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/ice <br /> h. J <br /> REVENUE REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt <br /> 1PLEASE TYPE OR PRINT CHAPTER 8243 RCW-CHAPTER 438-61 WAC when stamped by cashier. <br /> SEE BACK PAGE FOR INSTRUCTIONS FOR USE AT COUNTY TREASURER'S OFFICE <br /> (Use Form No.84-0001B for Reporting Transfers of Controlling Interest of Entity Ownership to the Department of Revenue) <br /> THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS 1-7 ARE FULLY COMPLETED <br /> 1111 Name ARTHUR L.SWANSON © Name JULIE A.FISCO <br /> P MONTE LEMIEUX a <br /> c, 51ree 1505 19TH Street Street 11232 1st Ave NW <br /> City/State/Zip Everett,WA 98201 City/State/Zip Seattle,WA 98177 <br /> 0 ADDRESS TO SEND ALL PROPERTY TAX RELATED CORRESPONDENCE ALL TAX PARCEL NUMBERS COUNTY TREASURER PLACE <br /> ASSESSED VALUE IF TAX EXEMPT <br /> Name JULIE A.FISCO 004370-369-015-00 <br /> Street 11232 1st Ave NW <br /> City/State/Zip Seattle,WA 98177 <br /> InLEGAL DESCRIPTION OF PROPERTY SITUATED IN 0 UNINCORPORATED COUNTY 0 OR M CITY OF Everett <br /> Street Address(if property is improved): <br /> See Attached Legals Descriptions for parcel"A"and"B" <br /> 0 Is this property currently: YES NO 0 Description of personal property included in gross selling price,both <br /> tangible(eg;furniture,equipment,etc.)or intangible(eg,goodwill, <br /> Classified or designated as forest land? 0 El agreement not to compete,etc.) <br /> Chapter 84.33 RCW <br /> Classified as current use land(open space,farm 0 121 <br /> and agricultural,or timber)?Chapter 84.34 RCW <br /> Exempt from property tax as a nonprofit 0 Ei If exemption claimed,list WAC number and explanation. <br /> organization?Chapter 84.36 RCW WAC No.(Sec/Sub) 458-61-235(1) <br /> Seller's Exempt Reg.No. <br /> Receiving special valuation as historic ❑ 1] Explanation a boundary line adjustment over a fence location <br /> property?Chapter 84.26 RCW <br /> Property Type: Ri land only ❑land with new building quit claim deed <br /> Elland with previously used building 0 land with mobile home Type of Document <br /> ❑timber only 0 building only Date of Document <br /> Principal Use: 0 Apt.(4+unit) RI residential <br /> ❑timber 0 agricultural 0 commercial/industrial Gross Selling Price 5 0.00 <br /> ❑other Personal Property(deduct) $ 0 00 <br /> 0 (1)NOTICE OF CONTINUANCE(RCW 84.33 OR RCW 84.34) Taxable Selling Price 5 0.00 <br /> If the new owner(s)of land that is classified or designated as current use Excise Tax: State 5 0.00 <br /> or forest land wish to continue the classification or designation of such Local $ 0.00 <br /> land,the new owner(s)must sign below.If the new owner(s)do not desireDelinquent Interest: State 5 <br /> 0.00 <br /> to continue such classification or designation,all compensating or Local 5 0.00 <br /> additional tax calculated pursuant to RCW 84.33.120 and 140 or RCW 0.00 <br /> 8434.108 shall be due and payable by the seller or transferor at the time Delinquent Penalty $ <br /> of sale.The county assessor must determine if the land transferred Total Due $ 0.00 <br /> qualifies to continue classification or designation and must so indicate <br /> below.Signatures do not necessarily mean the land will remain in A MINIMUM OF$2.00 IS DUE AS A PROCESSING FEE AND TAX. <br /> classification or designation.If it no longer qualifies,it will be removed 0 AFFIDAVIT <br /> and the compensating taxes will be applied.All new owners must sign. <br /> I Certify Under Penalty of Perjury Under The Laws of The State of <br /> This land 0 does 0 does not qualify for continuance. Washington That The Foregoing Is True And Correct.(See back page of this <br /> form). <br /> Date ' <br /> DEPUTY ASSESSOR Signature ofJj- f <br /> Grantor/Agent �'WI'r•L +��(' (.�iL lft�'L--t <br /> (2) NOTICE OF COMPLIANCE(Chapter 8426 RCW) ARTHUR L. <br /> SWANSON andMONTE LEMIEUX <br /> If the new owner(s)of property with special valuation as historic property Name(print) f.0,..F.47-wish to continue this special valuation the new owner(s)must sign below. Date and Place of Si g' <br /> in 3 1/z�3 Od ,d'7 s-��y�� <br /> If the new owner(s)do not desire to continue such special valuation,all <br /> additional tax calculated pursuant to Chapter 84.26 RCW,shall be due �/�F <br /> and payable by the seller or transferor at the time of sale. Signature of <br /> Grantee/Agent <br /> (3) OWNER(S)SIGNATURE Name(print) U -E A.FISCO <br /> Date&Place of Signing: /--'".6r. 4'> 5,cAjirr tom,\. <br /> Perjury:Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more <br /> 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 <br /> fine(RCW 9A.20.020(IC)). <br /> REV 84 0001a(3-18-99)(PD 10-18-01) FOR TREASURER'S USE ONLY COUNTY TREASURER <br /> 1 6 <br />