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ELECTRONICALLY RECORDED <br /> 201112057169 2 <br /> 12/05/2011 04:37 PM 0.00 <br /> SNOHOMISH COUNTY,WASHINGTON <br /> REAL ESTATE EXCISE TAX AFFIDAVIT <br /> C. 82 45 RC <br /> 'ti-CHAPTER 458-SIA WAC Tft forrin,4 your fill <br /> PLEASE TYFE CA PRINT whert stamped by cashier. <br /> -Ml AFFIDAVIT Yl MOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES Al FULLY COMPLETED <br /> • (See bark of last page for instructions) <br /> 13 Clieck box;?oartlail safe of properly If multiple owners,list ll of ownership next to a". <br /> Bertha A Potted,-a married woman as her l <br /> Nara RaIIA,I—Pored,husband of Sertha A.Pofterf ?4erl and separate property <br /> -4dorass Mdf� <br /> 'T "in@ 6014 cherrer Rd., 6014 Schemer Rd. <br /> '0 <br /> zip Granite Fails WA 98252 <br /> 'z S"&Z' Gran Is,WA 98252 <br /> co <br /> Phone No.0Sdulqq ireocoPilono No.clndudsry area CDC* <br /> List d ra&I and pmonal pw.qy tax owvv� <br /> 3 account rul-d*ck box it pe,*wW pruptnty Lial wwnecl vahA(s) <br /> ti P <br /> Nam 29052000401000 0 $180,400.00 <br /> LO <br /> 0 <br /> N Mailing Aftem <br /> City/State/lip <br /> No.(nclvlktg area copal <br /> ETISt'"t address of propertY.'2 403,Maple.Sf,Everett,WA 38201 <br /> The prcp&rTy Is located in13 UP)rxpoirill............. County OR withn RJ city of Everett <br /> 0 Check box-9 any of the"'wpX641s Ili bohV."grega.ted incm another pacer,we pat of a bou rKi&-j&no aop,strrvnt or pavols b*N ml <br /> Lego;desaiption of property(If..ra spats ie,n eodad��you Thay ztwa.v.?ePwM sheet to 080 me 0(th a all <br /> SEE EXHIBIT"A'ATTACHED HERETO AND MADE A PART HEREOF FAR) <br /> 7 <br /> Lij Soled Land Use Code(a): 11 Lift 9 personal propecty(tanill"I and wAwole)ircil M aeiiiM p**. <br /> Erw"addft-Woodes: <br /> (Sao track oflast page farinstructlions) <br /> -1fS wo <br /> is this prop"waW,from prop", Not per draper I!l4.30 <br /> .. l <br /> (nourolit,orgal <br /> y9a No i <br /> Is j*property clesigated as forest hm, par cha"f 84.33 ..vl' ' an exemMon,?41,l nurl and resson rot warw4wr <br /> Is tha Prop"cassilled as 0imarl use(wan space,fae7'and <br /> - <br /> agrimcural.crJmbzbl IesW perainapter"14? 4KMl-20'34-11 <br /> is am property ramoving wciat vatuaton 5&hl property pir 0 -Roasgofor exemll to separate community property <br /> .t!aptw 84.211 <br /> If any­osare yep,cornp.Late se hsiruc5ad be v. <br /> (l)NOTICE OF COiMNUAMCE(FOREST LAND OR CURRF-4T USE) <br /> NEW OWNER(S): To CorMo Me ourrent deslraMA 99 16'W' 'IgM Or Type ol.dooument Out ClIalm Deed <br /> eassif.cation as camp use(open apace,", and al w 5r n land,yet <br /> must sign on(Z)bs(w. The owx*jjaaesaw jymt then doia-.InTle if the il Qsoj d Document <br /> tinsrelarred oorft—to q=fy and will Indicate ty sil bolmv. r?the and no 115.0130,00 <br /> longer qua;.fts or you do not wird Iocar,.W�A the Grl Soiling Puke 5 <br /> be rayl and the compensadl or addl Lases wM is due and poyabia by#T6 <br /> son"or Iransforu w,the&�of safe. (ROW$4.34.140 v RCW 84.34.10a), ptizr "Personal Properly(deducti s- 0.00 <br /> - <br /> to siq�mg C3) below, may mirtmt your i*a COUnlY assessor for rror� EK9wivnion r,;a&,iod(dcd..jco s�_ 0.00 <br /> Inl Twable Sel�n%;Pr,08 S 115.000.co <br /> &C"lrax:Sol S <br /> This land[3 clon 0&,eo not qua0y b-=trusnee. ...... Loch 8 <br /> Wk <br /> Nuentuftneilit-State$ <br /> DEPUTY ASSESSOR CATE Loa(3 <br /> (2)NOTICE 0;COMPLIANCE(Hil PPOP"TY) S <br /> NEw cWNER(s): To octfinuo spedai vzlust;on as historic;property,sego m <br /> below. If Lie now mvner(s)do"r4i vi'ah to contlrvje.all addlil Lox csivilatud 3 <br /> purm-1.to Chapter B4.2e RCw,shall to due and payWe W Bre sa4W or Trans*w <br /> sero 7 <br /> echn6 <br /> logy Fee 3 5.00 <br /> at the time of sale, 5.00 <br /> :-Affll Rooelws <br /> (3)OWNF-RM SIGNATURE TMI.Dk.m S. 10.00 <br /> .............. <br /> PRIM'NAK- Ai;,MIMUM OF$1ilLW lill IN0643)ANIDIOR TAX <br /> I;-3EEL4lSMjjdhQNA`- <br /> I CZ.Rnl UNDER p_"AL T-Y W PEP ItiR THAT THE FORE-eOl NO IS TRLW-AND t!{ECT <br /> a*or Pra�"o'z Aaor,4 <br /> \Rrz.rr�of Grantoes Agent <br /> m-na(print) Ralph E.Potted Bertha A Potted <br /> Date&al�f O!'.9"n-L� Dow&C4 of aignin —2- <br /> Paruqf. Perjury is a,*.0 fe"which is pmiahiablo by ImprIsonmard 41 the State 0offK:t1wal rstihAcm for a mal term of nqt-6,ors tha.-I�,ve yeas,oj by a fine In an <br /> amount ftxodbythe cart ofnot <br /> Thank YOU.10I;4o*Ur payment <br /> E007953 <br /> BELINDA L. 1210510..j <br /> REV d400D1&a(M7fI0) THIS SPACE-TRU--JFZEITS USE ONLY M "reaww <br /> Order NO.:a'10135715-SE .'13 Dept'VIFIl <br /> SchxI NSL Q 'or* <br />