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Home My WebLink About125450 Revenue s�� ' Washington State REAL ESTATE EXCISE TAX AFFIDAVIT PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC Thiswhen form sitamped by youy receipt THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED cashier. (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 Frances J.Rosanelli,as her separate estate ®Name David Winters and Sandra Wanstall,husband and wife Mailing Address Las Villas Del Norte,1325 Las Villas Way w Mailing Address 6752 41st Avenue SW ti City/State/Zip Escondido,CA 92029 01 g City/State/Zip Seatttle,WA 98136 Phone No.(including area code) (949)525-6568 L Phone No.(including area code) (206)478-8193 Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value s numbers-check box if personal property () Name David Winters&Sandra Wanstall 989710104 0 $229,824.00 Mailing Address 6752 41st Avenue SW 0 City/State/Zip Seatttle,WA 98136 ❑ Phone No.(including area code) (206)478-8193 ❑ Q Street address of property: 528 Madison St.,Port Townsend,WA 98368-5616 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) Lot 8 and the West%of Lot 6 in Block 101 of the Original Townsite of Port Townsend,Washington,as per plat recorded in Volume 1 of Plats,page 1,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 YES NO 84.36 RCW(nonprofit non rofit o rganproper)?tax per chapter ❑ ization)? 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 El 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 19,2016 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 S 295,000.00 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 $ 295,000.00 to signing(3)below,you may contact your local county assessor for more Excise Tax State $ 3776.00 information. , This land 0 does 0 does not qualify for continuance. Local $ 1,475.00 'Delinquent Interest: State $ DEPUTY ASSESSOR DATE Local $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) 'Delinquent Penalty S NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 5,251.00 sign(3) below. If the new owner(s) does not wish to continue, all additional tax calculated pursuant to chapter 84.26 RCW,shall be due 'State Technology Fee $ 5.00 and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ (3) OWNER(S)SIGNATURE Total Due $ 5,256.00 PRINT NAME A MINIMUM OF S10.00 IS DUE IN FEE(S)AND/OR TAX 'SEE INSTRUCTIONS ® I CERTIFY UNDER PENAL- OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of g � Grantor or Grantor's Agent z` L' ;07-17 Grantee or Grantee s Agent NUO t� Name(print) Frances J.Rosanelli Name(print) 4"tom+ Win n .314,141.141 SnGO1L Date&city of signing: (05-t2-V-1-0((42 f SCC AJO1OO() Date&city of signing: 5/ /Z401/ Por r-m 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(55,000.00),or by both imprisonment and fine(RCW 9A.20.020(IC)). COUNTY TREASURER 75'::7'37 I:-!5-1 C .85 r25 '2'316 25