HomeMy WebLinkAbout125499 'r Department of
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wast ngton 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.artial sale of.ro e If multiple owners,list.ercenta_e of ownershi.next to name.
I ' Name Wade Johnston, Personal Representative 2 NameAmerican Timber Resources, a Washington
of Estate of Stan & Candis L. Johnston, Limited Liability Company
W P.O. Box 251 deceased x w
Mailing Address W E" Mailing Address P.O. Box 810
d City/State/Zip Brinnon, WA 98320 w. city/state/zip Brinnon, WA 98320
CD
Phone No.(including area code) (360) 796-3137 Phone No.(including area code) (360) 301-1703
1131 Send all property tax correspondence to: Same as Buyer/Grantee List all real and personal property tax parcel account
p p y p y numbers—check b x if personal property List assessed value(s)
Name ,z 010 1=1118,266
, 602281001 227,250
Mailing Address /602281002 El220,050
City/State/Zip ,v602344021y 0 204,540
Phone No.(including area code) v602353009 ❑ 90.00
/nap✓
IIStreet address of property: 102 / 1.70 Schoolhouse Rd. , Brinnon, WA 98320
This property is located in ®unincorporated Jefferson County OR within 0 city of
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)
Abbreviated Legal Description: Ptn(s) 28T26N R2W, S35T26 R2W Tax 5 (LS N15' and S15' )
LS Tax 34, 35, S34T26 R2W, Tax 29, S35T26 R2W Tax 5 (N15' )
Legal Description attached hereto on page 2 incorporated herein by this reference.
112 Select Land Use Code(s): 88, 11 ® List all personal property(tangible and intangible)included in selling
price.
enter any additional codes:
(See back of last page for instructions)
YES NO
Is this property exempt from property tax per chapter 0 []
84.36 RCW(nonprofit organization)?
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
Is this property classified as current use(open space,farm and ❑ ao WAC No. (Section/Subsection)
agricultural,or timber)land per chapter 84.34? Reason for exemption
Is this property receiving special valuation as historical property 0 ER
per chapter 84.26 RCW?
If any answers are yes,complete as instructed below.
(1) NOTICE OF CONTINUANCE (FORESTLAND ORCURRENT USE) Type of Document S:tatutory Warranty Deed
NEW OWNER(S):To continue the current designation as forest land or
5/25/1
classification as current use(open space,farm and agriculture,or timber) Date of Document6
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 $ 1,005,000.00
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 Exemption Claimed(deduct) $
will be due and payable by the seller or transferor at the time of sale.(RCW
84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Taxable Selling Price $
your local county as essor for more information. Excise Tax : State $ 12,864.00
This n does ❑does no q alify for continuance. Local $ 5,025.00
_(fp_.) /' d 5 7 /t7 *Delinquent Interest: State $
DEPUTY A SESSOR DATE Local $
(2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $
NEW OWNER(S):To continue special valuation as historic property, 17,889.00
sign (3)below.If the new owner(s)does not wish to continue,all Subtotal $
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.
A (3) OWNER(SGNAT Rh *Affidavit Processing Fee $
/
Total Due $ 17,894.00
PRINT NAIE
/CC
)1 A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX
7
%7/C .2✓�ecci 77t ea_6___hi. *SEE INSTRUCTIONS
0 I CERTIFYnUNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of '2 / �" Signature of 7 i
Grantor or Grantor's Agent //vv � �fs Grantee or Grantee's Agent
Name(print) 1 r�//Pin Name(print)ALcaffG(�fpt GLc �c? tptj�G. G.�.G
Date&city of signing: 5-Z.-G 6 8`( ,�C, Date&city of signing: $ ,-`(6 0f / ,A Com-_
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(I C)).REV 84 0001a(04/30/09) THIS SPACE-TREASURER'S USE ONLY Pq
COUNTY TREASURER
LEGAL DESCRIPTION
The Northeast',the North%of the Southeast%,the Southeast%of the Southeast'A,Section 28,
Township 26 North, Range 2 West.;
EXCEPT the Dosewallips Country Road as conveyed by Auditor's File No 212027;
ALSO EXCEPT that portion of the Southeast%of the Southeast%of said Section 28, described as follows:
That certain tract containing 3 1/2 acres, more or less, in the Southwest corner(enough to take in the
spring of water)of the Southeast%of the Southeast 1/4 of said Section 28, being designated on the
County Assessor's Plat and description Book as Tax No. 1 in said Section 28
And,
The East 400 feet of the North 1/2 of the Southeast'A of the Southeast'A of Section 34,Township 26
North, Range 2 West, W.M.;
EXCEPT that portion thereof described as follows:
Beginning at the Northeast corner of said Southeast""A of the Southeast 1/4;
thence West, along the North line thereof, 358 feet to the true point of beginning;
thence South 58 42'West to the West line of said East 400 feet;
thence North,along said West line to the Northwest corner of said East 400 feet;
thence East,along said North line to the true point of beginning;
TOGETHER WITH the North 15 feet of the following described tract;
Beginning at the Southwest corner of Section 35,Township 26 North, Range 2 West, W.M..;
thence North on the Section line 881 feet;
thence East 589.4 feet;
thence South, parallel to the County Road,881 feet to the South line of said Section 35;
thence West, along said South line, 564 feet to the point of beginning.
And,
A tract of land in the Southwest%of Section 35,Township 26 North, Range 2 West,W.M., in the County
of Jefferson and State of Washington,described as follows:
Beginning at the Southwest corner of said Section 35,and running thence North along the Section line,
881 feet;
thence East 589.4 feet;
thence Southerly, parallel to the County Road 881 feet to the Township line;
thence West on the Township line, 564 feet to the place beginning;
EXCEPT the North 15 feet thereof; ALSO EXCEPT the South 315 feet thereof.
Situate in the County of Jefferson,State of Washington.
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