Loading...
HomeMy WebLinkAbout125465 to1:.'i trttn ent of evenue 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 (See back of last page for instructions) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. III Name Colleen Rodrigues and Tammy Ridgway MI Name Colleen Rodrigues(50)%and Tammy Ridgway(50%) aS cv a- A W S-ee_._ o�-�� _, a4 ctl Z Mailing Address 154 Gamble Lane z Mailing Address 154 Gamble Lane un C City/State/Zip Port Ludlow,WA 98365 oci ge City/State/Zip Port Ludlow,WA 98365 Phone No.(including area code) (360)643-0776 Phone No.(including area code)(360)643-0776 © List all property tax correspondence to Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers-check box if personal property Name ( 96"' 900— ICA 0 $254I35N . d0 Mailing Address 39 S 1 Co 17 City/State/Zip 0 Phone No.(including area code) n ® Street address of property: This property is located in Select Location ❑Check box if any of the listed parcels are being segregated from a larger parcel. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) LOT 1,AREA 1,PORT LUDLOW NO. 1,AS PER PLAT RECORDED IN VOLUME 5 OF PLATS, PAGES 26 TO 32,INCLUSIVE,RECORDS OF JEFFERSON COUNTY,WASHINGTON. ® Select Land Use Code(s): © List all personal property(tangible and intangible)included in selling 11-Household:single family emits price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter 0 0 84.36 RCW(nonprofit organization)? © 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 Is this property classified as current use(open space,farm and 0 0 WAC No. (Section/Subsection) 458-61A-203(1) agricultural,or timber)land per chapter 84.34? Reason for exemption Is this property receiving special valuation as historical property ❑ ❑r per chapter 84.26RCW? Fstahlishing Community Property If any answers are yes,complete as instructed below. p (I) NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document (- \..A-1k C ►'Y' I- NEW OWNER(S):To continue the current designation as forest land or Date of Document �j 12-2-- I classification as current use(open space,farm and agriculture,or timber) land,you must sign on(3)below.The county assessor must then determine ''eY' if the land transferred continues to qualify and will indicate by signing below. Gross Selling Price $ If the land no longer qualifies or you do not wish to continue the designation *Personal Property(deduct) $ or classification,it will be removed and the compensating or additional taxes Exemption Claimed(deduct) $ 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 $ 0.00 your local county assessor for more information. Excise Tax : State $ 0.00 This land 0 does 0 does not qualify for continuance. 0.0000 'Local $ 0.00 *Delinquent Interest: State $ DEPUTY ASSESSOR DATE Local $ (2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ NEW OWNER(S):To continue special valuation as historic property, sign(3)below.If the new owner(s)does not wish to continue,all Subtotal $ 0.00 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. (3) OWNER(S)SIGNATURE *Affidavit Processing Fee $ 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 A D C'OLZt? T. j - Signature o ----r- , ---- -----,Signature of ` ,' Grantor or Grantor's Agent Grantee or Grantee's Agent Colleen Rodrigues Tammy Ridg y Colleen Rodrigues Tammy Ridgway Name(print) f Name(print) ✓y� Date&city of signing: S 1 di-,� 1/ ( ca n't t� OLL3 r I�K1'C Mute&city of signing: 012-1 24(6 ?Clip;(" lei sa, �rt'�t ( ll,''tr J -- 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(1/29/09) THIS SPACE-TREASURER'S USE ONLY COUNTY ASSESSOR 0 Seller/Grantor Colleen Rodrigues, a married woman, formerly an unmarried woman and Tammy Ridgway, a married woman, formerly an unmarried woman Buyer/Grantee Colleen Rodrigues and Tammy Ridgway, a married couple, as community property with right of survivorship