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Home My WebLink About125446 1 - n�arimant of \\ � ( 1 7 ,.. .1Uk revenue l REAL ESTATE EXCISE TAX AFFIDAVIT P This form is your recei t -3/ ` '1 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 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 Name RAYMOND B.JOHNSON and NADINA ItII Name ERIC M.JOHNSON,a single man JOHNSON,husband and wife aO Mailing Address 944 YALE STREET Mailing Address 1118 14TH STREET Il City/State/Zip SANTA MONICA,CA 90403 m City/State/Zip BELLINGIIAM,WA 98225 `r'c9 Phone No.(including area code) 310-993-2883 O Phone No.(including area code) (360)570-5159 Send all property tax correspondence to:®Same as Buyer/Grantee List all real and personal tax parcel account numbers-check box if personal property Listed assessed value(s) Name ERIC M.JOHNSON 955900040 PID 29782 0 AV:5179,215.00 Mailing Address 1118 14TH STREET TC:0100 0 City/State2ip BELLINGHAM,WA 98225 0 Phone No.(including area code) (360)570-5159 0 ® Street address of property: 2209 SHASTA PLACE,PORT TOWNSEND,WA 98368 This Property is located in 0 unincorporated • County OR within g city of PORT TOWNSEND -- - ❑Check box if any of the listed parcels are being segregated from another 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 40 OF HAMILTON HEIGHTS,PHASE 2,AS PER PLAT RECORDED IN VOLUME 8 OF PLATS,PAGES 12 THROUGH 17,RECORDS OF JEFFERSON COUNTY,WASHINGTON. SITUATE IN THE COUNTY OF JEFFERSON,STATE OF WASHINGTON ® 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 deferred under chapters 84.36,8437,or 84.38 RCW (nonprofit organization,senior citizen,or disabled person, 0 DA homeowner with limited income)? ® YES NO Is this property designated as forest land per chapter 8433 If claiming an exemption,list WAC number reason for exemption: RCW? 0 Is this property classified as current use(open space,farm and ❑ agricultural,or timber)land per chapter 8434? WAC No.(Section/Subsection) WAC 458-61A-215(2e) Is this property receiving special valuation as historical property per chapter 84.26 RCW? ❑ ® Reason for exemption TO CLEAR TITLE If any answers arc yes,complete as instructed below. Type of Document QUIT CLAIM 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 16,2016 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 $ 179,215.00 If the land no longer qualifies or you do not wish to continue the designation *Personal Property(deduct) $ _0_ • 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) $ 179,215.00 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 $ _0_ This land❑roes Excise Tax: State $ • ❑does not qualify for continuance Local $ *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) 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 $ 5.00 (3) OWNER(S)SIGNATURE Total Due $ 10.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS ® I CERTIFY UNDER PENALTY OF PE THAT THE FOREGOING IS TRUE AND CORRECT Signature of f w/1Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) RAYMOND B.JOHNSON Name(print) ERIC M.JOHNSON Date&city of signing. /7/2a/6 SRAfti.✓1 t.4 c i- 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). REV 84 0001a(6/05/13) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 755747_ I..r'75446 .i= ;:,�/2016 10i�i_i (lY ]lam IZiA -Ito • • f)epartment of evenue N4fheren Sone 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 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 I. Name RAYMOND B.JOHNSON and NADINA R. Name ERIC M.JOHNSON,a single man JOHNSON,husband and wife OMailing Address 944 YALE STREET w Mailing Address 1118 14TH STREET Lu City/State/Zip SANTA MONICA,CA 90403 City/State/Zip BELLINGHAM,WA 98225 C7 Phone No.(including area code) 310-993-2883 c7 Phone No.(including area code) (360)570-5159 3. Send all property tax correspondence to: ®Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s) numbers—check box if personal property Name ERIC M.JOHNSON 955900040 PID 29782 LJAV:$179,215.00 Mailing Address 1118 14TH STREET TC:0100 [� City/State/Zip BELLINGHAM,WA 98225 ❑ Phone No.(including area code) (360)570-5159 ❑ MI Street address of property: 2209 SHASTA PLACE,PORT TOWNSEND,WA 98368 This Property is located in❑unincorporated County OR within®city of PORT TOWNSEND ❑Check box if any of the listed parcels are being segregated from another 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 40 OF HAMILTON HEIGHTS,PHASE 2,AS PER PLAT RECORDED IN VOLUME 8 OF PLATS,PAGES 12 THROUGH 17,RECORDS OF JEFFERSON COUNTY,WASHINGTON. SITUATE IN THE COUNTY OF JEFFERSON,STATE OF WASHINGTON ® Select Land Use Code(s): 11 0 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 deferred under chapters 84.36,84.37,or 84.38 RCW (nonprofit organization,senior citizen,or disabled person, 0 homeowner with limited income)? ® 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 El Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® WAC No.(Section/Subsection) WAC 458-61A-215(2e) Is this property receiving special valuation as historical ❑ ® property per chapter 84.26 RCW? Reason for exemption TO CLEAR TITLE If any answers are yes,complete as instructed below. Type of Document QUIT CLAIM 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 16,2016 classification as current use (open space, farm and agriculture, or timber) land,you must sign on(3)below. The county aysessor must then determine if the land transferred continues to qualify and will indicate by signing below. Gross Selling Price $ 179,215.00 If the land no longer qualifies or you do not wish to continue the designation *Personal Property(deduct) $ -0- 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) $ 179,215.00 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 $ -0- This land 0 does 0 does not qualify for continuance Excise Tax: State $ Local $ *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 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 $ 5.00 (3) OWNER(S)SIGNATURE Total Due $ 10.00 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 A I COR'E' Signature of Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) RAYMOND B.JOHNSON Name(print) ERIC M.JOHNSO Date&city of signing: Date&city of signing St,ltkr. R s 12,7,1 1 Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maxima ter• • not more than five ears,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•A.20.020(IC). REV 84 0001a(6/05/13) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER WHATCOM LAND TITLE COMPANY,INC. 2011 Young Street Bellingham,WA 98225 Phone (360)676-8484/Toll Free (800)334-6314 Fax (360)671-0982 Website www.whatcomtitle.com "Locally Owned and Operated since 1982" To whom it may concern: The purpose of my being on title for the property located at 2209 Shasta Place,Port Townsend, WA 98368 is due to a lender requirement for a co-signor at the time that Eric M.Johnson purchased the property. He has now qualified for financing that no longer has this requirement and so I am being removed from title. I was on title for co-signing purposes only and not as a co-purchaser. I have not contributed to the repayment of the loan at any time. Thank you, ,RA ti ND B.J• is it i(� � ' NIrINAR.JI Mrs E'S. M.i71—it