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DePannient of
_ Wwmplanne 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.
Namagylesworth.James T. c / Q,��� _,.� Name Avlesworth,James T.and Avleswaih,Bette J.,co-trustees of
571)C TiLKJs t the Avlemwwttlt Revocable Living Trust
Mailing Address 314543 Hlmhwav 101 Mailing Address 314543 Highway 101
City/State/Zip Brinnon.Washington 9832D m City/SutdLip Brinnon,Washington 98320
1:1]
Phone No.(including area code) Phone No.(including area code)
Send alltax correspondenceSame as B List all real and personal properly tax parcel account
property to:0 vyer/Gmnnee [M List assessed vat
numbers13008—check box if personal property L7
N 5
Name 502313008 n , t
Mailing Address (�,c/ n
City/State/Zip `-'�D n
Phone No.(including area code) n
IIIStreet address of property: 314543 Highway 101 Brinnon,Washington 98320
This property is located in Jefferson County
0 Check box if any of the listed parcels are being segregated from another parcel,ere 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) .
331 T25 R2W TX 13&Ti.TX 1.80CHS ENLGD BY PTN TX 17 SUBJ TO ACCESS RD
t
PlAi , i TYL, CLSK 41--- 1 ---11 2-P I. .0-Li9 ° '1:.'
111 Select Land Use Code(s): II List all personal property(tangible and intangible)included in selling
111-household.single family unite I price.
enter any additional codes: .
(See back of last page for instructions)
YES NO
Is this property exempt from property tax per chapter 0 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 ascurrent use(openspace,gent and 0 0 WAC No.(Section/Subsection) 458-81A-211(2)(0)
agricultural,ortimber)land perdrepter 84.34? Reason for exemption
Is this property receiving special valuation es historical property 0 0 Transfer toe revocable trust
•
per chapter 8426 RCW?
If any answers are yes,complete as instructed below.
(I)NOTICE OF CONTINUANCE(FOREST LAPID ORCURRENT USE) Type of Document Quit Claim Deed
NEW OWNER(S):To continue the current designation as forest land or Date of Document `V T t
rlaasification as current use(open space,fame 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
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
will be due and payable by the seller or transferor at the lime of sale.(RCW Exemption Claimed(deduct)$
84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Taxable Selling Price $ 0.00
your local county assessor for more information. Excise Tax:State $ 0.00
This land 0 does 0 does not qualify for continuance. 0.0050 Local S 0.00
*Delinquent Interest:State S
DEPUTY ASSESSOR DATE Local $
(2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty S
NEW OWNER(S):To continue special valuation as historic pr
si (3)below.If the new owner(s)does not wish to continue,all Subtotal S 0.00
additional tax calculated pursuant to chapter 84.26 RCW,shall be due *State Technology Fee 5 5.00
. and payable by the seller or transferor at the time of sale.
(3)OWNER(S)SIGNATURE *Affidavit Processing Fee S
Total Due S 10.00
PRINT NAME
A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX
*SEE INSTRUCTIONS
® I ', FY UNDER' LTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of r-- ' •ignature of y.�L�0
if
Grantor or Grantor's Age a i„� !� 4 _ .11 Grantee or Grantee's Agent ;-'4.4:1.60/7..
Name(print) James T.A Name(per) Bette J.Aylesworth
Date&city of signing: Date&city of signing:
Perjury:Perjury is a class C felony which is punishable by imprisonment in the state correctional institution fora 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 000lae(07/07/09) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURE!
680449 1 555 *1/15/2015 10.00* 122555
5887a9
Gloria Lung Wakayama, Esq.
Harris, Mericle & Wakayama, P.L.L.C.
901 Fifth Avenue, Suite 4100
Seattle, Washington 98164
Document Title(s) (or transactions therein): Quit Claim Deed
Grantor(s) (last, first, middle initial): Aylesworth, James T. and Aylesworth, Bette J.
Grantee(s) (last, first, middle initial): Aylesworth, James T. and Aylesworth, Bette J., Co-
Trustees of the Aylesworth Revocable Living Trust
Legal Description (abbreviated): S31 T25 R2W TX 13&TL TX 1.80CHS ENLGD BY PTN
TX 17 SUBJ TO ACCESS RD
Full Legal Description on Page(s): 1
Assessor's Tax Parcel Number(s): 502313008
Reference Numbers(s)of
Document(s)Assigned or Released:
The Auditor/Recorder will rely on the information provided herein. The staff will not read the document to verify the accuracy or
completeness of the indexing information.
QUIT CLAIM DEED
The Grantors, JAMES T.AYLESWORTH and BETTE J.AYLESWORTH, husband
and wife, for and in consideration of the transfer to their grantor trust and other valuable
consideration, do hereby convey and quit claim to JAMES T. AYLESWORTH and BETTE
J. AYLESWORTH, Co-Trustees of the AYLESWORTH REVOCABLE LIVING TRUST
dated January 8, 2015, all of their interest in the following described real estate, situated in
Jefferson County, State of Washington, to wit:
S31 T25 R2W TX 13& TL TX 1.80CHS ENLGD BY PTN TX 17 SUBJ TO
ACCESS RD
Commonly known as 314543 Highway 101, Brinnon, Washington 98320.
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