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HomeMy WebLinkAbout125494 • REAL ESTATE EXCISE TAX AFFIDAVIT This form is yourrecaipt "I LI�— PLEASE TYPE OR PRINT when stamped by cashier, CHAPTER 82.45 RCW-CHAPTER 458-6I A WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED (See back of Last page for instructions) Fife No.&226113MAl 0 Check box if partial sale of property It-multiple owners,list percentage of ownership next to name Name Michael Traband and Suzann Traband.husband Name llama Hama Company,a Washington corporation and wits - Mailing Address P.O.Res 2067 ,,: t-ladine Address 35846 N U.S.Hwy 101 J Jz z s City/State/Zip Port Angeles,WA 4$362 City:State/Zip Lilliwaup WA 98555 w- Phone ho.tuteluding arca code) • Phone No.(including area code) (307)231-3795 S d all property fav corresp ndence ta:❑Same as BuvedGrantee List all real and personal tax parcel account Listed assessed value(s) numbers-cheek box if personal property 702 014 001117901;701 063 264,685.93;131.091.00 Name Hama Barna Company,Inc. 001/17185 0 Mailing Address 35846 N G.S.Hwy 101 0 City/State/Zip Lilliwaup,WA 98555 Phone No. including area code) (3071231-3795 ❑ ® Street address ofprope�rttty: XXX Center Rd,Qullrene,WA 9$376 This Property is located t \ unincorporated Jefferson County OR within 0 city ufCpultcenc 0 Check box if any of the listed parcels are being segregated from a larger parcel,arc part of boundary line adjustment or parcels being merged Legal description of property Of more space is needed,you may attach a separate sheet to each page of the affidavit) SEE EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF FOR COMPLETE LEGAL DESCRIPTION ® Select Land Use Codels): 91:It$ 7._ 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 ineotne(7 x 6' YES NO is this property designated as forest land per chapter 54.33 If claiming an exemption,list(YAC number reason for exemption RCW! 0 a Is this property classified as current use(open space,farm and ❑ x agricultural,or timber)land per chapter 84.341 - WAC No.(Section/Subsection) Is this property receiving special valuation as historical 0 x property per chapter 8426 RCW? Reason for exemption If any answers are yes,complete as instructed below. Type of Document Statutory Warrants Heed (I)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S): To continue the current designation as forest land or Date of Document May.24.2016 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 S 399,000.00 If the land no longer qualifies or you do not wish to continue the designation *Personal Property(deduct) S or classification,it will he 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 114.33.140 or RCW 84.34.inti).Prior to signing(3)below,you may contact your local count ss sir for mon.infamtabon, Taxable Selling Price $ 394,000.00 Excise Tax: State S 5,107.20 This land does 0 does not qualify for continuance Local S 1,995.00 4e��j �js� �] / *Delinquent Interest: State S : //fit. l-/40 Local S DEPUTY ASSESSOR DATE. *Delinquent Penalty S (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal S 7,402.211 NEW OWNERtS):1'0 continue special valuation as historic property. sign(3)beton. If the new owners)do not wish to continue,ail *State Technology Fee $ 5.00 additional tax calculated pursuant to chapter 84.26 RCW,shall he due and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee S 1 (3)OWNER(S)SIGNATURE Total Due $ 7,107.20 t j- , PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX Kendra James,President of *SEE INSTRUCTIONS Hama Hama Company,Inc. U I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE ANpi CORRECT Signature of Signature of x Grantor'sJo Grantor or Agent Grantee or Grantee's Agent -j„,Gt.i 1 ,ii, Name(print) Michael Traband Name(print) Hansa Hama Company.Inc, Date&city of signing: Dote&city -of signing g g r`_� �'a Cc Ile; Li t..L(Vi A 17 Pi wA Perjury: Penury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum tern of not more than five_years.or by a fine in an amount fixed by the court of not inure than five thousand dollars(S5,1.00.t)0),or by both imprisonment and fine(RCW 9A.20.020 t IC). RET'84 0001 a(04/30/09) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 12C,1\ ' Department of Cevenue Vhshirwm Store REAL ESTATE EXCISE TAX AFFIDAVIT This forth is your receipt PLEASE TYPE OR PRINT when stamped by cashier. CHAPTER 82.45 RCW—CHAPTER 458-61A WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED (See back of last page for instructions) File No.82268JMM ❑Check box if partial sale of property If multiple owners,list percentage of ownership next to name I. Name Michael Traband and Suzann Traband,husband Name llama llama Company,a Washington corporation and wife LI)24 O Mailing Address P.O.Box 2067 aL Mailing Address 35846 N U.S.Hwy 101 az z d7,s City/State/Zip Port Angeles,WA 98362 City/State/Zip Lilliwaup,WA 98555 ( Phone No.(including area code) c7 Phone No.(including area code) (307)231-3795 3. Send all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal tax parcel account Listed assessed value(s) numbers—check box if personal property 702 014 001/17901; 701 063 269,685.00;131,000.00 Name Hama llama Company,Inc. (101/17185 ❑ Mailing Address 35846 N U.S.Hwy 101 ❑ City/State/Zip Lilliwaup,WA 98555 ❑ Phone No.(including area code) (307)231-3795 ❑ ® Street address of property: XXX Center Rd,Quilcene,'WA 98376 This Property is located iunincorporated Jefferson County OR within❑city of Quilcene ElCheck box if any of th 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): 91;88 EN 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: RCW? ❑ 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 property per chapter 84.26 RCW? ❑ x 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 24,2016 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 $ 399,000.00 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 $ 399,000.00 Excise Tax: State $ 5,107.20 This land ❑does ❑does not qualify for continuance Local $ 1,995.00 *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 7,102.20 NEW OWNER(S): To continue special valuation as historic property, 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 $ 7,107.20 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX Kendra James,President of *SEE INSTRUCTIONS Hama Hama Company,Inc. UI CERTIFY UNDER PENALTY OF PER.IU P Y THAT THE FOREGOING IS TRUE AND CORRECT Signature of r I' vir Signature of Grantor or Grantor's Agent/ Grantee or Grantee's Agent Name(print) Michael Traband Name(print) Hama Hama Company,Inc. Date&city of signing: -/b ,ems* " ' fe&s, ,1q Date&city of signing 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(04/30/09) THIS SPACE—TREASURER'S USE ONLY COUNTY TREASURER alarbra,at Of / ' �.4venue ' r.wyv.Gru REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE.TYPE OR PRINT when stamped by cashier. CHAPTER 82.45 RCW—CHAPTER 458-61A WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ARE FULLY COMPLETED (Sec back of last page for instructions) File No.h226/UMM 0 Check box if partiol sale of property If multiple owners,list percentage of ownership next to name Name Michael Traband and Suzann Traband,husband Name Hama Hama Company,a Washington corporation and wife Y Z4.1 Mailing Address P.O.Hox 2067 ae i..e Mailing Address 35846 N U.S.Hwy 101 l;,'i< City Port Angeles,WA 98362 J n zinil 3 P $ City/State/Zip LiiEYvvaup,WA 98555 �: Phone No.(including area code) G Phone No.(including area code) (307)231-3795 Send ali property tax correspondence to:0 Same as Buyer/Grantee List all real and personal tax parcel account numbers—check box if personal propey Listed assessed value(s) 702 014 001/17901;701 063 269,685.00;131.000.00 Name Hama Hama Company,inc. 001/17185 0 Mailing Address 35846 N U.S.Hwy 101 0 City/State/Zip Lilliwaup,WA 98555 0 Phone No.(including area code) (307)231-3795 0 LaStreet address of property: XXX Center Rd,Quitrent,WA 98376 This Properly is located illunincorporated Jefferson County OR within❑city of Quilcenc ❑Check box if any oldie 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 us Select Land Use('ode(s): 91:88 7. List all personal property(tangible and intangible)included in selling price. Enter any additional codes: (See back of last page for instructional Was the seller receiving a property tax exemption or YES NO deferral under chapters 84.36,84.37 or 84.38 RCW (nonprofit organizaation,senior citizen,or disabled person. ❑ homeowners with limited income)? x 6. YES NO Is this property designated as forest land per chapter 84.33 If claiming an exemption,list\VAC number reason for exemption: RCW? 0 a Is this property classified as current use(open space.farm and 0 x agricultural,or timber)land per chapter 84.34? WAC No.(Section/Subsectionl Is this property receiving special valuation as historical ❑ x property per chapter 8426 RCW? Reason for exemption If any answers are yes,complete as instructed below, ---- — -- 'TypeofDocument Statutory Warranty Deed (I)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(): To continue the current designation as forest land or Date of Document May 24,2016 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 S 399,000.00 If the land no longer qualifies or you do not wish to continue the designation *Personal Property(deduct) S or classification,it will be removed and the compensating or additional taxes wilt be due and payable by the seller or transferor at the time of sale. (RCW Exemption Claimed(deduct) S No X4.33.140 or RCW 84.34.1(18).Prior to signing(3)below,you may contact your local county assessor for more information. Taxable Selling Price S 399,000.00 This land ❑does IDdoes not qualify for continuance Excise Tax: State $ 5,107.20 Local S 1,995.00 *Delinquent Interest: State S Local S DEPUTY ASSESSOR DATE *Delinquent Penalty S (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ 7,102.20 NEW OWNER(S):To continue special valuation as historic property, sign(3)helms. If the new ownerisl do not wish to continue,ail *State Technology Fee S 5,00 additional tax calculated pursuant to chapter 84.26 RCW,shallbe due and payable by the killer or transferor at the time of sale. *.Affidavit Processing Fee S (3) OWNER(S)SIGNATURE Total Due S 7,107.20 - _ Y(f� PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX Kendra James,President of *SEE INSTRUCTIONS Hama Hama Company,Inc. ® I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AN l CORRECT Signature of Signature of X f/?, 0,4bk Grantor or Grantor's Agent Grantee or Grantee's Agent. 4 6-,GC, Name(print) Michael Traband Name(print) Hama Hansa Company,Inc. Date&city of signing: Date&city of signing x �r'"/4-)� Jic0, LiIL.l..cl✓v:AL;P( wA Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum tent[of not more than five years.or by a line in an amount fixed by the court of not more than five thousand dollars(S5,000.00).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 • EXHIBIT A PARCEL 1: The Southeast 'A of Section 1, Township 27 North,Range 2 West, W.M., Jefferson County, Washington. TOGETHER WITH an easement for ingress, egress and utilities over, under and across Parcels 1 through 7 on the existing private access road shown on Survey recorded under Auditor's File No. 485917. Situate in the County of Jefferson, State of Washington. PARCEL 2: Government Lot 6 in Section 6, Township 27 North, Range 1 West, W.M., Jefferson County, Washington. TOGETHER WITH an easement for ingress, egress and utilities over, under and across Parcels 1 through 7 on the existing private access road shown on Survey recorded under Auditor's File No. 485917. Situate in the County of Jefferson, State of Washington.