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Home My WebLink About94433PLEASE TYPE OR PRINT PLEASE SEE REVERSE Paul G. Buesnel Gail J. Buesnel P.O. Box 2108 s~t City/Sm~ip Silverdale, WA 98383-2108 .i REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt CHAPTER 82.45 RCW - CHAPTER 458-61 WAC when stamped by cashier. (Use Form No. 84-0001B for Reporting Transfers of Controlling Interest of Enti~ Ownership to the Department of Revenue) THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS 1-7 ARE FULLY COMPLETED ADDRESS TO SEND ALL PROPERTY TAX RELATED CORRESPONDENCE Same as:.~above stated Grantee Name Street City/State/Zip David Persing Sr. and Carol Persing Name_e~l~l~r~:~_of &~^ ~----~--~ V 4~,4--~ ' Trust and David H. Persing, Jr. and Susan H. Street 21995 Heights Way CA 95070 City/State/Zip ?_a_r a t 0 g a, 989 . 70l. 001 COUNTY TREASURER PI.ACE ASSESSED VALUE IF TAX EXEMffF LEGALDESCRIPTIONOFPROPERTYSITUATEDIN ~UNINCOR~RA~D COUNTY ~ORINCI~OFPt.Townsend 1001 Water Street, Port Townsend, Washington, 98368 Street Address (if property is improved): Lots 1, 2, 3 and 4, Block ].0, Original Townsite of the City of Port Townsend, as per plat recorded in Volume 1 of Plats, page 1, records of Jefferson County, Washington, being a portion of tidelands district 56, tidelands of the first class in front of the city of Port Townsend. ~is this currently: property Classified or designated as forest land? Chapter 84.33 RCW Classified as current use land (open space, farm and agricultural, ur timber)? Chapter 84.34 RCW Exempt from property tax as a nonprofit organization? Chapter 84.36 RCW Seller's Exempt Rog, No. -- Receiving special valuation as historic pro~rty? Chapter 84.26 RCW Property TyI~: ~l land only [] land with previously used building [] timber only Princilml Use: [] Apt. (4+ unit) [] timber [] agricultural [] other YES NO [] land with new building [-] land with mobile home [] building only [] residential [~ commercial/industrial l~l (1) NOTICE OF CONTINUANCE (RCW 84.33 OR RCW 84.34) If the new owner(s) of land that is classified or designated as current use 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 to continue such classification or designation, all compensating or additional tax calculated pursuant to RCW 84.33.120 and 140 or RCW 84.34.108 shall be due and payable by the seller or transtbror at thc time of sale. The county assessor must determine if the land transferred qualifies to continue classification or designation and must so indicate below. Signatures do not necessarily metro the land will remain in classification or designation, if it no longer qualifies, it will be removed and the compensating taxes will be applied. All new owners must sign. This land [-I does [] does not qualify tbr continuance. Dat~ DEPUTY ASSESSOR (2) NOTICE OF COMPLIANCE (Chapter 84.26 RCW) If the new owner(s) of property with special valuation as historic property wish to continue this special valuation thc new owner(s) must sign below. 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 and payable by the seller or transfbror at the time of sale. (3) OWNER(S) SIGNATURE tangible (eg; furniture, equipment, etc.) or intangible (eg; goodwill, UDescription of personal property included in selling price, both gross agreement not to compete, etc.) If exemption claimed, list WAC number and explanation. WAC No. (Sec/Sub) Explanation Type of Document Statudsory Warranty Deed Date of Document April 11, 2002 u/ Gross Selli.g Price $ 1,400,000.00'~/" Personal Property (deduct) $ - 0- ,, Taxable Selling Price $ 1~400~000.00 .. Excise Tax: State $ 17,920.00 Local $ 7,000.00 Delinquent Interest: State $ -0- Local $ ~0- Delinquent Penalty $ Total Due $ 24,920.00 A MINIMUM OF $2.00 IS DUE AS A PROCESSING FEE AND TAX. I~' AFFIDAVLT I Certify Under Pcn~ Perjury Undc/'de/aws of The State of/7 Washington That '~e Fo~egoing~r~e Anti/Correct. (See back2fftl]is form). /,/~f /~//( d ~ / Signature of Grant°r/Agent~...--L'~-t'O~'7--~-~- I/or- ~ / V I1 -- .n -- Name( nnt ~au. 1 G. [ ~3uesne.l. p' ) Date and ,'lace of Signing: V- / 2 q:> 2-~ (~¢g ~,.~-l~.~,?~cz~4~/- Signature of Grantee/Agent Namc(print) David Persing, Sr. Date & Place of Signing: Perjury: Perjrgy 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 thc cc, urt of not more than five thousand dollars ($5,000.00), or by both imprisonment and fine (RCW 9A.20.020 (lC)). REV 84 O001a (3-18-99) (PD 08-01-01) FOR TREASURER'S USE ONLY COUNTY TREASURER 094433 PLEASE TYPE OR PRINT PLEASE SEE REVERSE Name REAL ESTATE EXCISE TAX AFFIDAVIT CHAPTER 82.45 RCW ..- CttAPTER 458-61 WAC This form is your receipt when stamped by cashier. FOR USE AT Cot INlY TRI{ASt. JR ~-.R 'S OFFICt-. (Use Form No, 84-0001B for Reporting Transfers of Controlling Interest of Entity Ownership to the Department of Revenue) TttlS AFFIDAVIT WILl, NOT BE ACCEPTED UNt. ESS AI.L AREAS I-7 ARE FULLY COMPLETED Paul G. Buesnel ADDRESS 'to SEND ALt, PROPERTY TAX REI.ATEI) C(.)RRESPONDENCE Same asc'.~above stated Grantee Name Gall J. Buesnel P.O. Box 2108 S~eet Street City/State/Zip ciu/smt~zip Silverdale, WA 98383-2108 David Persing Sr. and Carol pe'rsJ Name Trust and David H. Persing, "-S-O-~Xh H. Persing City/State/Zip Saratoga, CA 95070 Jr. and.: AI,L TAX PARCEL NUMBERS 989.701.001 ASSESSED VAI.UE IF TAX EXEMPT /LEGALDESCRIPTIONOFPROPERTYSITUATEDIN ~UNINCORPORA~D COUN~ ~ORiNCI~OF~_t..Townsen St~t^ddress(i£propertyisimproved): 1001 Water Street, Port Townsend, Washington, 98368 Lots l, 2, 3 and 4, Block 10, Original Townsite of the City of Port Townsend. as per plat recorded in Volume 1 of Plats, page 1, records of Jefferson County, Washington, being a portion of tidelands district 56, tidelands of the first class in front of the city of Port Townsend. l/ils this property currently: YES NO Classified or designated a's forest land'? I-I []~ Chapter 84.33 RCW Classified as current use land (open space, farm [] [~ and agricultural, or timber)'? Chapter 84.34 RCW Exempt from property tax as a nonprofit [] E~ organization? Chapter 84.36 RCW Seller's Exempt Reg. No, -- Receiving special valuation as historic FI [~t property'? Chapter 84_26 RCW Property Type: [] land only [] land with previously used building [] timber only Principal Use: [] Apt. (4+ unit) [] timber [] agricultural [] other [] land with new building [] la:~d with mobile home [] building only [] r~idcntial [] commercial/industrial ~l (1) NOTICE OF CONTINUANCE (RCW 84.33 OR RCW 84.34) If the new owner(s) of land that is classified or designated as current use or tbrest land wish to continue the classification or designation of such land, the new owner(s) must sign below, if thc new owner(s) do not desire to continue such classification or designation, all compensating or additional tax calculated pursuant to RCW 84.33.120 and 140 or RCW 84.34~ 108 shall be due and payable by the seller or ~-ansferor at the time of sale. The county assessor must determine if the land transferred qualifies to continue classification or designation and must so indicate below. Signatures do not necessarily mcan the land will remain in classification or designation. [f it no longer qualifies, it will be removed and the compensating taxes will be applied. All new owners must sign. This land [] does [] does not qualify for continuance. Date DEPUTY ASSESSOR (2) NOTICE OF COMPLIANCE (Chapter 84.26 RCW) 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. lflhe new owner(s) do not desire to continue such special valuation, all additional tax calculated pursuant to Chapter 84.26 RCW, shall be due and payable by the seller or transferor at the time of sale. (3) OWNER(S) SIGNATURE MDescription of personal property included in gross selling price, both tangible (eg; furniture, equipment, etc.) or intangible (eg; goodwill, agreement not to compete, etc.) If exemption claimed, list WAC number and explanation. WAC No. (Sec/Sub) Explanation Type of Document Statutory Warranty Deed Da,eof Document April 11, 2002 Gross Selling Price $ 1,400, 000.00 Personal Property (deduct) $ -0- laxablc Selling Price $ 1~400,000.00 Excise Tax: State $ 17,9 2 0 . 0 0 t, ocal $ 7,000.00 Delinquent Interest: State $ Local $ -0- Delinquent Penahy $ Total Due $ __ 2 4, 9 2 0. 0 0 A MINIMUM OF' $2.00 IS DUE AS A PROCESSING FEE AND TAX. I AFFIDAVIT I Certify Under Penalty of Perjury Under The Laws of The State of Washington That The Foregoing Is Tree And Correct. (Sec back of this Ibrm). Signature of G rantor/Agent Paul G. Buesnel Name (print) Date and Place of Signing: . . Signature of //~2 ~C""~ G ranteelAgent ~ '~_~~".~l~~ Name(print) D&vid Persing, Sr. 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 (lC)). REV 840001 a (3-18-99) (PD 08-01-01 ) FOR TREASURER'S USE ONLY 094433