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HomeMy WebLinkAbout125466 Department of ^L'1�.'R f .,.T1(:'C)L) rC�evvnue . �` REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt r.t `a� , PLEASE TYPE OR PRINT when stamped by cashier. CHAPTER 82.45 RCW—CHAPTER 458-61A WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED (See back of last page for instructions) File No.82088.IMM 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name i. Name Jeffrey M.Morgan,as his separate estate Name Hampton B.Anderson and Donna G.Anderson, husband and wife x O Mailing Address 12715 131st KPN x w Mailing Address 60 Point View Ave a z w City/State/Zip Gig Harbor,WA 98329 City/State/Zip Brinnon,WA 98320 co r' c7 Phone No.(including area code) (253)732-2396 c7 Phone No.(including area code) (407)797-3531 3. Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s) numbers—check box if personal property Name Hampton B.Anderson and Donna G.Anderson 980 700 602/36914 0 106,126.00 Mailing Address 60 Point View Ave 0 City/State/Zip Brinnon,WA 98320 0 Phone No.(including area code) (407)797-3531 0 1111 Street address of property: 60 Point View Ave,Brinnon,WA 98320 This Property is located in\0unincorporated Jefferson County OR within 0 city of Brinnon 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) Lots 6&7, Block 6, Olympic Canal Addition No. 3, as per plat recorded in Volume 4 of Plats, pages 37 and 38, records of Jefferson County, Washington. Situate in the County of Jefferson State of Washington. ® Select Land Use Code(s): 11 7. 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)? ❑ x ® 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 x Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ x WAC No.(Section/Subsection) Is this property receiving special valuation as historical property per chapter 84,26 RCW? ❑ x 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 April 21,2016 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 $ 120,000.00 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 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 $ 120,000.00 This land 0 does 0 does not qualify for continuance Excise Tax: State $ 1,536.00 Local $ 600.00 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 2,136.00 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 $ 2,141.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS I. I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Signature of PI Signature of Grantor or Grantor's Agent PI /71/—,,, Grantee or Grantee's Agent dire r ,„11 Name(print) Jeffrey M.Morga Name(print) Hampton B Ande son Date&city of signing: /j cJi(t Date&city of signing 5/3ciJ IL, Pt i 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 0001a(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER 55818 125466 :t5 25/2016 2,141 ;001i Wik 1 State of Washington REAL ESTATE EXCISE TAX l"iI""."". ... C Department Revenue Miscellaneoouss Tax Section SUPPLEMENTAL STATEMENT PO Box 47477 Olympia WA 98504-7477 {t'F'`AI 4.58-6!A-304 I This form must be submitted with the Real Estate Excise Tax Affidavit(FOR 'I Ply 81 t 5 A L\for deeded transfers and I orm!4IA:34 000i B for controlling interest transfers)for claims of tax exemption as provided below.Completion of this form is required for the types of real property transfers listed in numbers 1-3 below.Only the first page of this form needs original signatures. AUDIT:Information you provide on this form is subject to audit by the Department of Revenue. In the event of an audit,it is the taxpayers'responsibility to provide documentation to support the selling price or any exemption claimed. This documentation must be maintained for a minimum of four years from date of sale.(1.0..:'N S2 15.1 oui Failure to provide supporting documentation when requested may result in the assessment of tax,penalties,and interest. Any filing that is determined to be fraudulent will carry a 50%evasion penalty in addition to any other accrued penalties or interest when the tax is assessed. PERJURY:Perjury is a class C felony which is punishable by imprisonment in a 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 ($5,000.00),or by both imprisonment and fine(14C'W 9.\:VI0.V.2 u(1(2)). The persons signing below do hereby declare under penalty of perjury that the following is true(check appropriate statement): 1.©DATE OF SALE:(WAC'458-G 1 A-306(2); I,(print name)Bethany Smith certify that the Statutory Warranty Deed (type of instrument),dated 04/21/2016 ,was delivered to me in escrow by Jeffrey M.Moroan (seller's name).NOTE:Agent named here must sign below and indicate name of firm.The payment of the tax is considered current if it is not more than 90 days beyond the date shown on the instrument.If it is past 90 days,interest and penalties apply to the date of the instrument Reasons h esc ow w... s o lend-r as*royal SA . L,Slay: r- Firm .me 2. GI -S:i A' 458 'I..A-20'; e gift of equity is non-taxable;however,any consideration received is not a gift and is taxable.The value exchanged or pal. or equity plus the amount of debt equals the taxable amount.One of the boxes below must be checked. Both Grantor(seller)and Grantee(buyer)must sign below. Grantor(seller)gifts equity valued at$ to grantee(buyer). NOTE:Examples of different transfer types are provided on the back.This is to assist you with correctly completing this form and paying your tax. "Consideration"means money or anything of value,either tangible(boats,motor homes,etc)or intangible_paid or delivered,or contracted to be paid or delivered,including performance of services,in return for the transfer of real property.The term includes the amount of any lien,mortgage,contract indebtedness,or other encumbrance,given to secure the purchase price,or any part thereof,or remaining unpaid on the property at the time of sale."Consideration"includes the assumption of an underlying debt on the property by the buyer at the time of transfer. A. Gifts with consideration 1. 0 Grantor(seller)has made and will continue to make all payments after this transfer on the total debt of $ and has received from the grantee(buyer)$ (include in this figure the value of any items received in exchange for property).Any consideration received by grantor is taxable. 2. D Grantee(buyer)will make payments on %of total debt of$ for which grantor(seller) is liable and pay grantor(seller)$ (include in this figure the value of any items received in exchange for property).Any consideration received by grantor is taxable. B. Gifts without consideration I. 0 There is no debt on the property;Grantor(seller)has not received any consideration towards equity. No tax is due. 2. LI Grantor(seller)has made and will continue to make 100%of the payments on the total debt of$ and has not received any consideration towards equity.No tax is due. 3. J Grantee(buyer)has made and will continue to make 100%of the payments on total debt of$ and has not paid grantor(seller)any consideration towards equity.No tax is due. 4. Q Grantor(seller)and grantee(buyer)have made and will continue to make payments from joint account on total debt before and after the transfer.Grantee(buyer)has not paid grantor(seller)any consideration towards equity. No tax is due. Has there been or will there be a refinance of the debt? ❑ YES p NO(If yes,please call(360)534-1503 to see if this transfer is taxable).If grantor(seller)was on title as co-signor only,please see G1'AC 453-P 7A-215 for exemption requirements. The undersigned acknowledge this transaction may be subject to audit and have read the above information regarding record-keeping requirements and evasion penalties. Grantor's Signature Date Grantee's Signature Date Grantor's Name(print) Grantee's Name(print) 3. ❑IRS"TAX DEFERRED"EXCHANGE(-'AG 1:58-61A-213) 1,(print name) ,certify that I am acting as an Exchange Facilitator in transferring real property to pursuant to IRC Section 1031,and in accordance with bR.A('ass-t-1 A-_13 NOTE:Exchange Facilitator must sign below. Exchange Facilitator's Signature Date Exchange Facilitator's Name(print) For tax assistance,contact your local County Treasurer/Recorder or visit http://dor.wa.gov or call(360)534-1503. To inquire about the availability_of this document in an alternate format,please call 1-800-647-7706.Teletype(TTY)users may use the Washington Relay Service by calling 711 REV 840002ea(8/13;15) COUNTY TREASURER