Loading...
HomeMy WebLinkAbout125488 Department of rfea,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. ® ge.(tAtP. r. rmioTTcA+-ab PE(,Gy A /Nuo7re- © '- . Name Name Q,4 ///vo t� filw lid ,--.41► 0 I/05ga4.in ANa to ire= w McAitilUbIPagyi•eIvont'11F/r44?ays7pMf f1,'101(, a z Mailing Address 20 3 50(040,4 IDLE L..4Mailing Address 20 3 'SesA.J Ny PLAce Lu City/State/Zip PeR7 LvOLei,Si WA 9834.5 m ae City/State/Zip Pa AT 1,./610. ,wA 9a3re5 Phone No.(including area code) 34e-'Y37-08 63 Phone No.(including area code) .31.0-1137-O84.3 © Send all property tax correspondence to:FISame as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers-check box if personal property© ,,5 `-) e) 7� Name 54.gbf, / 6 -)4,Lt 0 sJ(� e) Mailing Addressn City/State/Zip n Phone No.(including area code). n UStreet address of property: This property is located in Jefferson County 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 K-5; 1<' Pk•Jcst4 co4,00M/N 1d^-4/ A Coua0,44,ru:JtM RE4o4,0ca ii1 Vakvmc 2 c3F Co nr.bmAni eJ tv-A• S,. Ace, 1131'gdwr4N /j$ A cc o,n o•As6 Tv ;'% a .DEe.4,,A4A7/oA 7-6fc1eco F, RECoAce, IJ krocit- J.r=+oitsets@A cow,-rTy Av/ ,,r?o4`S P Le No- `/377ao Aevo Amy -AAIG.+e.MGare5 7-iic/1E 70 - Srs,r,d.-7c iv Ode eavtdrY dF JEffCcit5 57 7e of whiff(,j roA`) Select Land Use Code(s): 1111 List all personal property(tangible and intangible)included in selling Select Land Use Codes 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 ❑ 0 chapters 84.36,81..37.or 84..38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 6If claiming an exemption, list WAC number and reason for exemption: YES NO / Is this property designated as forest land per chapter 81L7 .33 RCW? 0 0 WAC No. (Section/Subsection) SS -L.1 A—2// 2.a/ Is this property classified as current use(open space,famm and 0 0 Reason for exemption TZOMFG4.. ,&ve)c. Ste ,t l/sa Tit"-n.7 agricultural,or timber)land per chapter 84.34 RCW? Is this property receiving special valuation as historical property 0 0 per chapter 84.2.6 RCW? If any answers are yes,complete as instructed below. Type of Document 'ATUTbf y W AR2q PrTY 13EE4:::. (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) .-y 1• I 5/Q6/f`_ NEW OWNER(S):To continue the current designation as forest land or Date of Document i • -, 1 ' y, / Sp classification as current use(open space,farm and agriculture,or timber)land, Gross Selling Price $ 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.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 84.33,141)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) 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 RGW,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 A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX PRINT NAME *SEE INSTRUCTIONS 13 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of '� j Grantor or Grantor's Agent (4.44,j1 _ _ Grantee or Grantee's Agent Q.0 ^.�'\ 6 ►\� ' `^% Name(print) 6E.l$L.D K `//Vo77T� Name(print) 1 ECC'1 YI 1- ac, -FTC Date&city of signing:6/29/20.i& PoAr law tJS 03`v Date&city of signing: i/.ai..0 /Xi t Pccc) I k)t,)sk NN,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(It CW 21..20.0:.0(IC)). REV 84 0001a(01/04/16) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER � $,1, 12Lt f