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Revenue
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REAL ESTATE EXCISE TAX AFFIDAVIT
TPLEASE TYPE OR PRINT CHAPTER 82.45 RCW-CHAPTER 458-61A WAC whenhformstamped is our cashier.
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED by cashier.
(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 William Hamlin,as his separate estate ®Name Debra R.Bradford,an unmarried person
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w F.Mailing Address 1722 SW 307th Street z Mailing Address 2910 Kimball Court#7
w a City/State/Zip Federal Way,WA 98023 co a City/State/Zip Port Townsend,WA 98368
L Phone No.(including area code) (253)517-3996
Phone No.(including area code) (360)297-3861
IISend all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal property tax parcel account
checnumbers— box if personal property List assessed values)
Name Debra R.Bradford 945800007 Z(i 14061 0 $198,225.00
Mailing Address 2910 Kimball Court#7 0
City/State/Zip Port Townsend,WA 98368 0
Phone No.(including area code) (360)297-3861 0
0 Street address of property: 2910 Kimball Court#7,Port Townsend,WA 98368
This property is located in 0 unincorporated Jefferson County OR within®city of Port Townsend
0 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)
Unit 7,Cottages of Umatilla Hill,a condominium recorded in Volume 2 of Condominiums,pages 145 and 146,according to the
declaration thereof,recorded under Jefferson County Recording No.489026 and any amendments thereto.
Situate in the County of Jefferson,State of Washington.
® Select Land Use Code(s): 8 List all personal property(tangible and intangible)included in selling
14 price.
enter any additional codes:
(See back of last page for instructions)
YES NO
Is this property exempt from property tax per chapter ❑
84.36 RCW(nonprofit organization)?
MIYES 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 El
WAC No.(Section/Subsection)
Is this property classified as current use(open space,farm and
agricultural,or timber)land per chapter 84.34? ❑ ® Reason for exemption
Is this property receiving special valuation as historical ❑ El
property per chapter 84.26 RCW?
If any answers are yes,complete as instructed below.
(1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Statutory Warranty Deed
NEW OWNER(S): To continue the current designation as forest land or
classification as current use(open space, farm and agriculture,or timber) Date of Document May 23,2016
land, you must sign on (3) below. The county assessor must then
determine if the land transferred continues to qualify and will indicate by Gross Selling Price $ 236 500.00
signing below. If the land no longer qualifies or you do not wish to *personal Property(deduct) $
continue the designation or classification, it will be removed and the
compensating or additional taxes will be due and payable by the seller or Exemption Claimed(deduct) $ No
transferor at the time of sale. (RCW 84.33.140 or RCW 84.34.108).Prior Taxable Selling Price $ 236,500.00
to signing(3)below,you may contact your local county assessor for more
information. Excise Tax: State $ 3,027.20
This land 0 does 0 does not qualify for continuance. Local $ 1,182.50
*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, Subtotal $ 4,209.70
sign (3) below. If the new owner(s) does not wish to continue, all
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. *Affidavit Processing Fee $
(3) OWNER(S)SIGNATURE Total Due $ 4,214.70
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
W•, Signature of �/
Grantor or Grantor's Agent ��� Grantee or Grantee's Agent r1/vi"
Name(print) William HamlinName(print) rand -kP-16 ttiSxh
Date&city of signing: 5`z'it t(e Qo `^+c Wb %St�11 Date&city of signing: ',/L'/ /"Lo(‘ P.t7ro" Te'
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)).
755`...W; '-:5472 ::- ; -,1 o - COUNTY TREASURER
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