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HomeMy WebLinkAbout125418 Department ofrc P)-1 tet 11,1 IC c.,)Revenue Washington State t£7..t,L t" 1 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) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. 0 Name David Bauman En Name David Bauman and Camille Bauman a u_ " a 2 Mailing Address 9575 Radcliffe NE Mailing Address 9575 Radcliffe NE w< City/State/Zip Bremerton,WA 98311, CO <City/State/Zip Bremerton,WA 98311 _ `i ,-.,'1 t" Phone No.(including area code) 719-460-2774 Phone No.(including area code) (719)460-2774 111 Send all roe tax correspondence to: Same as Buyer/Grantee List all real and personal property tax parcel account property rtY p ❑ y numbers—check box if personal property List assessed value(s) Name David Bauman and Camille Bauman 983 400 310,983 400 311 0 n"►'/Z„jo— Mailing Address 9575 Radcliffe NE ❑ ' 1-3 �' City/State/Zip Bremerton,WA 98311 0 Phone No.(including area code) (719)460-2774 ❑ ©Street address of property: 30 W Cedar St,Port Ludlow,WA 98365 This property is located in�unincorporated Jefferson County OR within El 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) Lots 11 and 12, Block 3 of Paradise Bay Estates,as per plat recorded in Volume 4 of Plats, page 5, 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 price. enter any additional codes: (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral ❑ El under chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? IIIIYES NO If claiming an exemption,list WAC number and reason for exemption: Isthis property designated as forest land per chapter 84.33 RCW? El ® �_ L ) 2— � WAC No.(Section/Subsection) _,tD ,G Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® Reason for exemption CA.t'c L k' C_ ymCWM�1, 1:14 1 Is this property receiving special valuation as historical ID ® U ",,.f,�1 n 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 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) Date of Document 5—) ~ -D 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 $ 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) $ transferor at the time of sale. (RCW 84.33.140 or RCW 84.34.108),Prior Taxable Selling Price $ to signing(3)below,you may contact your local county assessor for more Excise Tax: State $ information. This land El does ❑does not qualify for continuance. Local $ *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 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 $ 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 „, iI Grantor or Grantor's Agent ,,,, .( -yyn, -y.� Grantee or Grantee's Agent eU1VA•X/`-' C,(,UIJNL(7.N`_ Name(print) David Bauman Name(print) Camille Bauman Date&city of signing: 6”--/L-,20/4- &2 6.6c, k//4 Date&city of signing: 5"I(.a I (L+ Po t S b') k,--)A 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)). --R'S USE ONLY COUNTY TREASURER 7t-7;5547 1 e1 - - 10 O D 12A-0g 1,,,