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HomeMy WebLinkAbout125454 t. ��()��+y rrh/ { e.. 2,10-0- • Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This •form is your re!ei�t C, -3 PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-6 IA 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) • ifl Check box if partial sale of property If multiple owners,list percentage of ownership next to name. Robin Donner, LLC © Name Kala Point Village Association III Name . c/o Brenda Del Rosario fx W H 1704 Suwannee Circle w Mailing Address a z Mailing Address � 246 -7th Avenue a Port Hadlock, WA 98339 0 City/State/ZipWaUnakee, WI 53597 R City/State/Zip Phone No.(including area code) Phone No.(including area code) List all real and personal property tax parcel account ® Send all property tax correspondence to:❑✓Same as Buyer/Grantee List assessed value(s) numbers—che73LU box if personal property Name 965202304 5 5— 0 3,625.00 Mailing Address E City/State/Zip El • Phone No.(including area code) 11 — © Street address of property: 20 Village Drive,#23-D,Port Townsend,WA 98368 This property is located in Port Townsend ❑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) AN UNDIVIDED 1/12 INTEREST IN TSU APARTMENT NO.23 BEING TIMESHARE PERIOD D,ALL IN KALA POINT VILLAGE,A WASHINGTON HORIZONTAL PROPERTY REGIME AS SHOWN ON THE SURVEY MAP AND SET OF PLANS RECORDED IN • VOLUME 1 OF THE CONDOMINIUMS,PAGES 46 THROUGH 57 AND VOLUME 1,PAGES 97 THROUGH 101,AND PAGES 119 THROUGH 121,RECORDS OF JEFFERSON COUNTY WASHINGTON,AND AS IDENTIFIED IN THE DECLARATION RECORDED JUNE 5, 1978,AND FEBRUARY 20, 1980, UNDER RECORDING NOS 250367 AND 263587 AND 275985, RESPECTIVELY, RECORDS OF JEFFERSON COUNTY,WASHINGTON. 1111‘ Select Land Use Code(s): 0 List all personal property(tangible and intangible)included in selling 14-Residential condominiums 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 Q chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 6 YES NO If claiming an exemption, list WAC number and reason for exemption: Is this property designated as forest land per chapter 84.33 RCW7 0 0 WAC No. (Section/Subsection) 458-61A-208(3)(A) Is this property classified as current use(open space,fann and ❑ 0Reason for exemption agricultural,or timber)land per chapter 8+1.34 RCW? Deed in Lieu of Foreclosure Is this properly receiving special valuation as historical property 0 0 per chapter 8426 RCW? If any answers are yes,complete as instructed below. Type of Document Statutory Warranty Deed in Lieu of Foreclosure (1)NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE) 1 ) / NEW OWNER(S):To continue the current designation as forest land or Date of Document b classification as current use(open space,farm and agriculture,or timber)land, Gross Selling Price $ 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.If the *Personal Property (deduct) $ land no longer qualifies or you do not wish to continue the designation or Exemption Claimed(deduct) $ 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 84.33.141.)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. ET 0.0000 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 Subtotal $ 0.00 NEW OWNER(S): To continue special valuation as historic property, 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 $ 5,bb (3) OWNER(S)SIGNATURE Total Due $ 10.00 A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX PRINT NAME *SEE INSTRUCTIONS © I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT/ Signature of Signature of f �' ' Agent /� �' Grantee or Grantee's Agent �`- ,/ �' Grantor or Grant r s ( 1.G� _ , ti,,. �6;n Pe„ ,✓ L LC Name(print) i��''\\<s,-..-,. -15--Sk--s jted} 7'125-3?�i Name(print) i n r (p ) Date&city of signing: 01 W 770(6 - lnia`''^u l<re —' Date&city of signing:;3 ,2‘.)/i 6. k 3 Gvti 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 000la(01/04/16) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 0 `' N (644