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HomeMy WebLinkAbout125445 Department of Z 3 1-�/ Revenue C� 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 percentage of ownership next to name. In Name Fannie Mae A/K/A Federal National Mortgaae IIII Name Elizabeth Morgan Tyler and Michael J. Tyler. o Assnr iatinn w wife and husband a z Mailing Address PO Box 650043 w‘.1.1 Mailing Address 1205 W. Egg & I Road va, city/state/zip Dallas. TX 75265-0043 go city/state/zip Chimacum, WA 98325 Phone No.(including area code) Phone No.(including area code) ® Send all property tax correspondence to:❑✓ Same as Buyer/Grantee List all real and personal property tax parcel account numbers—check box if personal property List assessed value(s) Name 801-044-008/ 19373 0 $357,719.00 Mailing Address I nvy endP' 021 fl City/State/Zip `TOU( a 3 n Phone No.(including area code) El I f l Cif r/ © Street address of property: 1205 W.Egg&I Road-Chimacum,WA 98325 This property is located in Jefferson County ❑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) The East 330.489 feet(measured along the South line)of the Northwest quarter of the Southeast quarter of Section 4,Township 28 North,Range 1 West,W.M.,in Jefferson County,Washington; EXCEPT the North 650.5 feet thereof(as measured along the East line).(Tract 21 of Volume 2 of Surveys,page 25) Situate in the County of Jefferson,State of Washington. Select Land Use Code(s):II! ® List all personal property(tangible and intangible)included in selling 11-Household,single family units price. enter any additional codes: (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under 0 ❑✓ chapters 84.36,84.37,or 84.38 RC'W(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? ■ YES NO If claiming an exemption, list WAC number and reason for exemption: Is this property designated as forest land per chapter 84.33 RCW? 0 0 WAC No. (Section/Subsection) 458-61A-217(1) Is this property classified as current use(open space,farm and 0 ❑✓ agricultural,or timber)land per chapter 84.3414'W? Reason for exemption Rerecord to correct legal description Is this property receiving special valuation as historical property 0 0 per chapter 84.26 RC W? 01/1`M wi, 4 1 2-S 7 S1/0//4 If any answers are yes,complete as instructed below. Type of Document Special 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 4/29/16 classification as current use(open space,farm and agriculture,or timber)land, 360,000.00 you must sign on(3)below.The county assessor must then determine if the Gross Selling Price $ 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) $ 360,000.00 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 $ 0.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax : State $ 0.00 your local county assessor for more information. �~-�- I 0.0050 I Local $ 0.00 This land 0 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 $ 0.00 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 $ 0.00 (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 AND CORRECT. Signature of ofn Jf \14)÷Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) Jessica Bennett, as agent Name(print) Jessica Benn , as agent Date&city of signing: 5/23/16-Port Angeles Date&city of signing: 5/23/16- Port Angeles 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(RC W 9A.20.020(I C)). REV 84 0001a(01/04/16) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 75574625445 :4:5/24/2016 10.0i:A