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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 458-61A 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)
❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name.
flName John J Mar:Donald a married man as his separate III Name John J.MacDonald and Lori R.Wilson,as co-Trustees of THE MACDONALD
O estate &WILSON LIVING TRUST,U/A dated April 12,2016 otv�C 1::1•01 ctonneinAvv evAi
a Z Mailing Address 73890 Masson St Z Mailing Address 73890 Masson St •4.s.rz,"\-0
v)6. City/State/Zip Palm Desert CA 92260-9316 City/State/Zip Palm flesert CA 92260-9316
Phone No.(including area code) Phone No.(including area code)
® Send all roe tax comes ondence to: Same as Bu er/Grantee List all real and personal property tax parcel account
p p p ® y numbers—check box if personal property List assessed value(s)
Name 990 700 045 n $195.266
Mailing Address n
City/State/Zip n
Phone No.(including area code) fl
Street address of property: 41 Mainsail Ln
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 45,Port Ludlow No.3,as per plat recorded in Volume 5 of Plats,pages 95 through 97,records of Jefferson County,Washington.
® Select Land Use Code(s): 11 List all personal property(tangible and intangible)included in selling
11-Household,single family units price.
enter any additional codes:
(See back of last page for instructions)
YES NO
Was the seller receiving a property tax exemption or deferral under ❑ ❑r
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? 0 ❑✓ WAC No. (Section/Subsection) 458-61A-211(2)(q)
Is this property classified as current use(open space,farm and 0 0 Reason for exemption
agricultural,or timber)land per chapter 84.34? Transfer into a revocable trust.
Is this property receiving special valuation as historical property 0 ❑i
per chapter 84.26 RCW?
If any answers are yes,complete as instructed below. Type of Document Quit Claim 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 ‘z,
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 ❑does 0 does not qualify for continuance. *Delinquent Interest: State $
Local $
DEPUTY ASSESSOR DATE
*Delinquent Penalty $
(2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) 0.00
NEW OWNER(S):To continue special valuation as historic property, Subtotal $
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 CER IFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of SI Signature of
Grantor or Grantor's Agent Grantee or Grantee's Agent
Name(print) John J.MacDon d Name(print) John J.MacDonal
Date&city of signing: April 12,2016,Palm Desert,CA Date&city of signing: April 12,2016,Palm Desert,CA
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(01/04/16) THIS SPACE-TREASURER'S USE ONLY COUNTY ASSESSOR
75 /26 C5:4: f\NQ
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