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REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt
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.82274JMM
0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name
I. Name Gail Greene,Trustee of the Gail Greene Living Name James R.Scarantino and Kara L.Kellogg,husband
Trust,dated April 29,2008,Paul J.Greene,Jr., and wife
Trustee of the Paul James Greene,Jr.Living Trust
dated April 23,2007,Charles G.Logue and Candy
S.Logue,Co Trustees of the 2000 Logue Family
Trust dated July 5,2000 as amended and
completely restated on September 25,2015 and
Jennifer L.King,as her separate estate
brAT, E irk
O Mailing Address 2395 Delaware Ave w it Mailing Address 120 as, .rLane
City/State/Zip Santa Cruz,CA 95060 City/State/Zip Port Townsend,WA 98368
v v Phone No.(including area code) (831)295-7729 t7 Phone No.(including area code) (360)344-2765
3. Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal tax parcel account
numbers-check box if personal property Listed assessed value(s)
Name James R.Scarantino and Kara L.Kellogg 947 300 018/26817 ❑
88,000.00
Mailing Address 120 Baview Lane ❑
City/State/Zip Port Townsend,WA 98368 0
Phone No.(including area code) (360)344-2765 0
Street address of property: Lot 18,Bayview Lane,Port Townsend,WA 98368
This Property is located in El unincorporated Jefferson County OR within❑city of Port Townsend
0 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 7. 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)? 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? El x
Is this property classified as current use(open space,farm and
agricultural,or timber)land per chapter 84.34? ❑ x WAC No,(Section/Subsection)
Is this property receiving special valuation as historical
property per chapter 84.26 RCW? ❑ x 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 17,2016
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 $ 66,000.00
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 $ 66,000.00
Excise Tax: State $ 844.80
This land El does ❑does not qualify for continuance
Local $ 330.00
*Delinquent Interest: State $
Local $
DEPUTY ASSESSOR DATE *Delinquent Penalty $
(2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 1,174.80
NEW OWNER(S): To continue special valuation as historic property,
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) OWNER(S)SIGNATURE Total Due $ 1,179.80
PRINT NAME A MINIMUM OF$10.00 IS DUE 1N FEE(S)AND/OR TAX
*SEE INSTRUCTIONS
® 1 CE "IFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
Signature of e � -Vi �- Signature of �'
Grantor or Granto 's Alen ,iall`�
iF, a,_!;,",� // Grantee or Grantee's Al•.,( �,
Paul ,me !reene, . ' �f April 23, 41
Name(print) 2007 ' • t; •• - 'X.)j. X11? . Name(print) James R. v+rantino
Date&city of signing: c)--- I(f 2 0 1.,1 6.61.41,a-02.(4,"2 C X13 Date&city of signing ��1Q111.
Perjury: Perjury is a class C felony which is punishable by imprisonment tot a state correctional institution for a maximum term of not more than five years,or ip
7555,4*fin; ,.y,2..Inyf:_'t «tyi el',IT,mrirp than five thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(IC).
THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER ;ik
EXHIBIT A
Lot 18, Discovery Bay Heights, Division No. 1, as per plat recorded in Volume 6 of Plats, pages 75 and 76,records of
Jefferson County, Washington.
Situate in the County of Jefferson, State of Washington.