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HomeMy WebLinkAbout125432 Department of re ( r)- / Revenue • Washington State pt REAL ESTATE EXCISE TAX AFFIDAVIT This form is yom- eipt 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) ®Check box if partial sale of property If multiple owners,list percentage of ownership next to name. IIIName Steohen Arthur George and JoAnn Irene Georae Name Richard F. Georae P4 LT-1 z Mailing Address 8542 173rd Ave. SW Mailing Address 3025 SW 110th St. in city/State/zip Rochester. WA 98579 w City/State/Zip Seattle WA 98146 Phone No.(including area code) Phone No.(including area code) (206)246-3310 List all real and personal property tax parcel account © Send all property tax correspondence to:El Same as Buyer/Grantee List assessed value(s) numbers—check box if personal property Name Francie Stefan 601091002L-f ) IISS,/9TL 7f(` r'Nly31' 1 1 (6 D Mailing Address 26708 Ohio Ave NF 6011020141/1-"TY Ag 3.1 C h n 3 °►l 9, city/State/zip Kingston, WA 98346-8602 601102005cti W C jS & /q j n 55)5c Phone No.(including area code)___ 601102002 i-Ct-d l /S S9/7' \a 5 a O ® Street address of property: tY1 / This property is located in Jefferson County ❑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) 1/9 Interest in thg I, Ler Described Property: � I/ S�FcT►o N c�/ •Tbuio sfN6 1-10e114/P 2BA 066 t LOSeeAttached:22 p Io I VOL. IBI OF bEas, LOT 2 / SECT707-1 to, Towilso f Z6 1, PA WE I Wi 3) Sffc77oN Io/ ibctimSkirt' 2h N• / R4.u6-% i I4.) LI, I-or 2 , S*cc T'Tvu tp 7JDwuStiff 26 N/ RAIJGE I c.1�5T ® Select Land Use Code(s): List all personal property(tangible and intangible)included in selling 91-Undeveloped land(land only) price. enter any additional codes: (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under 0 0 chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 6 If claiming an exemption,list WAC number and reason for exemption: YES NO Is this property designated as forest land per chapter 84.33 RCW? 0 (] WAC No. (Section/Subsection) Is this property classified as current use(open space,fann and 0 0 Reason for exemption agricultural,or timber)land per chapter 84.34? Is this property receiving special valuation as historical property 0 ❑✓ per chapter 84.26 RCW? 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 i/7 z classification as current use(open space,farm and agriculture,or timber)land, Gross Selling Price $ 28,500.00 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.If the *Personal Property (deduct) $ land no longer qualifies or you do not wish to continue the designation or Exemption Claimed(deduct) $ 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 Taxable Selling Price $ 28,500.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax: State $ 364.80 your local county assessor for more information. 0.0050 Local $ 142.50 This land ❑does 0 does not qualify for continuance. *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) 507.30 NEW OWNER(S):To continue special valuation as historic property. Subtotal $ sign(3)below.If the new owner(s)does 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 $ 0.00 (3) OWNER(S)SIGNATURE Total Due $ 512.30 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 Grantor or Grantor's Age>�t D�� � .072.�Grantee or Grantee's Agent Name(print) Stephen Arthur George,JoAnn Irene George i v Name(print) Richard F.George Date&city of signing: RCaGt{ 51 -/Wr4-' 4-(Z yZO(. Date&city of signing: .S'e e /e Lv A o Y/2.2/2.0/6 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(01/04/16) THIS SPACE-TREASURER'S USE ONLY COUNTY ASSESSOR (01 "755596 125432 4.:5123,1201,:..; 512.11M L 1C,VDt Legal Description: Property located in Jefferson County, Washington, to wit : Government Lot 1, Section 9, Township 26 North, Range 1 West, W.M. , EXCEPT the South 919 feet thereof; together with tidelands of the second class as conveyed by the State of Washington, situate in front of, and adjacent to or abutting upon the above described uplands . Tax Parcel No. 601091002 Legal Description: Property located in Jefferson County, Washington, to wit : Tidelands of the second class lying below the government meander line as conveyed by the State of Washington by instrument recorded in Vol 161 of Deeds, page 143 records of \/ Jefferson County, Washington, situate in front of, adjacent to or abutting upon Government Lot 2 , Section 10, Township 26 North, Range 1 West W.M. , with a frontage of 3 . 14 lineal chains more or less . Tax Parcel No. 601102014 Legal Description: Property located in Jefferson County, Washington, to wit : The Southeast quarter of the Northwest quarter of Section 10 , Township 26 North, Range 1 West W.M. , except the South 919 feet thereof. Tax Parcel No. 601102005 Legal Description: Property located in Jefferson County, Washington, to wit : Government lot 2 , in Section 10, Township 26 North, Range 1 West, W.M. , except the South 919 feet thereof; together with tidelands of the second class as conveyed by the State of Washington, situate in front or, adjacent to or abutting upon the above described uplands . Tax Parcel No. 601102002