HomeMy WebLinkAboutPW Grant of Easement to Shold Department of Public Works
O Consent Agenda
Page 1 of 1
Jefferson County
Board of Commissioners
Agenda Request
To: Board of Commissioners
Mark McCauley, County Administrator
From: Monte Reinders P.E., Public Works Director/ County Engineer ,/
Agenda Date: T �
Subject: Grant of Easement to Shold Excavating, Inc.
Statement of Issue:
The County purchased certain real property (Tax Parcel 901-112-009) from John T. "Duke"
Shold in 2013 for the percolation pond to serve the Port Hadlock Wastewater Project. Shold
Excavating, Inc. ("Shold") continues to own and operate its business on the adjacent parcel
(901-112-002). Shold has now requested an easement over portions of the County parcel to
better accommodate its on-going operations. In particular, it has requested an easement over
the eastern 20-feet and over the eastern 200 feet of the southern 20 feet of the County's
property for purposes of ingress, egress, storage of materials and utilities.
Analysis / Strategic Goals / Pros Et Cons:
The County has completed design and is currently in the process of constructing its facilities
on the percolation pond property. The easement requested by Shold is not expected to
adversely impact the County's wastewater facilities or operations. Granting the easement
allows the County to continue to maintain good relations with the property owners abutting
the wastewater facilities.
Fiscal Impact/Cost Benefit Analysis:
Shold is willing to pay the County $16,100 for the easement, which compensation is based on
the purchase price paid by the County in 2013 for fee simple title to the property. In
addition, Shold is willing to make a lump sum payment of $2,500 to the County to cover
anticipated staff time and other expenses in preparing, processing and recording the
easement.
Recommendation:
Please sign and notarize the attached Grant of Easement and sign REET affidavit (or authorize
Public Works to sign affidavit) and return to Public Works for recording and distribution.
Department Contact: Colette Kostelec, Engineer III, 360-385-9218
Revie y:
005
Mark McCain y County Administrator Date
CONTRACT REVIEW FORM Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)CONTRACT WITH: Shold Excavating, Inc. Contract No:FW
y�i43`0
Contract For: Grant of Easement(County to Shold) Term: perpetual
COUNTY DEPARTMENT: Public Works
Contact Person: Colette Kostelec
Contact Phone: 360-385-9218
Contact email: ckostelec@co.jefferson.wa.us
AMOUNT: $16,100 PROCESS: Exempt from Bid Process
Revenue: 40516936.59435.61 Cooperative Purchase
Expenditure: Competitive Sealed Bid
Matching Funds Required: Small Works Roster
Sources(s) of Matching Funds Vendor List Bid
Fund# , RFP or RFQ
Munis Org/Obj ✓ Other:
APPROVAL STEPS:
STEP 1: DEPARTM
ENT CERTIFIES C MPLIANWITH E JCC 3.55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: N/A:[ 127 Ito I
x
Signature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
CERTIFIED: N/A: n alio 12,D7,"
Signature Date
STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche):
Electronically approved by Risk Management on 8/17/2023.
Easement for the BOCC packet had typos corrected.
STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 8/16/2023.
Necessary for sewer.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
After recording return document to:
Jefferson County
Department of Public Works
623 Sheridan St.
Port Townsend, WA 98368
Document Title: GRANT OF EASEMENT
Grantor: JEFFERSON COUNTY, a political subdivision of the State of Washington
Grantee: SHOLD EXCAVATING, INC., a Washington for -profit corporation
Legal Description: Ptn. NE 1/4, NW 1/4, of Sec. 11, Twp. 29 N, Rng 1W, W.M.
Additional Legal Description on Page 6 of this Document.
Assessor's Parcel No: 901-112-009
GRANT OF EASEMENT
GRANTOR, Jefferson County, a political subdivision of the State of Washington ("Jefferson County" or
"the County"), for and in consideration of the sum of SIXTEEN THOUSAND ONE HUNDRED
DOLLARS ($16,100.00) in hand paid, hereby grants, conveys and establishes a permanent non-exclusive
easement to GRANTEE Shold Excavating, Inc., a Washinton for -profit corporation, over, under, across
and through the following described property:
For legal description of the Easement Area
see Exhibit A attached hereto and made a part hereof.
This Easement is for the benefit of the following described property, the title to which is currently held by
Grantee:
For legal description of the Benefitted Property
see Exhibit B attached hereto and made a part hereof.
Attached as Exhibit C is a site plan showing the affected properties and Easement Area. The Easement
Area may be used by Grantee for ingress, egress, storage of materials and utilities to serve the Benefitted
Property. No permanent structures shall be built, installed or maintained within the Easement Area.
Jefferson County may use the Easement Area as long as such use is not inconsistent with Grantee's
Easement rights.
GRANT OF EASEMENT Page 1 of 8
Parcel 901-112-009
This Easement and the covenants contained herein shall run with the land and shall be binding on the
successors, heirs, and assigns of both parties hereto.
Grantee shall defend, indemnify and hold Jefferson County, its officers, officials, employees, agents and
volunteers (and their marital communities) harmless from and against any and all claims, injuries,
damages, losses or suits, including reasonable attorney's fees, except as may be caused by the sole
negligence of the County, which may arise as a result of this Grant of Easement. Should a court of
competent jurisdiction determine this Indemnification provision is subject to RCW 4.24.115 if liability for
damages occurs arising out of bodily injury to persons or damages to property caused by or resulting from
the concurrent negligence of Grantee and Jefferson County, Grantee's liability, including the duty and
cost to defend, shall be only to the extent of the negligence of Grantee. It is further specifically
understood that the indemnification provided constitutes Grantee's waiver of immunity under Industrial
Insurance, Title 51 RCW, solely for the purposes of this indemnification. This waiver has been mutually
negotiated by the parties. It is agreed and understood that this hold harmless indemnification recognizes
that the Easement Area may be traversed and used by Jefferson County and simultaneously by Grantee,
and the risks and liabilities arising from this joint use are expressly included in this indemnity and hold
harmless provision.
[Signatures on following pages]
GRANT OF EASEMENT Page 2 of 8
Parcel 901-112-009
GRANTOR JEFFERSON COUNTY
Approved By:
SEAL:
ATTEST:
Carolyn Gallaway, CMC
Clerk of the Board
Approved as to form only:
Philip C. Hunsucker
Chief Civil Deputy
Prosecuting Attorney
GRANT OF EASEMENT
Parcel 901-112-009
JEFFERSON COUNTY BOARD OF
COMMISSIONERS
Greg Brotherton, Chair
Kate Dean, Commissioner
Heidi Eisenhour, Commissioner
Date
August 17, 2023
Date
Page 3 of 8
State of Washington
County of Jefferson
This record was acknowledged before me on , by Greg Brotherton
as a Commissioner and the Chair of the Jefferson County Board of County Commissioners.
Notary Public in and for the State of Washington.
My Commission Expires
State of Washington
County of Jefferson
This record was acknowledged before me on , by Kate Dean as a
Commissioner on the Jefferson County Board of County Commissioners.
Notary Public in and for the State of Washington.
My Commission Expires
State of Washington
County of Jefferson
This record was acknowledged before me on , by Heidi Eisenhour
as a Commissioner on the Jefferson County Board of County Commissioners.
Notary Public in and for the State of Washington.
My Commission Expires
GRANT OF EASEMENT Page 4 of 8
Parcel 901-112-009
GRANTEE SHOLD EXCAVATING INC.
Acknowledged and Accepted by:
Signature: Print Name: Y i 5 hp. �J" l a r-
Title:lf�YvR.Y-
State of Washington
County of Jefferson
S 1 zy (Z-O Z3
Date
This record was acknowledged before me on
as &061h �- Ioway of Shold Excavating, Inc.
'►►►►►►►ItlL AAC ►►►r►►p o a Pu is in and for t e St4 of Washington.
nv o ... My Commission Expires � err,�e ►- j/ a o 3 (A
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PUBLIC
GRANT OF EASEMENT Page 5 of 8
Parcel 901-112-009
EXHIBIT A
Legal Description of Easement Area
THE EASTERN TWENTY FEET (20% AND THE EASTERN TWO HUNDRED FEET (200') OF
THE SOUTHERN TWENTY FEET (20% OF THE FOLLOWING DESCRIBED PROPERTY:
THAT PORTION OF THE SOUTH HALF OF THE NORTHEAST'A OF THE
NORTHWEST 1/4 , SECTION 11, TOWNSHIP 29 NORTH, RANGE 1 WEST, W.M.,
JEFFERSON COUNTY, WASHINGTON, MORE PARTICULARLY DESCRIBED AS
FOLLOWS:
COMMENCING AT THE NORTH'/4 CORNER OF SAID SECTION 11, TOWNSHIP
29 NORTH, RANGE 1 WEST, W.M., JEFFERSON COUNTY, WASHINGTON;
THENCE SOUTH 01 037'51" WEST ALONG THE NORTH -SOUTH CENTERLINE OF
SAID SECTION 11 A DISTANCE OF 685.56 FEET TO A POINT ON THE SOUTH
MARGIN OF LOPEMAN ROAD;
THENCE NORTH 87042'09" WEST ALONG SAID SOUTH MARGIN OF LOPEMAN
ROAD A DISTANCE OF 350.00 FEET TO THE TRUE POINT OF BEGINNING;
THENCE CONTINUING ALONG SAID SOUTH MARGIN OF LOPEMAN ROAD A
DISTANCE OF 373.22 FEET;
THENCE SOUTH 01024'19" WEST A DISTANCE OF 506.34 FEET;
THENCE SOUTH 83052'07" EAST A DISTANCE OF 372.35 FEET;
THENCE NORTH 01037'51" EAST ALONG A LINE PARALLEL WITH SAID
NORTH -SOUTH CENTERLINE OF SECTION 11 A DISTANCE OF 531.21 FEET,
MORE OR LESS, TO THE TRUE POINT OF BEGINNING AND THE TERMINUS
OF THIS LINE.
SITUATE IN THE COUNTY OF JEFFERSON, STATE OF WASHINGTON.
End of Legal Description of Easement Area.
Easement Area: 14,200 square feet, more or less.
GRANT OF EASEMENT Page 6 of 8
Parcel 901-112-009
EXHIBIT B
Legal Description of Benefitted Property
THE SOUTH'/z OF THE NORTHEAST'/4 OF THE NORTHWEST 1/4 , SECTION 11, TOWNSHIP 29
NORTH, RANGE 1 WEST, W.M., JEFFERSON COUNTY, WASHINGTON;
EXCEPTING THEREFROM THE NORTH 20 FEET THEREOF FOR THE SOUTH'/2 OF LOPEMAN
ROAD;
EXCEPTING THEREFROM THE WEST 600 FEET THEREOF AND EXEPTING THAT PORTION
OF LAND DESCRIBED IN AUDITOR'S FILE NO. 276777, RECORDS OF JEFFERSON COUNTY,
WASHINGTON, ALSO KNOWN AS TAX 62, AS DESCRIBED AS FOLLOWS:
COMMENCING AT THE NORTH/4 CORNER OF SAID SECTION 11;
WHENCE THE SOUTH/4 CORNER OF SAID SECTION 11 BEARS SOUTH 1037'39" WEST
5,308.65 FEET DISTANT;
THENCE SOUTH 1 °37'39" WEST 1,240.16 FEET ALONG THE NORTH -SOUTH CENTERLINE OF
SAID SECTION 11 TO THE NORTH LINE OF SAID TAX 62, THE TRUE POINT OF BEGINNING;
THENCE CONTINUING SOUTH 1037'39" WEST 90.77 FEET TO THE SOUTHEAST CORNER OF
THE SOUTH ''/z OF THE NORTHEAST'A OF THE NORTHWEST'/4 OF SECTION 11;
THENCE NORTH 87037'26" WEST ALONG THE SOUTH LINE OF SAID SUBDIVISION 485.94
FEET;
THENCE NORTH 2036'40" WEST ALONG THE WESTERN LINE OF SAID TAX 62, 68.84 FEET;
THENCE NORTH 89047'17" EAST ALONG THE NORTHERN LINE OF SAID TAX 62, 491.24 FEET
TO THE TRUE POINT OF BEGINNING;
ALL AS SHOWN IN VOLUME 19 OF SURVEYS, PAGE 128, RECORDS OF JEFFERSON
COUNTY, WASHINGTON.
EXCEPTING THEREFROM THAT PORTION OF LAND DESCRIBED AS FOLLOWS:
COMMENCING AT THE NORTH'/4 CORNER OF SAID SECTION 11, TOWNSHIP 29 NORTH,
RANGE 1 WEST, W.M., JEFFERSON COUNTY, WASHINGTON;
THENCE SOUTH 01037'51" WEST ALONG THE NORTH -SOUTH CENTERLINE OF SAID
SECTION 11 A DISTANCE OF 685.56 FEET TO A POINT ON THE SOUTH MARGIN OF
LOPEMAN ROAD;
THENCE NORTH 87042'09" WEST ALONG SAID SOUTH MARGIN OF LOPEMAN ROAD A
DISTANCE OF 350.00 FEET TO THE TRUE POINT OF BEGINNING;
THENCE CONTINUING ALONG SAID SOUTH MARGIN OF LOPEMAN ROAD A DISTANCE OF
373.22 FEET;
THENCE SOUTH 01024'19" WEST A DISTANCE OF 506.34 FEET;
THENCE SOUTH 83052'07" EAST A DISTANCE OF 3 72.3 5 FEET;
THENCE NORTH 0103T5I" EAST ALONG A LINE PARALLEL WITH SAID NORTH -SOUTH
CENTERLINE OF SECTION 11 A DISTANCE OF 531.21 FEET, MORE OR LESS, TO THE TRUE
POINT OF BEGINNING AND THE TERMINUS OF THIS LINE.
SITUATE IN THE COUNTY OF JEFFERSON, STATE OF WASHINGTON.
End of Legal Description of Benefitted Property.
GRANT OF EASEMENT Page 7 of 8
Parcel 901-112-009
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Department of � Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
Revenue Only for sales in a single location code on or after March 1, 2023.
Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed.
Form 84 0001 a This form is your receipt when stamped by cashier. Please type or print.
❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name.
1 Seller/Grantor 2 Buyer/Grantee
Name Jefferson County. a politcal subdivision of the State of Washinaton Name Shold Excavating, Inc., a Washington for -profit corporation
Mailing address PO Box 1220
City/state/zip Port Townsend. WA 98368
Phone (including area code) 360 385-9160
3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee
Name Jefferson County
Mailing address PO Box 179
City/state/zip Port Hadlock. WA 98339
Phone (including area code) (360) 3779-88"- 315" 04 � 0
List all real and personal property tax Personal Assessed
parcel account numbers property? value(s)
901-112-009 ❑ $ 79.010.00
❑
Mailing address PO Box 1220 $ 0.00
City/state/zip Port Townsend. WA 98368 ❑
$ 0.00
4 Street address of property no assigned address
This property is located in Pefferson Count (for unincorporated locations please select your county)
❑ Check box if any of the listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged.
Legal descrlption of property (if you need more space, attach a separate sheet to each pag_e_of the affidavit).
See Exhibit A attached hereto and made a part hereof
5 191 - Undeveloped land (land only) 7 List all personal property (tangible and intangible) included in selling
price.
Enter any additional codes
(see back of last page for instructions)
Was the seller receiving a property tax exemption or deferral
under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior
citizen or disabled person, homeowner with limited income)? ❑ Yes 0 No
Is this property predominately used for timber (as classified
under RCW 84.34 and 84.33) or agriculture (as classified under
RCW 84.34.020) and will continue in it's current use? If yes and
the transfer involves multiple parcels with different classifications,
complete the predominate use calculator (see instructions) []Yes m No
6 Is this property designated as forest land per RCW 84.33? ❑Yes 0No
Is this property classified as current use (open space, farm
If claiming an exemption, list WAC number and reason for exemption.
WAC number (section/subsection) WAC 458-61A-205(2)
Reason for exemption
Governmental entity (County) selling real property interest (easement).
Type of document Grant of Easement
and agricultural, or timber) land per RCW 84.34? ❑ Yes ❑ No Date of document
Is this property receiving special valuation as historical
property per RCW 84.26? ❑ Yes 0 No
If any answers are yes, complete as instructed below.
(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
NEW OWNER(S): To continue the current designation as forest land
or classification as current use (open space, farm and agriculture, or
timber) land, you must sign on (3) below. The county assessor must then
determine if the land transferred continues to qualify and will indicate
by signing below. If the land no longer qualifies or you do not wish to
continue the designation or classification, it will be removed and the
compensating or additional taxes will be due and payable by the seller
or transferor at the time of sale (RCW 84.33.140 or 84.34.108). Prior to
signing (3) below, you may contact your local county assessor for more
information.
This land: ❑ does ❑ does not qualify for
continuance.
Deputy assessor signature Date
(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)
NEW OWNER(S): To continue special valuation as historic property, sign
(3) below. If the new owner(s) doesn't wish to continue, all additional tax
calculated pursuant to RCW 84.26, shall be due and payable by the seller
or transferor at the time of sale.
(3) NEW OWNER(S) SIGNATURE
Gross selling price
16.100.00
*Personal property (deduct)
0.00
Exemption claimed (deduct)
16.100.00
Taxable selling price
0.00
Excise tax: state
Less than $525,000.01 at 1.1% 0.00
From $525,000.01 to $1,525,000 at 1.28% 0.00
From $1,525,000.01 to $3,025,000 at 2.75% 0.00
Above $3,025,000 at 3% 0.00
Agricultural and timberland at 1.28% 0.00
Total excise tax: state 0.00
0.0050 Local 0.00
*Delinquent interest: state 0.00
Local 0.00
*Delinquent penalty 0.00
Subtotal 0,00
*State technology fee 5.00
Affidavit processing fee 5,00
Signature Signature Total due 10.00
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
Print name Print name *SEE INSTRUCTIONS
H I CERTIFY UNDER PENALTY OF PERJURY THATTHE FOREGOING IS TRUE AND CORRECTgQ,
Signature of grantor or agent Signature of grantee or agent
Name (print) Name (print) ns�,m �
Date & city of signing Date & city of signing bA-"P-Jt� %—Z+��Z J
Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maximum term of five ears, or by
a fine in an amount fixed by the court of not more than $10,000, or by both such confinement and fine (RCW 9A.72.030 and RCW 9A.20.021�1)(c)).
To ask about the availability of this publication in an alternate format for the visually impaired, please call 360-705-6705.Teletype
(TTY) users may use the WA Relay Service by calling 711.
REV 84 0001a (02/28/23)
THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER
Print on legal size paper.
Page 1 of 6
EXHIBIT A
Legal Description of Easement Area
THE EASTERN TWENTY FEET (20'), AND THE EASTERN TWO HUNDRED FEET (200') OF
THE SOUTHERN TWENTY FEET (20'), OF THE FOLLOWING DESCRIBED PROPERTY:
THAT PORTION OF THE SOUTH HALF OF THE NORTHEAST'/4 OF THE
NORTHWEST 1/4 , SECTION 11, TOWNSHIP 29 NORTH, RANGE I WEST, W.M.,
JEFFERSON COUNTY, WASHINGTON, MORE PARTICULARLY DESCRIBED AS
FOLLOWS:
COMMENCING AT THE NORTH'/4 CORNER OF SAID SECTION 11, TOWNSHIP
29 NORTH, RANGE 1 WEST, W.M., JEFFERSON COUNTY, WASHINGTON;
THENCE SOUTH 01037'51" WEST ALONG THE NORTH -SOUTH CENTERLINE OF
SAID SECTION I I A DISTANCE OF 685.56 FEET TO A POINT ON THE SOUTH
MARGIN OF LOPEMAN ROAD;
THENCE NORTH 87042'09" WEST ALONG SAID SOUTH MARGIN OF LOPEMAN
ROAD A DISTANCE OF 350.00 FEET TO THE TRUE POINT OF BEGINNING;
THENCE CONTINUING ALONG SAID SOUTH MARGIN OF LOPEMAN ROAD A
DISTANCE OF 373.22 FEET;
THENCE SOUTH 01024'19" WEST A DISTANCE OF 506.34 FEET;
THENCE SOUTH 83052'07" EAST A DISTANCE OF 372.35 FEET;
THENCE NORTH 0103T51" EAST ALONG A LINE PARALLEL WITH SAID
NORTH -SOUTH CENTERLINE OF SECTION 11 A DISTANCE OF 531.21 FEET,
MORE OR LESS, TO THE TRUE POINT OF BEGINNING AND THE TERMINUS
OF THIS LINE.
SITUATE IN THE COUNTY OF JEFFERSON, STATE OF WASHINGTON.
End of Legal Description of Easement Area.
Easement Area: 14,200 square feet, more or less.
Page 1 of 1
Department of
Revenue
toa
Washington State
Form 84 0001 a
Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
Only for sales in a single location code on or after March 1, 2023.
This affidavit will not be accepted unless all areas on all pages are fully and accurately completed.
This form is your receipt when stamped by cashier. Please type or print.
❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name.
1 Seller/Grantor 2 Buyer/Grantee
Name Jefferson County, a political subdivision of the State of Washington Name Shold Excavating, Inc., a Washington for -profit corporation
Mailing address PO Box 1220
City/state/zip Port Townsend. WA 98368
Phone (including area code) (360) 385-9160
3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee
Name Jefferson County
Mailing address PO Box 1220
City/state/zip Port Townsend, WA 98368
Mailing address PO Box 179
City/state/zip Port Hadlock, WA 98339
Phone (including area code) (360) 374,689$ 3$ S—O y XU
List all real and personal property tax
parcel account numbers
901-112-009
Personal
Assessed
property?
value(s)
❑
$ 79,010.00
❑
$ 0,00
❑
$ 0.00
4 Street address of property no assigned address _
This property is located in efferson Count (for unincorporated locations please select your county)
❑ Check box if any of the listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged.
Legal description of property (if you need more space, attach a separate sheet to each page of the affidavit).
See Exhibit A attached hereto and made a part hereof.
5 191 - Undeveloped land (land only) 7 List all personal property (tangible and intangible) included in selling
price.
Enter any additional codes
(see back of last page for instructions)
Was the seller receiving a property tax exemption or deferral
under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior
citizen or disabled person, homeowner with limited income)? ❑ Yes 0 No
Is this property predominately used for timber (as classified under
RCW 84.34 and 84.33) or agriculture (as classified under RCW
84.34.020) and will continue in it's current use? If yes and the
transfer involves multiple parcels with different classifications,
complete the predominate use calculator (see instructions) Dyes ONo
6 Is this property designated as forest land per RCW 84.33? ❑Yes ONo
Is this property classified as current use (open space, farm
and agricultural, or timber) land per RCW 84.34? ❑ Yes ❑ No
Is this property receiving special valuation as historical
property per RCW 84.26? ❑ Yes m No
If any answers are yes, complete as instructed below.
(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
NEW OWNER(S): To continue the current designation as forest land
or classification as current use (open space, farm and agriculture, or
timber) land, you must sign on (3) below. The county assessor must then
determine if the land transferred continues to qualify and will indicate
by signing below. If the land no longer qualifies or you do not wish to
continue the designation or classification, it will be removed and the
compensating or additional taxes will be due and payable by the seller
or transferor at the time of sale (RCW 84.33.140 or 84.34.108). Prior to
signing (3) below, you may contact your local county assessor for more
information.
This land: ❑ does ❑ does not qualify for
continuance.
Deputy assessor signature Date
(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)
NEW OWNER(S): To continue special valuation as historic property, sign
(3) below. If the new owner(s) doesn't wish to continue, all additional tax
calculated pursuant to RCW 84.26, shall be due and payable by the seller
or transferor at the time of sale.
Signature
Print name
(3) NEW OWNER(S) SIGNATURE
Signature
Print name
If claiming an exemption, list WAC number and reason for exemption.
WAC number (section/subsection) WAC 458-61A-205 2
Reason for exemption
Governmental entity (County) selling real property interest (easement).
Type of document Grant of Easement
Date of document
Gross selling price
16,100.00
*Personal property (deduct)
0.00
Exemption claimed (deduct)
16.100.00
Taxable selling price
0,00
Excise tax: state
Less than $525,000.01 at 1.1% 0.00
From $525,000.01 to $1,525,000 at 1.28% 0.00
From $1,525,000.01 to $3,025,000 at 2.75% 0.00
Above $3,025,000 at 3% 0.00
Agricultural and timberland at 1.28% 0,00
Total excise tax: state 0.00
0.0050 Local 0.00
*Delinquent interest: state 0.00
Local 0,00
*Delinquent penalty 0.00
Subtotal 0.00
*State technology fee 5.00
Affidavit processing fee 5.00
Total due 10,00
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
*SEE INSTRUCTIONS
I CERTIFY UNDER PENALTY OF PERJURY THATTHE FOREGOING IS TRUE AND CORRECT
Signature of grantor or agent
Name (print)
Date & city of signing
Signature of grantee or agent`
Name (print)
Date & city of signing �Df tU 24 7-0z-',
Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maximum term of five ears, or by
a fine in an amount fixed by the court of not more than $10,000, or by both such confinement and fine (RCW 9A.72.030 and RCW 9A.20.021r1)(c)).
To ask about the availability of this publication in an alternate format for the visually impaired, please call 360-705-6705. Teletype
(TTY) users may use the WA Relay Service by calling 711.
REV840001a (02/28/23)
THIS SPACE TREASURER'S USE ONLY COUNTY ASSESSOR
Print on legal size paper.
Page 2 of 6
EXHIBIT A
Legal Description of Easement Area
THE EASTERN TWENTY FEET (20'), AND THE EASTERN TWO HUNDRED FEET (200') OF
THE SOUTHERN TWENTY FEET (20'), OF THE FOLLOWING DESCRIBED PROPERTY:
THAT PORTION OF THE SOUTH HALF OF THE NORTHEAST 1/4 OF THE
NORTHWEST 1/4 , SECTION 11, TOWNSHIP 29 NORTH, RANGE 1 WEST, W.M.,
JEFFERSON COUNTY, WASHINGTON, MORE PARTICULARLY DESCRIBED AS
FOLLOWS:
COMMENCING AT THE NORTH '/4 CORNER OF SAID SECTION 11, TOWNSHIP
29 NORTH, RANGE 1 WEST, W.M., JEFFERSON COUNTY, WASHINGTON;
THENCE SOUTH 01037'51" WEST ALONG THE NORTH -SOUTH CENTERLINE OF
SAID SECTION 11 A DISTANCE OF 685.56 FEET TO A POINT ON THE SOUTH
MARGIN OF LOPEMAN ROAD;
THENCE NORTH 87042'09" WEST ALONG SAID SOUTH MARGIN OF LOPEMAN
ROAD A DISTANCE OF 350.00 FEET TO THE TRUE POINT OF BEGINNING;
THENCE CONTINUING ALONG SAID SOUTH MARGIN OF LOPEMAN ROAD A
DISTANCE OF 373.22 FEET;
THENCE SOUTH 01024'19" WEST A DISTANCE OF 506.34 FEET;
THENCE SOUTH 83052'07" EAST A DISTANCE OF 372.35 FEET;
THENCE NORTH 0103T51" EAST ALONG A LINE PARALLEL WITH SAID
NORTH -SOUTH CENTERLINE OF SECTION I 1 A DISTANCE OF 531.21 FEET,
MORE OR LESS, TO THE TRUE POINT OF BEGINNING AND THE TERMINUS
OF THIS LINE.
SITUATE IN THE COUNTY OF JEFFERSON, STATE OF WASHINGTON.
End of Legal Description of Easement Area.
Easement Area: 14,200 square feet, more or less.
Page 1 of 1
Department of
Revenuepc
Washington State
Form 84 0001 a
Rea[ Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
Only for sales in a single location code on or after March 1, 2023.
This affidavit will not be accepted unless all areas on all pages are fully and accurately completed.
This form is your receipt when stamped by cashier. Please type or print.
❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name.
1 Seller/Grantor 2 Buyer/Grantee
Name Jefferson County, a politcal subdivision of the State of Washingtor Name Shold Excavating, Inc., a Washington for profit corporation
Mailing address PO Box 1220
City/state/zip Port Townsend. WA 98368
Phone (including area code) (360) 385-9160
3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee
Name Jefferson County
Mailing address PO Box 1220
City/state/zip Port Townsend. WA 98368
Mailing address PO Box 179
City/state/zip Port Hadlock. WA 98339
Phone (including area code) (360) $,� %SS-041yd
List all real and personal property tax
parcel account numbers
901-112-009
Personal
Assessed
property?
value(s)
❑
$ 79, 010.00
❑
$ 0.00
❑
$ 0.00
4 Street address of prope no assigned address
This property is located in IJefferson Count (for unincorporated locations please select your county)
❑ Check box if any of the listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged.
Legal description of property [if need more space, attach a separate sheet to each pale of the affidavit).
See Exhibit A attached hereto and made a part hereof.
5 191 - Undeveloped land (land only)
Enter any additional codes
(see back of last page for instructions)
Was the seller receiving a property tax exemption or deferral
under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior
citizen or disabled person, homeowner with limited income)? ❑ Yes 0 No
Is this property predominately used for timber (as classified under
RCW 84.34 and 84.33) or agriculture (as classified under RCW
84.34.020) and will continue in it's current use? If yes and the
transfer involves multiple parcels with different classifications,
complete the predominate use calculator (see instructions) ❑ Yes 0 No
6 Is this property designated as forest land per RCW 84.33? ❑Yes 0No
Is this property classified as current use (open space, farm
and agricultural, or timber) land per RCW 84.34?
7 List all personal property (tangible and intangible) included in selling
price.
If claiming an exemption, list WAC number and reason for exemption.
WAC number (section/subsection) WAC 458-61A-205 2
Reason for exemption
Governmental entity (County) selling real property interest (easement).
Type of document Grant of Easement
❑ Yes 0 No Date of document
Is this property receiving special valuation as historical
property per RCW 84.26? ❑ Yes 0 No
If any answers are yes, complete as instructed below.
(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
NEW OWNER(S): To continue the current designation as forest land
or classification as current use (open space, farm and agriculture, or
timber) land, you must sign on (3) below. The county assessor must then
determine if the land transferred continues to qualify and will indicate
by signing below. If the land no longer qualifies or you do not wish to
continue the designation or classification, it will be removed and the
compensating or additional taxes will be due and payable by the seller
or transferor at the time of sale (RCW 84.33.140 or 84.34.108). Prior to
signing (3) below, you may contact your local county assessor for more
information.
This land: ❑ does ❑ does not qualify for
continuance.
Deputy assessor signature Date
(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)
NEW OWNER(S): To continue special valuation as historic property, sign
(3) below. If the new owner(s) doesn't wish to continue, all additional tax
calculated pursuant to RCW 84.26, shall be due and payable by the seller
or transferor at the time of sale.
Signature
(3) NEW OWNER(S) SIGNATURE
Signature
Gross selling price
16.100.00
*Personal property (deduct)
0.00
Exemption claimed (deduct)
16 100.00
Taxable selling price
0,00
Excise tax: state
Less than $525,000.01 at 1.1% 0.00
From $525,000.01 to $1,525,000 at 1.28% 0.00
From $1,525,000.01 to $3,025,000 at 2.75% 0.00
Above $3,025,000 at 3% 0.00
Agricultural and timberland at 1.28% 0.00
Total excise tax: state 0.00
0.0050 Local 0.00
*Delinquent interest: state 0.00
Local 0.00
*Delinquent penalty 0.00
Subtotal 0.00
*State technology fee 5.00
Affidavit processing fee 5.00
Total due 10.00
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
Print name Print name *SEE INSTRUCTIONS
I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AN
Signature of grantor or agent
Name (print)
Date & city of signing
D CORRECT p
Signature of grantee or agents
Name (print) Wh-- �N-kV -k U,¢
Date & city of signing Qd•r N 4tK A1c3 Ck O -
Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maximum term of five ears, or by
a fine in an amount fixed by the court of not more than $10,000, or by both such confinement and fine (RCW 9A.72.030 and RCW 9A.20.021(1)(c)).
To ask about the availability of this publication in an alternate format for the visually impaired, please call 360-705-6705. Teletype
(TTY) users may use the WA Relay Service by calling 711.
REV 84 0001a (02/28/23)
THIS SPACE TREASURER'S USE ONLY
TAXYPAYER
Print on legal size paper.
Page 4 of 6
EXHIBIT A
Legal Description of Easement Area
THE EASTERN TWENTY FEET (20% AND THE EASTERN TWO HUNDRED FEET (200') OF
THE SOUTHERN TWENTY FEET (20% OF THE FOLLOWING DESCRIBED PROPERTY:
THAT PORTION OF THE SOUTH HALF OF THE NORTHEAST'/4 OF THE
NORTHWEST 1/4 , SECTION 11, TOWNSHIP 29 NORTH, RANGE 1 WEST, W.M.,
JEFFERSON COUNTY, WASHINGTON, MORE PARTICULARLY DESCRIBED AS
FOLLOWS:
COMMENCING AT THE NORTH'/4 CORNER OF SAID SECTION 11, TOWNSHIP
29 NORTH, RANGE 1 WEST, W.M., JEFFERSON COUNTY, WASHINGTON;
THENCE SOUTH 01037'51" WEST ALONG THE NORTH -SOUTH CENTERLINE OF
SAID SECTION 11 A DISTANCE OF 685.56 FEET TO A POINT ON THE SOUTH
MARGIN OF LOPEMAN ROAD;
THENCE NORTH 87042'09" WEST ALONG SAID SOUTH MARGIN OF LOPEMAN
ROAD A DISTANCE OF 350.00 FEET TO THE TRUE POINT OF BEGINNING;
THENCE CONTINUING ALONG SAID SOUTH MARGIN OF LOPEMAN ROAD A
DISTANCE OF 373.22 FEET;
THENCE SOUTH 01024'19" WEST A DISTANCE OF 506.34 FEET;
THENCE SOUTH 83052'07" EAST A DISTANCE OF 372.35 FEET;
THENCE NORTH 0103T51" EAST ALONG A LINE PARALLEL WITH SAID
NORTH -SOUTH CENTERLINE OF SECTION I 1 A DISTANCE OF 531.21 FEET,
MORE OR LESS; TO THE TRUE POINT OF BEGINNING AND THE TERMINUS
OF THIS LINE.
SITUATE IN THE COUNTY OF JEFFERSON, STATE OF WASHINGTON.
End of Legal Description of Easement Area.
Easement Area: 14,200 square feet, more or less.
Page 1 of 1