The URL can be used to link to this page

Home My WebLink About125467 Se This form is your receipt PLEASE TYPE OR PRINT REAL ESTATE EXCISE TAX AFFIDAVIT .S L� I 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.82136JMM 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name I. Name Marvin J.Pitts and Mary Beth E.Pitts,husband Name Glenn D.Prather II and Courtney R.Prather, and wife husband and wife C4 O Mailing Address 612 Olympic Ridge Dr x w Mailing Address 612 Olympic Ridge Dr Z w City/State/Zip Port Ludlow,WA 98365 ci c. City/State/Zip Port Ludlow,WA 98365 c7 Phone No.(including area code) (208)301-4695 C7 Phone No.(including area code) (540)645-2963 3. Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal tax parcel account numbers—check box if personal property Listed assessed value(s) Name Glenn D.Prather II and Courtney R.Prather 821 355 046/21068 0 331,635.00 Mailing Address 612 Olympic Ridge Dr 0 City/State/Zip Port Ludlow,WA 98365 0 Phone No.(including area code) (540)645-2963 0 Ira Street address of property: 612 Olympic Ridge Dr,Port Ludlow,WA 98365 This Property is located in unincorporated Jefferson County OR within 0 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 Ell 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, homeowners 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: RCW0 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 ❑ x 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 20,2016 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 $ 390 000.00 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 $ 390,000.00 This land 0 doesExcise Tax: State $ 0 does not qualify for continuance 4,992.00 Local $ 1,950.00 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 6,942.00 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 $ 6,947.00 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 AND CORRE Signature of Signature of 7 Grantor or Grantor's Agent �cvc t. �, Z,/ i�d Grantee or Grantee's Age Name(print) Marvin J.Pitts Name(print) Glenn D. jer I Date&city of signing: SI2 i//(ri "Per -"Ta..m;etiJ WA" Date&city of signing �.7��t 60 ) '7 , 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 i7,514(01 ti EXHIBIT A Parcel 10 of survey recorded October 19, 1989 in Volume 10 of Surveys, page 168, under Auditor's File No. 325439, and as re-recorded November 17, 1989 in Volume 10 of Surveys, page 178, under Auditor's File No. 326192 being known as "Olympic Ridge Estates", records of Jefferson County, Washington, being a portion of the Northwest 1/4 of the Northwest '/4 and of the Southwest 1/4 of the Northwest 1/4, and of the Southeast 1/4 of the Northwest 1/4, and a portion of all quarters of the Southwest 1/4, all of Section 35, Township 28 North, Range 1 East, W.M., Jefferson County, Washington. Situate in the County of Jefferson, State of Washington.