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REAL ESTATE EXCISE TAX AFFIDAVIT
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 COMPLETED ped by 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.
Robert M.Erickson and Cindy L.Erickson,as Trustees
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Name wife ord Parsons and Juana Tingdale,husband and
of The Robert M.Erickson and Cindy L.Erickson
Name Revocable Living Trust dated September 17,]988 1g.* CA4--
a
„,a41Mailing Address 472 S State St.#103 a: Mailing Address 25 Sea Vista Place
w a City/State/Zip Bellingham,WA 98225 ea a City/State/Zip Port Ludlow,WA 98365 4 i 5cjkj
a Phone No.(including area code) (360)933-1267
Phone No.(including area code) (936)697-0038
111 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)
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Robert M.Erickson and Cindy L.Erickson,as
Trustees of The Robert M.Erickson and Cindy L.
_ ,,/ Erickson Revocable Living Trust dated September 17,
���//J"'
p Jl/ Name & 1 Cli' 989600012 0 $96,000.00
Mailing Address 25 Sea Vista Place
City/State/Zip Port Ludlow,WA 98365 3" 2,6-2- ❑
o
Phone No.(including area code) (936)697-00380
0 Street address of property: 0-Lot 12 Prospect Avenue,Port Townsend,WA 98368
This property is located in®unincorporated Jefferson CountyOR within 0 cityof
Port Townsend
❑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 12 of Prospect View Estates,as recorded in Volume 17 of Surveys,pages 22 through 24,being a survey of portions of plat
of Irondale Division 6,as per plat recorded in Volume 2 of Plats,page 139,records of Jefferson County,Washington.
Situate in the County of Jefferson,State of Washington.
® Select Land Use Code(s):
91 Q List all personal property(tangible and intangible)included in selling
price.
enter any additional codes:
(See back of last page for instructions)
YES NOIs this propertyexem t from propertytaxPer 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 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
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 5,2016
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 $ 67,500.00
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 $ 67 500.00
to signing(3)below,you may contact your local county assessor for more
information. Excise Tax: State $ 864.00
This land 0 does 0 does not qualify for continuance. Local $ 337.50
*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 $ 1,201.50
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 $ 1,206.50
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 Grantee or Grantee's Agent
Name(print) Juana Tingdale Name(print) Robert M.Erickson,Trustee
Date&city of signing: S -L;" —tAo kibsctWal„,, 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(IC)).
755526 125414 *5/19/2016 1 ,206.50* j
RER S USE ONLY COUNTY TREASURER
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