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HomeMy WebLinkAbout125468 Department of re Revenue Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61 A 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. 0 Name GERALD F. THUOTTE AND PEGGY A. THUOTTE. U NameGerald F Thuotte&Peggy A Thuotte, trustees, of the o Husband and Wife w Gerald& Peaav Thuotte Livina Trust dated 3/15/16 a z Mailing Address2O3 Seaway Place W H Mailing Address 203 Seaway Place City/State/Zip Port Ludlow. WA 98365 eg City/State/zip Port Ludlow, WA 98365 Phone No.(including area code)(360)437-0863 Phone No.(including area code)(360)437-0863 List all real and personal property tax parcel account © Send all property tax correspondence to:❑✓ Same as Buyer/Grantee numbers—check box if personal property List assessed value(s) Name 998 700 072 0 _ .35q 4.'to Mailing Address n City/State/Zip n Phone No.(including area code) n 11 Street address of property: 203 Seaway Place This property is located in Jefferson County ❑Check box if any of the listed parcels are being segregated from another parcel,are part of a 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) Lot 72,of Teal Lake Village Division 1,as per plat recorded in Volume 6 of Plats,pages 158 through 169 and amended in Volume 6 of Plats,pages 189 through 197,records of Jefferson County,Washington. Situate in the County of Jefferson,State of Washington. Select Land Use Code(s):IIII List all personal property(tangible and intangible)included in selling 11-Household.single family units price. enter any additional codes: none (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under ❑ 0 chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 111 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? ❑ ❑� WAC No. (Section/Subsection) 458-61A-211(2a) Is this property classified as current use(open space,farm and 0 ❑✓ agricultural,or timber)land per chapter 84.34 RCW? Reason for exemption Transfer to revocable living trust Is this property receiving special valuation as historical property 0 0 per chapter 84.26 RCW? 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 3/15/16 classification as current use(open space,farm and agriculture,or timber)land, 0.00 you must sign on(3)below.The county assessor must then determine if the Gross Selling Price $ land transferred continues to qualify and will indicate by signing below.If the *Personal Property(deduct) $ land no longer qualifies or you do not wish to continue the designation or Exemption Claimed(deduct) $ 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 Taxable Selling Price $ 0.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax : State $ 0.00 your local county assessor for more information. 0.0050 Local $ 0.00 This land 0 does ❑does not qualify for continuance. *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 $ 0.00 sign(3)below.If the new owner(s)does 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 $ 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 AND CORRECT. Signature of �' � Signature of Grantor or Grantor's Agen . _ �Se�l���� Grantee or Grantee's` Agent •�'C} Lc) 0,-, ('L. l '\ail. xl Name(print) GErL„t_a F. Tva a Name(print) f' C ,:y i%1 1 1-I Z.1 1 : a� Date&city of signin ,lL.' oFlam QoiKt•%�it)Srrr�11J� Date&city of signing: t./�-acs 1 1L, PG��S I ci,ui a�iv k,h l 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(l C)). REV 84 0001a(01/04/16) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER „ 1 ti1c4