HomeMy WebLinkAbout125462 Department of
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mini,ton State
PLEASE TYPE OR PRINT REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt
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)
File No.58151 LS
❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name
1. Name Jack L.Manning and Kathleen A.Muir,husband Name Michael C.Purcell II and Jennifer J.Purcell,
and wife and Loren G.Kragh and Nancy Kragh, husband and wife
husband and wife
W O Mailing Address 10901 176th Circle NE#3421 w H Mailing Address 1425 58th Way SE
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City/State/Zip Redmond,WA 98052 z City/State/Zip Auburn,WA 98092
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Phone No.(including area code) (360)301-3238 Phone No.(including area code) (253)269-6621
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 Michael C.Purcell II 970 800 508/34743 ❑
154,244
Mailing Address 1425 58th Way SE 970 800 509/34744 ❑ 69,270
City/State/Zip Auburn,WA 98092 ❑
Phone No.(including area code) (253)269-6621 0
El Street address of property: 80 Prospect St,Port Ludlow,WA 98365
This Property is located in®unincorporated Jefferson County OR within❑city of Port Ludlow
0 Check box if any of the listed parcels are being segregated from a larger 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)
SEE EXHIBIT"A" ATTACHED HERETO AND MADE A PART HEREOF FOR COMPLETE LEGAL DESCRIPTION
® Select Land Use Code(s): 11,91 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
Deferral under chapters 84.36,84.37 or 84.38 RCW
(nonprofit organization,senior citizen,or disabled person,
homeowner with limited income)? ❑
01
6. 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)
Is this property receiving special valuation as historical
property per chapter 84.26 RCW? ❑ ® Reason for exemption
If any answers are yes,complete as instructed below.
Type of Document Statutory 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 May 10,2016
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 $ 325,000.00
if the land no longer qualifies or you do not wish to continue the designation —*personal roperty(deduct) $
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) $ No
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 $ 325,000.00
Excise Tax: State $ 4,160.00
This land ❑does ❑does not qualify for continuance
Local $ 1,625.00
*Delinquent Interest: State $
Local $
DEPUTY ASSESSOR DATE *Delinquent Penalty $
(2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 5,785.00
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 $
(3) OWNER(S)SIGNATURE Total Due $ 5,790.00
PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX
*SEE INSTRUCTIONS
UI CERTI Y UNDER PEN "In'OF PE JURY THAT THE FOREGOING IS TRUE AND CORRECT(A2."
Signature of Signature of
Grantor or antor's /�- .t' Grantee or G. ntee's Agen
Name(print) wu r f Name(print) • �' r •• �.. •, 111
Date&city of signing: $ 2..1 l j -b f; -frYl . Date&city of signing 5/
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(1C).
REV 84 0001a(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER
a
EXHIBIT A
PARCEL A:
Lot 13, Block 5, plat of Mats Mats Beach, as per plat recorded in Volume 3 of Plats, page 21, records of Jefferson
County, Washington;
TOGETHER WITH all tidelands of the second class suitable for the cultivation of oysters, as conveyed by the State of
Washington, situate in front of,adjacent to, and abutting upon the above described uplands; said oyster lands being of
indeterminate area and included within the boundaries of that certain tract conveyed by the State of Washington to
Calvin Philips, and sold subject to all of the provisions of said deed.
PARCEL B:
Lot 14, Block 5, plat of Mats Mats Beach, as per plat recorded in Volume 3 of Plats, page 21, records of Jefferson
County, Washington;
EXCEPT the Southerly 38 feet of the Easterly 100 feet thereof;
TOGETHER WITH all tidelands of the second class suitable for the cultivation of oysters, as conveyed by the State of
Washington, situate in front of, adjacent to, and abutting upon the above described uplands; said oyster lands being of
indeterminate area and included within the boundaries of that certain tract conveyed by the State of Washington to
Calvin Philips, and sold subject to all of the provisions of said deed.
All situate in the County of Jefferson, State of Washington.