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HomeMy WebLinkAbout79752 110 • ( 1lL0 ZS - PLEASE TYPE OR PRINT REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt when stamped PLEASE SEE REVERSE by cashier. CHAPTER 82.45 RCW -CHAPTER 458-61 WAC For Use at County Treasurer's Office (Use Form No. 84-0001B for Reporting Transfers of Controlling Interest of Entity Ownership to the Department of Revenue) THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS 1-7 ARE FULLY COMPLETED RO1 ERT E. ANDERSON, JR. , TRUSTEE Name AND JUDITI�I.,. ANDERSON, `i tIJETRE EllName RiCHARD K. CHILDERS a OF THE GREY GLE TRUST DATED w —_ __KAREN L. CHILDERS a JIWE 23,,•-I 92 aw 627 WILLGW STREET w d Stre 1` FAL LI3RCJt 1I: C'GLIFti ' E Street 4--i1 .;-' City/State/Zip LON TA, CA 9190 City/State/Zip PORT TOWNSEND, WA 98368 ADDRESS TO SEND ALL PROPERTY TAX RELATED CORRESPONDENCE ALL TAX PARCEL NUMBERS R ` < : Name _ 2! 936 300 +'.'' ......................... ..... ............. Street . ! i ii�ii .nu c :nnnnn niinnic ncc nurn City/State/Zip '21.)! :::;:»ssss::: > > :>. in LEGAL DESCRIPTION OF PROPERTY SITUATED IN ❑UNINCORPORATED COUNTYKOR IN CITY OF P•T• Street Address (if property is improved): LOT 10, BLOCK 5, BROADWAY ADDITION TO THE CITY"` OF PORT 1GWNSEND, AS " : PER PLAT RECORDED IN VOLUME 1 OF PLATS, PAGE 112, RECORDS OF JEFFERSON COUNTY, WASHINGTON. , ® Is this property currently: YES NO ©Description of tangible personal property if included in sale (furniture, appliances, etc.) Classified or designated as forest land? ❑ El Chapter 84,33 RCW Classified as current use land (open space, farm El - - and agricultural, or timber)? Chapter 84.34 RCW Exempt from property tax as a nonprofit ❑ ] If exemption claimed, list WAC number and explanation. organization? Chapter 84.36 RCW ' Seller's Exempt Reg. No. — WAC No. (Sec/Sub) . _ _ s) yaI VaIuatlon as historic Fxplanahon property? Chapter 84,26 RCW ® � ��� Property Typei"a land only ❑ land with new building ` 0 land with previously used building ❑ land with mobile home Type of Do ment STk>TUTROY' WARRANTY DEED . ❑ timber only ❑ building only Date of Document JUNE 12, 1996 Principal Use: ❑ Apt. (4 + unit) presidential El timber ❑ agricultural ❑ commercial/industrial Gross.Siak t rice 15,0©C •CJ V ❑ other Perso iiperty (ded(yt) fi.!,746151570GC 8 (1) NOTICE OF CONTINUANCE (RCW 84.33 or RCW 84.34) Taxable Sale Price $ Excise Tax: . State $ 19 2.0 0 If the new owner(s)of land that is classified or designated as current use » .1or forest land wish to continue the classification or designation of such °i ,,• ,"iLocal _ 1 O` �xr ' � land,the new owner(s)must sign below.If the new owner(s)do not desire Delinquept Interest: State $... f3 to continue such classification or designation, all compensating or addi- Local $ __0_ tional tax calculated pursuant to RCW 84.33.120 and 140 or RCW �"-T-- 84.34.108 shall be due and payable by the seller or transferor at the time Delinquent Penalty: State $ _=_ 2 0/ .0 0 of sale.The county assessor must determine if the land transferred qualifies Total Due $ .._ to continue classification or designation and must so indicate below. THERE IS A$2.00 FEE FOR PROCESSING THIS FORM IF NO TAX IS DUE Signatures do not necessarily mean the land will remain in classification or designation. If it no longegualiifes, it will be removed and the corn- all AFFIDAVIT pensating taxes will be applied. AH4-new owners mus( sigq;, •,..- t I certify under pe ** of perjury under the laws of the state of This land ❑does ❑does not qualify for continuance. Washington that the foregoing is true and correct(See back of this \ 1. m).r fo ` 1. �ww D , -, ., ,4•.- ,, . 4 signature , JZ w-�; ' f`..,,,.. DEPUTY ASSESSOR , Grantor/Agent ff` (2) NOTICE OF COMPLIANCE (Chapter 84.26 RCW) Name (print) RO i-t' L• r,iwlik1R 014/ :i R. , T US TEL If the new owner(s)of property with special valuation as historic property ,. 47( r,•`" .i wish to continue this special valuation the new owner(s)must sign below. Date & Place of Signing Ifthe new owner(s)do not desire to continue such special valuation, all additional tax calculated pursuant to Chapter 84.26 RCW, shall be due Signature of and payable by the seller or transferor at the time of sale. Grantee/Agent (3) OWNER(S) SIGNATURE Name (print) RICHARD K. CIHILDERU 1 ,. Date & Place of Signing d Perjury: Perjury is a class C felony which is punishable by imprisonment in a state correctional institution for a maximum ter oft more than five years,or by a fine in an amount fixed by the court of not more than five thousand dollars($5,000.00),or by both imp •sonr eflt and fine (RCW 9A.20.020 (1C)). e—t 4 REV 84 0001a(6-16-95) (PD 6-19-95) FOR TREASURER'S USE ONLY COU Y ASSESSC$