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Home My WebLink About125431 Department of 411 • �`�'�+ Uig 1 evenueq s te Ds Washington State 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. II Name O i i r e 4 t T.,. 7:a:..--3v , ''...-_-:\,\ - a Name -r d r r C3 o:4 {i. B a�:L c'i :..e. ., ‘Ii„': W .,A.A\ to`1 . \ �.,._ W z Mailing Address 4- a_,; r i.. u ",� w H Mallin Address r..t i , , } Slea Yi..L...._ _`ia 9 ✓ , '2 ,+z g .. 1 35.�.vit. r 1 L-“,..,. R.y,ad, vWi og City/State/Zip F_ a.rr t 1 r- e Vi d . ,.P .. i ^. y . 9 F C7 - - � W City/State/Zip i£..,,,t11., , t�!:�:� � 3 S 2 Phone No.(including area code) Phone No.(including area code) ® Send all roe tax cones ondence to Same as List all real and personal property tax parcel account j p p p Buyer/GranteeList assessed value(s) numbers-check box if personal property 1 Name C('�©1 20" f 0 Tye ,Qui) Mailing Address —6\ 0 City/State/Zip ,. ,j. \ ❑ Phone No.(including area code) gild by(� et-14-'0 1 i 2 `f fy`•) ❑ ( ,,r` ® Street address of property: This property is located infl unincorporated 5 e f f=e r s o l? County OR within 0 city of ❑Check box if any of the listed parcels are being segregated from a larger parcel. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) Sl,r' A`i ,:ACFD ®Enter Abstract Use Categories: il List all personal property(tangible and intangible)included in selling price. (See back of last page for instructions) t j A. YES NO Is this roe exempt from roe taxper chapter If claiming an exemption,list WAC number and reason for exemption: property rtY P property rtY P ❑ KI 84.36 RCW(nonprofit organization)? WAC No. (Section/Subsection) 6 YES NO Reason for exemption Is this property designated as forest land per chapter 8433 RCW? 0 j ] Is this property classified as current use(open space,farm and ❑ j agricultural,or timber)land per chapter 84.34? Is this property receiving special valuation as historical property 0 f 7 Type of Document per chapter 84.26 RCW? 06.. t. s.1 31•-t If any answers are yes,complete as instructed below. Date of Document i? (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Gross Selling Price $ 22. , v t;(? NEW OWNER(S):To continue the current designation as forest land or *Personal Property(deduct) $ r,. classification as current use(open space,farm and agriculture,or timber) •/•= land,you must sign on(3)below.The county assessor must then determine Exemption Claimed(deduct) $ if the land transferred continues to qualify and will indicate by signing below. Taxable Selling Price $ If the land no longer qualifies or you do not wish to continue the designation Excise Tax: State $ or classification,it will be removed and the compensating or additional taxes -('.1 . -y,•t will be due and payable by the seller or transferor at the time of sale.(RCW Local $ 1C i; s �, %A:,`) 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact *Delinquent Interest: State $ your local county assessor for more information. Local $ This land ❑does-•Q does not qualify for continuance. *Delinquent Penalty $ Subtotal $ DEPUTY ASSESSOR DATE (2)NOTICE OF COMPLIANCE *State Technology Fee $ • %IV (HISTORIC PROPERTY) NEW OWNER(S):To continue special valuation as historic property, *Affidavit Processing Fee $ . sign(3)below.If the new owner(s)do not wish to continue,all additional tax calculated pursuant to chapter 84.26 RCW,shall be due Total Due $ ;� ) _. �`+ and payable by the seller or transferor at the time of sale. (3) OWNER(S)SIGNATURE A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS PRINT NAME © I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of of •/ ,r ,.Grantor or Grantor's Agent )t`' 44-- ?-_i Grantee oor Grantee's Agent t`-'-''r- �L._-- / j Name(pent) u: i:.r i,*.T 1 •- f,-.!1-,,-1 Name(print) ;.l t, , ^s • 'f` Date&city of signing: ; %.r j r` .^ -,./..„1; i Date&city of signing: ':-:E?. { , \i,(4-11 r•'7,, =;,, 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)). REV 84 0001a(06/02/06) THIS SPACE-TREASURER'S USE ONLY COUNTY ASS SO r 12G44? . 1 Attachment "A" Parcel Number 002342044 MAT Pt atrIOS OF TBB OST Q{o1N = OF TBS goal1INNOT QUARIRROF 34, TOVISKIP 30 NORM RAMOS 2 ABET, LLII/113Bi1ST OF 7111 1NNII LT OF KM NEST QE= aaa , CF T1 E aznunaff COUNT?• SID ISOM D8 RANORLAI SOLD » OF INN -OF 1111Y OF INN =am, ST. PISS. >tSITa12i O11D. T 11=1 Mi.. OF MR Me /NAL REMIN CORPORATION Cml FORMAL - macaw, =mum ST. PAM AND iNICIFIC RAILROAD =Rem 100 18** luta RIONT-OF-NRY IS TER NORTIEBASI *WARM OF THB , 34, iNIINSKIP 30 N'8, UN= 2 NNW, R.N., IIIRMIRSON COMM NASNINGIOB; ANCIIPTING IMMO. 35W POW= OF '!'BAT PONEZO5 OF TRA MOM =CARD, , ST. PAS. ma PLIC RAILROAD CMZ'S 100 tour inma RIL11 OF-1N1T LIMO ZAlS' rar OF TBR comer MAD *104, -10/(11K AS-ml mam.LN HOLD. TBS ___ 3ffi�',BD TO ZN TBS mow =WM AS sarastram Y011D IS 11LmO ARMIN AS D. AND IS BYPASS 05 ml ROAD FLAK DATED A115Br-5, 1979 FOR cm= MORD >!BO►'11CI 454, catu ? POID ]1D.3.04, Ste=LOS 110.38570; aaF!!80>< CdOtl'!Y, llil. Recorded in Auditor' s File Number 572062.