HomeMy WebLinkAbout37860 ..•4. CHAPTER 28.45 RCW
PLEASE FILL OUT COMPLETELY
Parcel Number 1% REAL ESTATE EXCISE TAX Is Segregation
Required Yes❑
MAKE REMITTANCE PAYABLE TO JEFFERSON COUNTY TREASURER
CD
NAME No
NAME OF SELLER AND COMPLETE ADDRESS
ADDRESS
NAME
ADDRESS NAME OF BUYER AND COMPLETE ADDRESS
Send Statement to:
Legal description of real property situated in JEFFERSON COUNTY
s to : n in. .ve i oc k 75 of Mabel' s Addition to th._, Cit-,r
;ii.:` Port Townsend, as per plat recorded in Volume 2 of Plats on
.0a.(7n 12, recors of Jefferson County;
Situate in the City of Port Townsend, County of Jefferson, State
of Washing-ton.
DESCRIPTION OF PERSONAL PROPERTY IF INCLUDED IN SALE If tax exemption is claimed,explain fully the nature of the transfer.
,Ji C)OC)
GROSS SALES PRICE 1% EXCISE TAX
(equity plus obligated balance) . $ (Payable within 30 days of date of sale) $
PERSONAL PROPERTY (deduct) '$ PENALTY (1% per month) $
TAXABLE SALES PRICE $ TOTAL $
DATE OF INSTRUMENT AFFIDAVIT
(On date of delivery of instrument if that is the closing date provided in The undersigned being first sworn, on oath says that the foregoing is a
contract; otherwise upon execution of contract) true and correct statement of the facts pertaining to the transfer of the
TYPE OF INSTRUMENT above described real estate.
If sale covers property traded in under R.C.W. 28A.45.105 give date and SIGNATURE
affidavit number of prior sale.
DATE AFFIDAVIT NO. Any person willfully giving false information in this affidavit shall be subject
to the PERJURY LAWS of the State of Washington.
TYPE OF PROPERTY? ❑ Commercial ❑ Residential
❑ Agricultural ❑ Industrial ❑ Recreational
❑ Mobile Home Site ❑ Multiple Dwelling ❑ Bare Land •
Does sale include current crop? ❑ YES ❑ NO Subscribed and sworn to before me this day
Served by a public sewer? ❑ YES ❑ NO of , 19
Does sale price include real estate commission? ❑ YES ❑ NO
If more than one county parcel number,will property Notary Public in and for the State of Washington
be used as a single parcel? ❑ YES ❑ NO residing at
,g:, Will this property be used with any adjoining
property presently owned by the purchaser? ❑ YES ❑ NO PROCESSED BY AFFIDAVIT NUM R
Does this conveyance involve ? ❑ Partial Interest
❑ Corporate affiliations ❑ Related Parties
❑ Trust Agreement ❑ Estate Property
DEPUTY
❑ Trade ❑ Life Estate
THIS BOX FOR STATE DEPARTMENT OF REVENUE USE ONLY
A.V. CLASS