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HomeMy WebLinkAbout125439 ne0. washkeonsteite,ventirett, REAL ESTATE EXCISE TAX AFFIDAVIT PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WACform is THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMwLE sthen st mp your receipt ED amp ed by cashier. (See back of last page for instructions) 0 Check box if.artial sale of•ro;,�i, If multi IN.le owAl ners list n. e of ownershi.next to name. rI Name Corena M.Stern and BataF.Stern,wife and husband 2 Name married couple and Jennifer C.Rotermund,a a i Mailing Address 1005 Cedar St. 0 i Mailing Address P.O.Box 936 tzt a City/State/Zip Port Townsend,WA 98368 g City/State/Zip Port Townsend,WA 98368 Phone No.(including area code) (360)643-1264 c Phone No.(including area code) (206)417-1091 la 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 Jennifer C.Rotermund&Loren N.Alexanian 936300302 12512 Mailing Address P.O.Box 936 0 $165,426.00 City/State/Zip Port Townsend,WA 98368 0 0 Phone No.(including area code) (206)417-1091 0 ©Street address of property: 1015 Cedar St.,Port Townsend,WA 98368-4003 This property is located in 0 unincorporated Jefferson CountyOR within®cityof 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) Lots 5 and 6,Block 3,Broadway Addition to the City of Port Townsend,as per plat recorded in Volume I of Plats,page 112, records of Jefferson County,Washington. Situate in the County of Jefferson,State of Washington. ® Select Land Use Code(s): 8 List all personal property(tangible and intangible)included in selling 11 price. enter any additional codes: (See back of last page for instructions) Is this property exempt from property tax per chapter YES NO 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 8433 RCW? 0 ® WAC No.(Section/Subsection) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? 0 ® Reason for exemption Is this property receiving special valuation as historical 0 123 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 20,2016 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 $ 265,000.00 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 $ 265,000.00 to signing(3)below,you may contact your local county assessor for more Excise Tax: State $ 3,392.00 information. This land 0 does 0 does not qualify for continuance. Local $ 1,325.00 *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 $ 4,717.00 sign (3) below. If the new owner(s) does not wish to continue, all *State TechnologyFee $ 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) OWNERS)SIGNATURE Total Due $ 4,722.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® I CER ER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of �//� __ Grantor or Grantor's Agent Grantee or Grantee's Agent 7 Name(print) Corena M.Stern Name(print) Je. .ifer C.Rotermund Date&city of signing: 3 /, Li 7:71)1,)1 'Date&city of signing: C` ORM . {1- 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(1 C)). THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER # - e55y_.4 12.e.1"». 5. ,c.1.:1Pie4 22.0_I.f. 4