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Home My WebLink About125420 WashOrtortState REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt J L/i PLEASE TYPE OR PRINT when stamped by cashier. CHAPTER 82.45 RCW—CHAPTER 458-61A WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED (See back of last page for instructions) File No.82156.1MM 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name I. Name Eric Lutzker and Alicia Moffat,husband and wife Name Donna Imes and Terry Imes,wife and husband w O Mailing Address 6255 Palatine Ave N w F Mailing Address 723 Johnson Rd wCity/State/Zip Seattle,WA 98103 .' City/State/Zip Onalaska,WA 98570 c7 co Phone No.(including area code) (206)601-3813 c Phone No.(including area code) (360)880-1122 3. Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s) numbers—check box if personal property Name Donna Imes and Terry Imes 601 354 006/16126 0 $133,882.00 Mailing Address 723 Johnson Rd Tek .—I 0 City/State/Zip Onalaska,WA 98570 i^ let y #/ (2 .`/Sch-p Phone No.(including area code) (360)880-1122 0 Q�t./ MIStreet address of property: 65 Turnagain Ln,Quilcene,WA 98376 Y This Property is located in 1 unincorporated Jefferson County OR within 0 city of Quilcene ❑Check box if any of the listed parcels are being segregated from a larger parcel,are part of 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) SEE EXHIBIT"A" ATTACHED HERETO AND MADE A PART HEREOF FOR COMPLETE LEGAL DESCRIPTION ® Select Land Use Code(s): 91 ® List all personal property(tangible and intangible)included in selling price. Enter any additional codes: (See back of last page for instructions) ' ' Was the seller receiving a property tax exemption or YES NO deferral under chapters 84.36,84.37 or 84.38 RCW (nonprofit organization,senior citizen,or disabled person, homeowners with limited income)? 0 x ® YES NO Is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption: RCW? 0 El Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® WAC No.(Section/Subsection) Is this property receiving special valuation as historical ❑ ® property per chapter 84.26 RCW? Reason for exemption If any answers are yes,complete as instructed below. Type of Document Statutory Warranty Deed (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S): To continue the current designation as forest land or Date of Document May 12,2016 classification as current use (open space, farm and agriculture, or timber) land,you must sign on(3)below. The county assessor must then determine if the land transferred continues to qualify and will indicate by signing below. Gross Selling Price $ 145,000.00 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 will be due and payable by the seller or transferor at the time of sale. (RCW Exemption Claimed(deduct) $ No 84.33.140 or RCW 84.34.108). Prior to signing(3)below, you may contact your local county assessor for more information. Taxable Selling Price $ 145,000.00 Excise Tax: State $ 1,856.00 This land 0 does ®does not qualify for continuance Local $ 725.00 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 2,581.00 sign(3)below. If the new owner(s)do not wish to continue,all *State Technology Fee $ 5.00 additional tax calculated pursuant to chapter 84.26 RCW,shall be due and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ (3) OWNERS)SIGNATURE Total Due $ 2,586.00 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 ofSignature of Grantor or Grantor's Agent �,, Grantee or Grantee's Agent Name(print) Eric Lutz r Name(print) Donna Imes Date&city of signing: c) /1Sfi\-41e)VAI Date&city of signing Perjury: Perjury is a class 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 0001a(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER 115020 . enue REAL ESTATE EXCISE TAX AFFIDAVIT Toto orm vs soure‘Croi PI FAST TYPE OR PRIN I' when stamped by cashier CHAPTER 82.45 RCW-CHAPTER 458-6 IA WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED tF.ee back of Lou page for instructional Fik No.K2.1.51,1b1S1 Q Check box if punial sole of propeny If multiple OWneN,III.I.L.reentalp.,of ownership neat to name , Erie 1.90,Iter ond Midi morist.ImilAInd and*ik 1111[— .!.. Name Poona Inirs*rid Tern'Imes,vette an Ii_d___Efts# ', cc ,111°61bV-- ,.1N7e:nti'..m,,,Idre...s 6255 Palatine Ave.N ,es'12 Mailing Address 723 Johnson Rd —1 k, <1 Ciry/SimefZip Seattle,WA 98103 --)'S City/Slate/Zip Onalaska.WA 98570 az L. Phone Nn(including area code) (206)901-381 3 .c... Plume No.timflurling area code) (360)8$0-1122 _ - • - Send all property tax corrucpendence to 0"Same as Buyealnuitee LiSUall rt--al and personal i"ax parcel account Listed assessed voILY.IY) numbers-check box if personal pnmeny Name Donna lints and Terry Imes MI 35400h/1612h C $133.882.00 Mailing Address 723 Jolanson Rd 0 : city,stalezin Onalaska,NVA 98.570 Phone No.(including urea ccale) (360)UR-I I 2 2 El III Street acklress of properly: 6$"Turnagain Lk Ouikene,WA 98376 This.Property is keeledin unincornontled )17 Jefferson County OR ovillito 0 city of Qrsilirene 0(-1,,,k box if any of theLac-cl parcels art,horng iegrepnocl from a harper parcel.an,part nihnumblry in acijm,arnent or narocic hemp rnorlat.YA Legal description of property(if mom space is needed,,i ou may amen a separate sheer to each page of the SEG&sit i SEE EXHIBIT"A"ATTACHED HERETO AND NIADE A PART HEREOF FOR COMPLETE LEGAL DESCRIPTION INWS„el eel Loral ese Cenle(s) 91 fast all personal prOptity onngiisle and intangible,included in selling price Enter any additional rodeo: 'See back of Litt pane(or instructions) Was the seller receiving a properly tax exemption or YES NO deferral under chapters 84.3n 8437 or 8438 RCW (nonprofit organization senior citiren,or disabled person, homeowners with limited income'? 0 k Ell ...._..._ YES NO k arts property designated as forest fond per chapter 84.33 If claiming:LI(exemption.list WAC numbs')reason for exemption. RCW, 0 0 Is this property classified as current use(opcn space.farm and 0 0. agneultural.or umber)land per chapter)14.347 WAC No,ISevittoreNobsechonl Is this property nxciving special valuation as historical 0 0 propcny per chapter 84.26 RCA'? Reason for exempocni If any answers arc y‘N.complme as RARK-1W below, Type of Document Stalutors Warranty Deed 01 NOTICE OP CONTINUANCE(FOREST LANDON CURRENT ISE) NEW OWNERIST To continue'the current designation as fOrtal land or mit,a ,,,,,,c-ni sial, 12.21116 elassifietnism as current vise(open space farm and agriculture,or timber) land.you Insist stun an(3)below. The Manly,aascasor must thon desenminc if the land mankind contentoro tO qualify and will indicate by signing helot,, Gross Selling Price S 145,000.1)0 If the land no longer qualifies or was do not wish to continue the designation Personal property(dedueo s or closistilinrion.it will be removed and he conipernaling or additional tones will be due and payable by the seller or transferor at the iimc of sale. (RCW Exemption Claimed(deduct t S No ltd 3114(1 or RCW 84.34.108).Prior to corning(3)below,you luny coolact your local county assessor for more information, Taxable Selling Price S. 145,000.00 Excise Tax: State S L856.00 This land Ei does(E)does not qualify for continuance Local S 725.00 *Delinquent Interest: Slate S Local S DEPUTY ASSESSOR DATE *Delinquent Penalty S (2)NOTICE(IF C(E)1PLIANCE III ISTt/RIC PROPERTY) Santmal S 2,581.00 NEW OWNER(S) To continue special valuation as biome property. sign 01 below. tribe new owners()ihi nor weth to continue.all *Stale Technology Fee S 5,00 additional tax calculated pursuant to chapter/44.10 RCW,shall he due mei payable by the selkr or transferor at the time of sale. "'A flidavit Processing Fee S. (31 OWNER(S)SIGNATURE. ifi(lil Due N 2 586 00 _ ....._ PRINT NANIE A MINIMUM OF 510.00 IS DUE IN FEEIS)AND/OR TAX *SEE INSTRUCTIONS OF- I CERTIFY UNDER PENALTY OF PERJURY TIIAT THE FOREGOING IS TRUE AND Ct/RRE(71 Sigh Here Nipnattlre of Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent Name((mini Eric Letzker Name Irwin) Deana lines Darr&city of signing: Date Re city of signing ,U./7, /‘.. —C7Z-s-/r..R,,...... Perjury: Perjury is a class C felony which is punishable by imprisonment in the shoe correct torwl institution for a maximum term oi not more than five sears,or by a tine in an amount fixed by the coon of not more that,five thousand dollars I S5.000.0031,or IT'both imprisonment Rein fined RCM,'9A 20,02011C I, REV 84 0001a(04/30/09) THIS SPACE-TREASURER'S USE ONLY COUNTY TREANU FtER — - _ • EXHIBIT A That portion of Government Lot 1, Section 35,Township 26 North, Range 1 West, W.M., described as follows: Beginning at a point on the South line of said Section 35 which bears South 88° 40' 14"East 460.00 feet from the Southwest corner of said Section 35; thence North 38° 42' 47"West 157.00 feet along the Northeasterly line of property sold to Philip L. Martin and Myrtle C. Martin, husband and wife, (being a line which, if extended,would intersect the 1/4 section line of Section 34, Township 26 North,Range 1 West, W.M., 860.00 feet East of the center of said Section 34),to the True Point of Beginning; thence North 38° 42' 47"West 79.00 feet; thence North 70° 31' 12" East 997.00 feet, more or less,to the line of ordinary high tide; thence Southeasterly along the line of ordinary high tide 200.00 feet to a point on a line which bears North 77° 32' 50"East from the True Point of Beginning: thence South 77° 32' 50"West 1,011.00 feet, more or less, to the True Point of Beginning; EXCEPTING THEREFROM a right-of-way for County Road; TOGETHER WITH all tidelands of the second class, as conveyed by the State of Washington, situate in front of, adjacent to and abutting upon the above described uplands. The tideland boundaries to be formed by the upland boundaries produced to mean low tide. Situate in the County of Jefferson, State of Washington.