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HomeMy WebLinkAbout125435 • + Department of r r! Revenue ` '.7 �-i Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61 A 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 pe nage of owners i next to name. INName tCIZC l��.1�3."`j � Name�"1Y�''--ti l.- U t p/.% 'LI _ W tis Y e: c0-,i2�(_r 4.—t— TIN 5"r 'LI§) Mailing Address U'2O�.,- 'J / Mailing Address Y O .'�\ ZF 7 8 City/State/Zip X I0k ft CJA '')(T 71'6/ City/State/Zip—A�-Y k) 6 2/ Of/I— Phone No.(including area code) 57 /1 —(` .Yy Phone No.(including area code) 4./....... 77''3 F9 © Send all property tax correspondence to:Lr1 5dme as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) ((((((���J numbers-c ec1k,box if pe/rso al property ,,,/ ` �//'�', Name 7 0 ). ///)! V LJ •-., / 1.) / 7 Mailing Address ❑ City/State/Zip T0X I S 0 Phone No.(including area code) 0 ill l t 1/ • 1 p Street address of property: ri. This property is located in unincorporated_v it County OR within 0 city of 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) 5L /7117:4C:11-it C,ID ®Select Land Use Code(s): 1111 List all personal property(tangible and intangible)included in selling price. enter any additional codes: (See back of last page for instructions) YES O Was the seller mceiving a property tax exemption or deferral under 0 chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 11 YES If claiming an exemption,list WAC number and reason for exemption: N q- Is this property designated as forest land per chapter 84.33 RCW2 0 WAC No.(Section/Subsection) T rC! l f/l w 11 J Is this property classified as current use(open space,farmand 0 [ agricultural,ortimber)land per chapter 84.34RCW? ! Reason for exemption \ p�A` _ Is this property receiving special valuation as historical property 0 [�/ /' � � V v� 5 per chapter 8426 RCW? p � If any answers are yes,complete as instructed below. Type of Document a t /// J t t/1^ DF F (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) ty-5-7(r / /�C NEW OWNER(S):To continue the current designation as forest land or Date of Document (J r , fd classification as current use(open space,farm and agriculture,or timber)land, Gross Selling Price $ 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 $ 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax:State $ your local county assessor for more infonnation. Local $ This land D does 0 does not qualify for continuance. *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 $ 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 $ (3) OWNER(S)SIGNATURE Total Due $ �(y)2 ce'r"n PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ) ® I CERTIFY UNDER PE LTY OF PERJURY THAT THE FOREGOING IS TRUE AN CORRECT / ,l Signature of / Signature of V/ /41„. -7-4157--e Grantor or Grantor's s Age Qea` ' i^� .. Grantee or Grantee's Agent .e.T • `it L.�' Name(print) Name(print) £, _ - D Date&city of signing _ i 1 Date&city of signing: _ °' % 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(IC)). 755602 125435 *5/23/2016 10.00* THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER I When recorded return to: Carol F. Questad PO Box 2528 Issaquah, WA 98027-0115 QUIT CLAIM DEED THE GRANTOR(S) CAROL F.QUESTAD, a single woman -17?fl n%5 -e;i/ T /PA 5-- for and in consideration of A _ ._ _ $ _ n ! , $. r _ , in hand paid,conveys and quit claims to CAROL F QUESTAD TRUST v-`3/D// the following described real estate,situated in the County of Jefferson, , State of Washington together with all after acquired title of the grantor(s)herein: Parcel 2 of Survey,recorded July 1, 1987,under Auditor's file No.308820,in Volume 8 pf Survey's,page 171 and 172,and as amended by surveys recorded November 25, 1987 and December 18, 1987,under Auditor's File Nos.311702 and 312067,in Volume 9 of surveys,pages 42,43,47 and 48,being a portion of Government Lots 1,2,and 3 in Section 31,Township 27 North,Range 1 West,W.M.in Jefferson County, Washington; EXCEPTING THEREFROM right of way for East Quilcene County Road. Situate in the County of Jefferson,State of Washington. LPB 12-05(r)rev 12/2006 Page 1 of 3 Subject to: Rights and easements of the public for commerce,navigation,recreation and fisheries; Easement recorded under Auditors File No.308820,311702 and 312067; Any restrictions on the use of the land resulting from the rights of the public or riparian owners to use any portion which is now,or has been formerly been,covered by water; Reservations contained in deed recorded under Recording No.311785; Easement recorded under Auditors File No,347252; Matters set forth by survey recorded under Auditors File NO.477539 Abbreviated Legal: (Required if full legal not inserted above.) • S31 T27 R1 W TAX 15 SUBJ/EASE Tax Parcel Number(s): 701311014 LPB 12-05(r)rev 12/2006 Page 2 of 3