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HomeMy WebLinkAbout125419 '- l�� --> 0epalimerlt of Jl Revere .( `1'S_y 2 Washington State 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. John S.Poehlman and Rita Poehlman,husband and Joseph J.Ahladis and Elizabeth A.Ahladis,husband II Name wife Name and wife a w F Mailing Address 12404 NE 112th Street x w a z Mailing Address 10650 NE 9th Place,Unit 2325 w a City/State/Zip Vancouver,WA 98682 01 a City/State/Zip Bellevue,WA 98004 t e 'r C.Phone No.(including area code) (360)907-8103 t7 Phone No.(including area code) IIISend 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) Name Joseph J.Ahladis&Elizabeth A.Ahladis 951500202 0 $174,900.00 Mailing Address 10650 NE 9th Place,Unit 2325 0 City/State/Zip Bellevue,WA 98004 0 Phone No.(including area code) 0 ©Street address of property: 60-B Fariway Lane,Port Ludlow,WA 98365 This property is located in 0 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) Unit 2-B Fairway Village a condominium,according to the declaration thereof,recorded under Jefferson County Recording No. 338531 and amendments thereto. Situate in the County of Jefferson, Sate of Washington. ® Select Land Use Code(s): Q List all personal property(tangible and intangible)included in selling 14 price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ 84.36 RCW(nonprofit organization)? El 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 Igi 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 CEI 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 $ 235 000.00 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 $ 235 000.00 to signing(3)below,you may contact your local county assessor for more information. Excise Tax: State $ 3,008.00 This land 0 does 0 does not qualify for continuance. Local $ 1,175.00 *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 $ 4,183.00 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 $ 4,188.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of —71 --- 4-L Grantor or Grantor's Agent (ir4Grantee or Grantee's Agent Name(print) John S.Poehlman Name(print) Joseph J.Ahl is Date&city of signing: _„ _ L/j Date&city of signing: C./$` (. T:80± .. d Pt CAA%CP iIj/r 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)). ', 5.54: 1 i4 i 9 :f.5 ` ; 0 6 4, __ .+=i' COUNTY TREASURER