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Home My WebLink About125458 • CDepartment of evellUe 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 ON ALL PAGES ARE FULLY COMPLETED (Sec back of last page for instructions) ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name. SName CAROLYN LOUISE MCCAMMON,as the sole Trustee fl Name Carolyn Louise McCammon as Ttee of the Carolyn Louise a c4 of the McCammon Family Trust,dated January 29,1987 McCammon Survivor's Trust ua...CONTINUED IN 7 BELOW 11 Mailing Address 1850 East Marrowstone Road Mailing Address 1850 East Marrowstone Road s N Ciry/State/Zip Nordland,WA 98358 �� wcYjCoy/State/bp Nordland,WA 98358 �,j.�/' Phone No.(including area code) / Phone No(including area code) '3 �.� • ��T IllSend 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 _ 12766,021333009 _ n 309,015 Mailing Address _ fl City/State/Zip __ _. n Phone No.(including area code) n IIStreet address of property: 1850 EAST MARROWSTONE RD NORDLAND WA 98358 This property is located in Jefferson County 0 Check box if any of the listed parcels are being segregated front another parcel,arc part of a boundary Ire 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) SEE ATTACHED ®Select Land Use Code(s): NI List all personal property(tangible and intangible)included in selling It 1-tiuusuitcia,single fanaty units I price. enter any additional codes: (continued from 2 above)...McCammon Family Trust ua 1-29-87as (See back of last page for instructions) amended or restated.and DAVID L.MCCAMMON,or his sccssrs,as Ttee YES NO of the Edward Gene McCammon Family Tr u/a The McCammon Family Is this property exempt from property tax per chapter 0 0 Trust,it/a 1-20-87,as amended or restated 84.36 RCW(nonprofit organization)? 1111 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 / Is this property classifiedascun sluse(openspace,farmand 0 0 WAC No.(Section/Subsection) 458-61A-202 l agricultural,or timber)land per chapter 84.34? Reason for exemption Is this piopaty receiving special valuation as historical ptupn ty ❑ INHERITANCE per chapter 84.26 RCW? If any answers are yes,complete as instructed below. (1)NOTICE OF CONTINUANCE(FOREST LAND ORCURRENT 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 71\1 e land,you must sign on(3)below.The county assessor must then determine 309,015.00 if the land transferred continues to qualify and will indicate by signing below. Gross Selling Price S If the land no longer qualifies or you do not wish to continue the designation •Personal Property I deduct) S 0.00 orclassification,it wilt be removed and the compensating or additional taxes Exemption Claimed(deduct) S 309,015.00 will be due and payable by the seller or transferor at the time of sale.(RCW 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Taxable Selling Price S 0.00 your local county assessor for more information. Excise Tax:State S 0.00 This land 0 does 0 does not qualify for continuance. 0.0050 Local $ 0.00 'Delinquent interest:State S 0.00 DEPUTY ASSESSOR DATE Local 5 0.00 (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) •Delinquent Penalty 5 0.00 NEW OWNER(Sl:To continue special valuation as historic property, sign(3)below.If the new owner(s)does not wish to continue,all Subtotal 5 0.00 additional tax calculated pursuant to chapter 84.26 RCW.shall be due 8- *State Technology Fee 5 5.00 and payable by the seller or transferor at the time of sale. (3)OWNER(S)SIGNATURE *Affidavit Processing Fee S Total Due $ 10.00 PRINT NAME A MINIMUM OF S10.00 IS DUE IN FEE(S)AND/OR TAX 'S NSTRUCTIONS ® I CERTIFY UNDER PENALTY OF PERJURY THAT THE FO'':. Signature of v ((�� Signature of '�/ �� ' Grantor or Grantor's AgenedeAe4 ,Co.s�, yv1.`Qd sat.ia„v� Grantee or G ante- j ,e I II, A. �-""`' Natne(print) CAROLYN LO SE AMMON.Tru Name(prior) Lamolvo•k Mc a on, ' steer David ,McLCammmon�rustee Date&city of signing `��1rC.-T7 Date&city of signing:/1� `7/24 i e Perjury:Perjury is a class C felony which is punishable try imprisonment in the state correctional institution for a maximum terns of not more than fiveyears,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 000lae(5/31/10 THIS SPACE-TREASURER'S USE ONLY DEPT.OF REVENUE P.1. 7551.-,OP, i'3-4!_ :S5)25/2016 10,:n::. 1 ZC20% When recorded return to: Michael Best & Friedrich LLP Attn: Jennifer Meyer 100 East Wisconsin Avenue, Suite 3300 Milwaukee, WI 53202 DOCUMENT TITLE: STATUTORY WARRANTY DEED GRANTOR(S): CAROLYN LOUISE MCCAMMON, as the sole Trustee, of the McCammon Family Trust,dated January 29, 1987, GRANTEE(S): CAROLYN LOUISE MCCAMMON, as the Trustee of Carolyn Louise McCammon Survivor's Trust u/a The McCammon Family Trust, dated January 29, 1987, as amended and/or restated,and DAVID L. MCCAMMON,or his successors,as Trustee of the Edward Gene McCammon Family Trust u/a The McCammon Family Trust, dated January 29,1987, as amended and/or restated, ABBREVIATED LEGAL DESCRIPTION: 1850 East Marrowstone Road Nordland,WA 98358 S33 T30 RI E ADDITIONAL LEGAL DESCRIPTION ON: PAGE(S)2 ASSESSOR'S TAX PARCEL NUMBER(S): 12766,021333009 STATUTORY WARRANTY DEED THE GRANTOR, Carolyn L. McCammon, as the sole Trustee, of the McCammon Family Trust,dated January 29, 1987, for and in consideration of the distribution to Trust beneficiary upon deaths of the Trust Grantor pursuant to the terms of said Trust: a one-half('/z) interest to Carolyn Louise McCammon, or her successors, as Trustee of Carolyn Louise McCammon Survivor's Trust u/a The McCammon Family Trust, dated January 29, 1987,as amended and/or restated, and 8!...8 ...2545 ..I6 -._ ei._* a one-half('/2) interest to David L. McCammon, or his successors, as Trustee of the Edward Gene McCammon Family Trust u/a The McCammon Family Trust, dated January 29,1987, as amended and/or restated, in the following described real estate, situated in the County of Jefferson, State of Washington: A portion of Government Lot 4 in Section 33, Township 30 North, Range 1 East, W.M., lying east of the Marrowstone County Road, more particularly described as follows: Beginning at a point 514 feet South of the North line of said Government Lot 4, said point intersecting the East right of way line of said County Road; thence Southeasterly along said County Road right of way, 554.90 feet to the TRUE POINT OF BEGINNING FOR THIS DESCRIPTION; thence continuing Southeasterly along said County Road right of way, 101.78 feet; thence South 88°15'17" East 340.92 feet to intersect to the Government Meander line; thence North 18°12' West along said Government Meander line to a point that lies South 88°15'17"East from the point of beginning; then North 88°15'17" West, 352.35 feet to the point of beginning. Subject to easements, restrictions, covenants, reservations, conditions, declarations and agreements of record. (Signature page follows.) SIGNATURE PAGE TO STATUTORY WARRANTY DEED Dated as of December 31,2015. GRANTOR: MCCAMMON FAMILY TRUST, DATED JANUARY 29, 1987 Carolyn L. VIcCammon, Sole Trustee ACKNOWLEDGMENT STATE OFWfiSh h ) f )SS. COUNTY OF J �/?Oil ) I certify that I know or have satisfactory evidence that Carolyn L. McCammon is the person who appeared before me, and acknowledged that she signed this instrument and acknowledged it to be a free and voluntary act for the uses and purposes mentioned in this instrument. Dated: March—arch' Iv? , 2016. # " / ),C.c�=mit Pr', t , a °: J Q Cc/ 1 Y/1 f/ /J /.CCE Notary Public Residing .ry Public in and for the State�of WA Residing at Pr1 r-)ul of 1-zf State of Washington My appointment is permanent. (expires: O2/o 0- j) Jacquelyn Stuart Commission Expires 2-10-19