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Home My WebLink About125497 Revenue rei4 ! . _ / 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) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. fl Name William Butterfield and Cheryl Butterfield,as 11 Name William C.Butterfield and Cheryl Mahrt-Butterfield, o husband and wife 14as Joint Tenants with Rights of Survivorship ifja Mailing Address 5175 Dabob Road w Mailing Address 5175 Dabob Road City/State/Zip Quilcene,WA 98376 . m o City/State/Zip Quilcene,WA 98376 Phone No.(including area code) (360)765-3523 Phone No.(including area code) (360)765-3523 ® Send all property tax correspondence to:❑✓ Same as Buyer/Grantee List all real and personal property tax parcel account numbers check box if personal property List assessed value(s) Name 701061012 dj2/ 250747 Mailing Address 0 City/State/Zip n Phone No.(including area code) n iiStreet address of property: 5175 Dabob Road.Quilcene.WA 98376 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) SEE ATTACHED EXHIBIT"A"FOR FULL LEGAL DESCRIPTION aSelect Land Use Code(s): III List all personal property(tangible and intangible)included in selling I11-Household,single family units price. enter any additional codes: 8300 (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under 0 0 chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? 1111 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? 00 WAC No.(Section/Subsection) 458-61A-294-a1"1(6) Is this property classified as current use(open space,farm and ❑✓ M—r1°�d2d LFa agricultural,or timber)land per chapter 8434? Reason for exemption 'f0 VI�C� ��j��s jj conveyance for the sole purpose of creating joint tenant*Alth rights of Is this property receiving special valuation as historical property 0 0 survivorship 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 54046 c/I 0/I `b 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 Gross Selling Price $ 0.00 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 classification,it will be removed and the compensating or additional taxes will Exemption Claimed(deduct) $ 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 countysessor for more.�o+ ati t i 60/cd,�7� 0.0050 Local $ 0.00 ThisIL d 0 dfes ❑ •oes n•.f ••rali or continuance. , / *Delinquent Interest: State $ i / _rte_:.. .:../dr s 7—/42 c//, Local $ DEPUTY ASSESSOR DATE (2)NOTICE OF COMPLIANCE *Delinquent Penalty $ (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) 0 ER(S)SIGNATURE Total Due $ 10.00 Al4dts— C* t . PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX ii G • , /', �y4l��' J^ *SEE INSTRUCTIONS ® I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of f�''� Signature of (C)7 Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) Kate Gamble WSBA#47332 Name(print) Kate Gamble WSBA#47332 Date&city of signing: 5/9/16 Port Townsend Date&city of signing: 5/9/16 Port Townsend 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 GC)). REV 84 0001a(04/28/15) THIS SPACE-TREASURER'S USE ONLY DEPT.OF REVENUE Af 0 755933 12.497 :#:5, i 1- l 10.001 1 zr744°11 EXHIBIT A THAT PORTION OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER OF SECTION 6, TOWNSHIP 27 N., RANGE 1 WEST, W.M., DESCRIBED AS FOLLOWS: BEGINNING AT THE INTERSECTION OF THE EAST LINE OF GOVT. LOT 1 re:r3' WITH THE SOUTHERLY RIGHT-OF-WAY LINE OF THE QUILCENE-CENTER coo r_ ROAD; THENCE SOUTH ALONG THE EAST LINE OF SAID SECTION 6, 6f113 FEET TO A TRUE POINT OF BEGINNING THENCE CONTINUING SOUTH ALONG THE EAST LINE OF SAID SECTION 6, 330 FEET; THENCE WESTERLY ON A LINE PARALLEL TO THE NORTH LINE OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER, 660 FEET; THENCE NORTHERLY PARALLEL TO THE EAST LINE OF SAID SECTION 6, 330 FEET; THENCE EASTERLY ON A LINE PARALLEL TO THE NORTH LINE OF SAID SOUTHEAST QUARTER OF THE NORTHEAST QUARTER 660 FEET,TO THE TRUE POINT OF BEGINNING. SUBJECT TO: AN EASEMENT FOR INGRESS,EGRESS,AND UTILITIES UNDER AND ACROSS THE EAST 30 FEET OF THE ABOVE DESCRIBED TRACT AND THE EAST 30 FEET OF THE WESTERLY ONE-HALF OF THE DESCRIBED TRACT; AGREEMENT AS DISCLOSED UNDER AUDITOR'S FILE NO. 378581; EASEMENT AS DISCLOSED UNDER AUDITOR'S FILE NO. 403868; ALL EASEMENTS,AGREEMENTS,AND RESTRICTIONS OF RECORD. SITUATE IN THE COUNTY OF JEFFERSON, STATE OF WASHINGTON. TAX PARCEL NO.701061012 —10 init. init.