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Home My WebLink About125424 epatsr�ettt of9 Revenue b Washington State "1 `� 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. 1111 Robert Threlkeld and Diane Threlkeld,husband and Mark G.Mandell and Nancy L.Holder,husband and Name wife Name wife a w C Mailing Address 5706 Kuhn Street x -a ,�� Mailing Address 11365 Lakerim Road w a City/State/Zip Port Townsend,WA 98368-1319 a City/State/Zip San Diego,CA 92131 cc L Phone No.(including area code) 360 ( )379-1172 Phone No.(including area code) (858)603-1760 11/1 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) Name Mark G.Mandell&Nancy L.Holder 936904103 ❑ $415,509.00 Mailing Address 11365 Lakerim Road 0 City/State/Zip San Diego,CA 921315f ❑ Phone No.(including area code) (858)603-1760 0 0 Street address of property: 5706 Kuhn Street,Port Townsend,WA 98368-1319 This property is located in 0 unincorporated Jefferson County OR within®city of Port Townsend 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) FULLY DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. ® Select Land Use Code(s): Q List all personal property(tangible and intangible)included in selling 11 price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ El 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 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 El 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 18,2016 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 $ 496 000.00 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 $ 496 000.00 to signing(3)below,you may contact your local county assessor for more } information. Excise Tax: State $ 6,348.80 This land 0 does 0 does not qualify for continuance. Local $ 2,480.00 *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 $ 8,828.80 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 $ 8,833.80 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 ,��(( � f ,, Grantor or Grantor's Agent Grantee or Grantee's Agent �-.k„�j �i/�ssrft"--- Name(print) obert Threlkeld Name(print) Mark"._Ma__-. 1. 544 fA.S' Date&city of signing: f' ., i .. 1.. s ate&city of signing: 5 t fl C(, 1,--zoic fort- 'i1-.6.y..k. t k 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(1C)). �rc: :. ;: � f.. -, : :1 `W,-' 30* RER'S USE ONLY COUNTY TREASURER V2ifii MtA „li EXHIBIT "A" Lots 5 and 6,Block 41 of the California Addition to the City of Port Townsend,Washington,as per plat recorded in Volume 2 of Plats,page 99,records of Jefferson County,Washington; TOGETHER WITH the North Y2 of that portion of vacated portion of 57`"Street adjoining,vacated October 7, 1958. by Ordinance 1348 of the City of Port Townsend,which would attach thereto by operation of law Situate in the County of Jefferson,State of Washington.