412 *5/18,i:2016 10.0!_.*. �Z� t2