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Home My WebLink About125438 t?Department of Vmshogtan Stare L, S 7(e.: P EasE TYPE OR PRINT REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receip 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.58130LS ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name 1. Name David C.Wheatley and Maisie V.Wheatley,as Name Vincent P.Bocci and Cherri L.Bocci,husband and tenants in common wife W O Mailing Address 22654 Stottlemeyer Rd. w 1 Mailing Address 10410 NE 92nd Avenue w a City/State/Zip Poulsbo,WA 98370 City/State/Zip Vancouver,WA 98662 up c7 Phone No.(including area code) (360)789-0774 0 Phone No.(including area code) (360)256-4884 3. Send all property tax correspondence to: El Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s) numbers-check box if personal property Name Vincent P. Bocci 935 100 015/24940 El296,545 Mailing Address 10410 NE 92nd Avenue El City/State/Zip Vancouver,WA 98662 ❑ Phone No.(including area code) (360)256-4884 ❑ lai Street address of property: 771 Thorndyke Rd,Port Ludlow,WA 98365-9292 This Property is located in®unincorporated Jefferson County OR within❑city of Port Ludlow El 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) Lot 16, Bridgehaven Division No. 5, as per plat recorded in Volume 5 of Plats, pages 3 and 4, records of Jefferson County, Washington. Situate in the County of Jefferson, State of Washington. ® Select Land Use Code(s): 11 ism 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, homeowner with limited income)? ❑ 6. 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 Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® WAC No.(Section/Subsection) Is this property receiving special valuation as historical property per chapter 84.26 RCW? ❑ ® 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 $ 415,500.00 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 $ 415,500.00 Excise Tax: State $ 5,318.40 This land ❑does ❑does not qualify for continuance Local $ 2,077.50 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 7,395.90 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 $ 7,400.90 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS UI CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Signature of Signature of Grantor or Grantor's AgentGrantee or Grantee's Agent Name(print) David C.Wheatley �, Name(print) Vincent P.Bocci Date&city of signing: ', t'� ( k, Qva•r--1- Date&city of signing Perjury: Perjury is a class Ctfelony 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($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(1C). REV 84 0001a(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER 755850 125438 4:!-..i. /20187,400_90* 1-4 Il aDopartmont of venue iNtannatan$tar 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.58130LS 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name 1. Name David C.Wheatley and Maisie V.Wheatley,as Name Vincent P.Bocci and Cherri L.Bocci,husband and tenants in common wife c4 0 Mailing Address 22654 Stottletneyer Rd. Mailing Address 10410 NE 92nd Avenue Z Z City/State/Zip Punish°,WA 98370 < City/State/Zip Vancouver,WA 98662 al I:4 C" Phone No.(including area code) (360)789-0774 Phone No.(including area code) (360)256-4884 3. Send all property tax correspondence to;El Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s) numbers—check box if personal property Name Vincent P.Bocci 935 100 015/24940 0 296,545 Mailing Address 10410 NE 92nd Avenue City/State/Zip Vancouver,WA 98662 0 Phone No.(including arca code) (360)256-4884 0 lal Street address of property: 771 Thorndyke Rd,Port Ludlow,WA 98365-9292 This Property is located in 121 unincorporated Jefferson County OR within 0 city of Port Ludlow 0 Check box if any of the listed parcels are being segregated from a larger tweet,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) Lot 16, Bridgehaven Division No. 5, as per plat recorded in Volume 5 of Plats,pages 3 and 4,records of Jefferson County, Washington. Situate in the County of Jefferson, State of Washington. Ell Select Land Use Code(s): 11 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, homeowner with limited income)? ED 6. YES NO Is this property designated as forest land per chapter 84.33 If claiming an exemption,list WAC number reason for exemption: RCW? 0 t.1 Is this property classified as current use(open space,farm and 0 agricultural,or timber)land per chapter 84,34? WAC No,(Section/Subsection) Is this property receiving special valuation as historical U. property per chapter 84.26 RCW? Reason for exemption If any answers arc 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 $ 415,500.00 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 $ 415,500.00 Excise Tax: State $ 5,318.40 This land 0 does 0 does not quality for continuance Local $ 2,077.50 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty S. (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) StIbtotal $ 7,395.90 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 $ 7,400.90 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS 111I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Signature of Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent -\ • Name(print) David C.Wheatley Name(print) Vincent P.Ilocci Date&city of signing: Date&city of sitylitl4 -SiPb111,e7 vA,Isx-,w,vosle... 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 tine 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), REV 84 0001a(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER