HomeMy WebLinkAbout37858 IIICHAPTER 28.45 RCW
PLEASE FILL OUT COMPLETELY 41)
1% REAL ESTATE EXCISE TAX
0 ¢ MAKE REMITTANCE PAYABLE TO ROBERT J. CLARK, CLALLAM COUNTY TREASURER
Name of Seller and complete address
Name of Purchaser and complete address
LEGAL DESCRIPTION OF REAL PROPERTY SITUATED IN CLALLAM COUNTY. PARCEL No
/),),")--4•-v ,--1-1 )
DESCRIPTION OF PERSONAL PROPERTY IF INCLUDED IN SALE:
GROSS SALES PRICE. . J Meaning—Equity plus 1% Excise Tax $
I obligated balance }$
PERSONAL PROPERTY (Deduct) $ Penalty (1% per month
TAXABLE SALES PRICE $ after 30 days) $
DATE OF INSTRUMENT—(On date of delivery of instrument if that Total $
is closing date provided in contract; otherwise upon execution of AFFIDAVIT
contract.) The undersigned being first sworn, on oath says
that the foregoing information is a true and cor-
TYPE OF INSTRUMENT rect statement of the facts pertaining to the
transfer of the above described real estate.
If tax exemption is claimed explain fully the nature of the
transfer
Signature
Any person wilfully giving false information in
If sale covers property traded in under Section 61, Chapter 149, this affidavit shall be subject to the PERJURY
1967 Ex. Session, give date of prior sale LAWS of the State of Washington.
Prior Affidavit No
Subscribed and sworn to before me this
FOR STATE DEPARTMENT OF REVENUE USE ONLY day of , 19
Notary Public in and for the State of Washington
Land $ School District . residing at
Improvements $ Year Last Appr. AFFIDAVIT RECEIPT NO.
PROCESSED BY
Total $ Property Class .
This becomes your receipt when stamped paid by the county
Deputy
treasurer. Payment must be made by cash or certified check. This
return is subject to audit and verification by the State Department
of Revenue, and an incomplete affidavit will be returned.
P
That portion of the North Half of the Northwest Quarter of Section
18, Township 27 North, Range 12 West , W.M. , lying Northerly of the
Northerly right-of-way line of Primary State Highway No . 9 (U. S .
101) described as follows :
Beginning at a point on the North line of said subdivision
478 . 53 feet South 89°17 ' East from the North Quarter corner of
said subdivision ; thence South 17° West 229 . 20 feet to the Norther
right-of-way line of said State Highway ; thence North 75°30 '
West along said highway right-of-way 154; feet thence North 17°
East 175 . 67 feet to the North line of said subdivision ; thence
North 89°17 ' East along said North line 161 . 67 feet to a POINT
OF BEGINNING ,
Situated in Jefferson County, Washington.