Loading...
HomeMy WebLinkAbout79870 74* $ .« • s. II b i.,.. 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 Q Name Leslie Harrington,/ El Name Edward H. Mills ''' 1;4 •:::+----- Marian A. Mi11si W a� W¢ Street 107 Renwal l Court Street 16047 Highway 305 NE �� City/State/Zip Chapel Hill, NC i 751b m0 Poulsbo, WA 9370 Y p City/State/Zip ©ADDRESS TO SEND ALL PROPERTY TAX RELATED CORRESPONDENCE ALL TAX PARCEL NUMBERS A`%S` EViTE F I BBB]:PLAErE' p5SPCSEI<3 VALUEt1?:;'AX;:EX Pt Same as grantee above U Name 002-352- Street V1/4,i 4 i / e C tY Stat /Zi P 4 LEGAL DESCRIPTION OF PROPERTY SITUATED IN$] UNINCORPORATED Jefferson COUNTY ❑ OR IN CITY OF Ptn SW NW 35-30-2 , Jefferson County, WR Street Address (if property is improved): • LEGAL DESCRIPTION ATTACHED HERETO MARKED "EXHIBIT A" AND BY THIS REFERENCE MADE A PART 1 HEREOF. 1 ��4, . L_G S K, (t v.4 —2(x).u9 ' ) -* r -FL © Is this property currently: YES NO ©Description of tangible personal property if included in sale (furniture, ,{ appliances, etc.) Classified or designated as forest land? ❑ PSl Chapter 84.33 RCW Classified as current use land (open space, farm ❑ k] and agricultural, or timber)? Chapter 84.34 RCW Exempt from property tax as a nonprofit ❑ K If exemption claimed, list WAC number and explanation. organization? Chapter 84.36 RCW Seller's Exempt Reg. No. — WAC No. (Sec/Sub) Receiving special valuation as historic ❑ [g Explanation property? Chapter 84.26 RCW Property Type: land only ❑ land with new building / Elland withNit previously used building 0 land with mobile home Type of Document a t C 1 a i is Deed r/ ❑ timber only 0 building only Date of Document 7- >4, Principal Use: ❑ Apt. (4 + unit) ,.,residential ❑ timber ❑ agricultural ❑ commercial/industrial Gross Sale Price $ 1,200.00 ❑ other Personal Property (deduct) $ Taxable Sale Price $ 1,200,00 8 (1) NOTICE OF CONTINUANCE (RCW 84.33 or RCW 84.34) 15.3E Excise Tax: State $ If the new owner(s)of land that is classified or designated as current use Local $ 3.00 or forest land wish to continue the classification or designation of such land,the new owner(s)must sign below.If the new owner(s)do not desire Delinquent Interest: State $ to continue such classification or designation, all compensating or addi- Local $ tional tax calculated pursuant to RCW 84.33.120 and 140 or RCW Delinquent Penalty: State $ 84.34.108 shall be due and payable by the seller or transferor at the time 1 6.36 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 T FORM IF TAXIS DUE Signatures do not necessarily mean the land will remain in classification mi or designation. If it no longer qualifies, it will be removed and the corn- AFFIDAVIT pensating taxes will be applied. All new owners must sign. I certify under penalty 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 form). Date Signature of DEPUTY ASSESSOR Grantor/Agent z (2) NOTICE OF COMPLIANCE (Chapter 84.26 RCW) Name (print) Leslie Harrington If the new owner(s)of property with special valuation as historic property wish to continue this special valuation the new owner(s)must sign below. Date & Place of Signing -' If the 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,,,..--7',---Th ' and payable by the seller or transferor at the time of sale. Grantedr�'•,e .. ' l ...r _ (3) OWNER(S) SIGNATURE "� 1 Name (print) A, . , --,th kl F A -rtcix'V k Date & Place of Signing 7" 3 ` 5'(r - t_,-.., Perjury: Perjury is a class C felony which is punishable by imprisonment in a 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(6-16-95)(PD 8-22-95) FOR TREASURER'S USE ONLY COUNTY ASSESSOR That portion of the Southwest quarter of the Northwest quarter of Section 35, Township 30 North, Range 2 West, W.M. , Jefferson County, Washington, lying Northerly of Bachelor Road, formerly known as Gerard Road, a county road. EXCEPT the Westerly 200 feet and the Easterly 900 feet therof. Situate in County of Jefferson, State of Washington. -- i 5 LAND TITLE COMPANY This Space Resvold For iecofd�r/YUse: OF OFFIC(l RECO r FORDS Filed for Record at Request of AFTER RECORDING MAIL TO: JEFD RSON COUNTDRIDGE Name LTE-S AUDITOR Address DEPUTY City, State, Zip 5697 PT-8485 Quit Claim Deed THE GRANTOR Leslie Harrington, an unmarried woman 2 )--'r'YG\ for and in consideration of In exchange for that certain Release of Easement from Mills recorded concurrently herewith conveys and quit claims to Edward H. Mills and Marian A. Mills, husband and wife the following described real estate, situated in the County of Jefferson State of Washington, together with all after acquired title of the grantor(s) therein: That portion of the Southwest quarter of the Northwest quarter of Section 35, Township 30 North, Range 2 West, W.M. , Jefferson County, Washington, lying Northerly of Bachelor Road, formerly known as Gerard Road, a county road. EXCEPT the Westerly 200 feet and the Easterly 900 feet therof. Situate in County pf Jefferson, State of Washington. fE �N COUNN EXCIS I6K Mi. No. _� 3b `S�' mt. I Date Paid -- 8y TREASURER Dated: 7 ' s,.,JL,�, c:NL. Leslie Harrington State of North Carol'na County of I certify that I know or have satisfactory evidence that Leslie Harrington is/are the person who appeared before me, and said person acknowledged that she signed this instrument and acknowledged it to be her free and voluntary act for the uses and purposes mentioned in t 's instrument. DATED: � , &/-eff.„4,4 . ce �. lC Signature of Notary Publ'c Printed Name of Notary i� ,4-C, ,LLG 49 WOW My commission expires: -9 9 s*• �� 4brei c pp^yy,, .6 yr►�i VOL J �,M., VO LPB-12 J u L 0 5 1996' /