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Home My WebLink About125413 Department of -� Revenue Washington State REAL ESTATE EXCISE TAX AFFIDAVITt L j 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. aName Northwest Trustee Services,Inc. IIII Name Federal National Mortgage Association xo - _ / Ic/I'i0/ a z Mailing •dress PO Box 997 H Mailing Address PO BOX 650043 w 8 City/State/Zip Bellevue,WA 98009-0997 City/State/Zip Dallas,TX 75265 Phone No.(including area code) Phone No.(including area code) (800)732-6643 © Send all property tax correspondence to:❑✓ Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers-check box if personal property Name 962 900 010: l $145,934.00 Mailing Address n City/State/Zip n Phone No.(including area code) n 111 Street address of property: 164 1st Street,Port Hadlock.WA,98339 (Jefferson County) This property is located in Port Hadlock 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) Lot 10,Irondale Heights Long Plat as per Plat recorded in Volume 7 of Plats,Page 131,Records of Jefferson County,Washington. Situate in the County of Jefferson,State of Washington. ® Select Land Use Code(s): 0 List all personal property(tangible and intangible)included in selling 11-Household,single family units price. enter any additional codes: None (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 0 ❑✓ WAC No. (Section/Subsection) 458-61 A-208(4) agricultural,or timber)land per chapter 84.34? Reason for exemption Is this property receiving special valuation as historical property ❑ ❑✓ Foreclosure-Deed of Trust#513070 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 Trustee's 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, Date of Document 5/16/16 you must sign on(3)below.The county assessor must then determine if the Gross Selling Price $ 169,910.46 land transferred continues to qualify and will indicate by signing below.If the land no longer qualifies or you do not wish to continue the designation or *Personal Property (deduct) $ 0.00 classification,it will be removed and the compensating or additional taxes will Exemption Claimed(deduct) $ 169,910.46 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 0 does not qualify for continuance. 0.0000 Local $ 0.00 *Delinquent Interest: State $ 0.00 DEPUTY ASSESSOR DATE Local $ 0.00 (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ 0.00 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 and *State Technology Fee $ 5.00 payable by the seller,or transferor at the time of sale. (3) OWNER(S)SIGNATURE *Affidavit Processing Fee $ 5.00 1 ` Total Due, $ 10.00 PRINT NAME A MINIMUM OF$10.00 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 r ' Grantee or Grantee's Agent Name(print) Northwest Trustee Services,Inc. Nyla Bivens Name(print) Northwest Trustee Services,Inc. Nyla Bivens Date&city of signing: 05/16/2016,Bellevue,WA Date&city of signing: 05/16/2016,Bellevue,WA 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 0001ae(9/2/11) THIS SPACE-TREASURER'S USE ONLY DEPT.OF REVENUE 1xL1122