|
,�. ��
<br /> Su6mi11oCounly�re��u�erollhs �J REAL ESTATE EXCISE TAX � Tn'•'°'�"'•r°""•`•'0'"n•"•'•�"o•a
<br /> counlYlnwhlchprop�rtYl�loc�led. DY c��Alb. P�Y �Y t��� or cerllli�E
<br /> . ehsck lo Cwn1Y Twuurn.
<br /> CHAPTER 82.�5 RCW �
<br /> � PLEASF TYPE OR PRINT GUPtEn �Sa�at WAC
<br /> THIS 11FFIOAVIT WILI NOT BE ACCEPTED UNLESS ITEM4 OO T�OUON OO ANE FULLY COMVLETED
<br /> 1 � T��• • .�T "
<br /> 0 ������')� t�11.1R.'!!Try.��'i Nems I" �
<br /> N�m�
<br /> Q W
<br /> ¢O ��
<br /> f
<br /> W
<br /> �a Slnel ��. (.'. ` ��! (•� m� Slreel �'.9�. ���.�,��i� �,rl'�I1
<br /> C
<br /> . � On^f:". � �7••- ��pi Sq�''4, ..r, r..�.•,�.,.
<br /> Ci� Ti�:.:`.'.�Yil,'• SIeN �•� ZI . CII Sl�b�• Z
<br /> ' OO r�.! ' r=;'r�yr; ALL TA% PARCEL NUMBERS
<br /> � NEW OWHER'S N�me
<br /> PERMANENT AUDPESS �!lj7_fpN;_��;5"_�1'ir�tt �
<br /> � FOn �lL PPOPERiY Sln�� '�`��r' f' ;'.�•,'. ;�y�?��
<br /> T�X RELA7ED �,�n
<br /> i CORAESPONDENCE f������' '�,'f4+1'•:y`c, Z�P
<br /> Ci�yiSl��e -
<br /> , �q ..�.:.,..:.„
<br /> � O LEOAL DESCRIPTION OF PROPERTY 91TUATE� IN UNINCORPORATEO COUNTV LCf OR IN CITY OF
<br /> � (� .,_ :1;1'L:C7�` :! �.; ��11. . .. .:C'{:y.`_f.011.� /�T'ly � I � ��V
<br /> � le Ihie proparly eurrenlly: � YES NO °� Doecriptlon ol pereonal property II included In eele(lurnllure,ep•
<br /> Clseelliedordesl0naledeeloreetlend? � '� pliancee,etc.) �''�'�'
<br /> Chepter 0�.33 RCW
<br /> Clse�flied�s current uaa land(apen epeca,
<br /> Iumende9deultural,orlimber)7Chep1ar84.31RCW � '�'L�i';�:.,.•: ;;,1.,•, . r�..... ;..',:
<br /> ' 11 eaemPlion elaimed,eaplain ' �
<br /> Eaempllrompmpetlylaxundernonpmlit � •� �:C: �d.�1 'i�l .::'�
<br /> , or0anizationaChaplerB�.38RCW9
<br /> . Receivinq epecielveluelion ee hietoric � ;�
<br /> � propedyunderCheplar81.28RCWT I rin;;�.;+.:�;; � �-
<br /> , Type ol Documenl
<br /> ' TypeProperly: ❑ lendonly ❑ Iendwilhnewb�ilAlnp. � ��'r 1"'
<br /> Dale ol Documenl
<br /> ❑ lend wilh previouely ❑ lend wilh mobiln home Oroee Sele PAce 1l s� !' %-��� -
<br /> ueed 6uildin9 Pereonal Property(deducl)2/ �3
<br /> , SEE TAX OBLIGAilON5 bN REVERSE SIDE TaKa6leSalePrlae s _• {� _
<br /> O Exciee Tex: Slata s
<br /> (t) NOTICEOFCONTINUANCE (RCW)84.33orRCW�4.34) �oca13/ s
<br /> 11 Ihs naw owner(s)al lend Ihat le cleeeilied or dael0�eted ae currenl uee or loresl Delinquenl lnlereal:4/Slete s
<br /> ownsr(�I mausltai0�balow.'I iha nswiowner(s)da(ee)eot�deel e lo cponllnoeee ch
<br /> Locel s
<br /> � ols�ellia�lion or daeipnsllon,all compenulinp or e0dillonal IaR ulculale4 pureuent
<br /> lo RCW B�.�J.120 and 1�0 or RCW 8�.�1.108 ehall bs Oue and poyeG�c 6y Ihe eaitor Delinquenl Penelly:�/Slele s
<br /> or tr�ndaror �1 Ihe Ilme ol �ele. The eounly esseaeor muet Aolarm'�no II Iho lend S '� —
<br /> Inn�Nn�d qu�liliee lo conlinus aleesilicalion or daelpnallon end muel ao Indicnto Tolel Due
<br /> � balow.910�eluree da nol neeeesnily me�n tha lend will remein In cle�ellicelion or (SEE 1•60N REVERSE SIDE)
<br /> i da�i9nellon.II It no lonper pusliliee,II will he removed and tho compenoelinp lexee
<br /> will bs app��ed.Ail new owner�muel si0n•
<br /> AFFIDAVIT
<br /> ' Thielend ❑ does ❑ doeenolquellly pEpU7YA59E590R O I CERTIFY UNDER PENAITY OF PERJURY UNDER THE LAWS OF
<br /> � lorconlinuanca. THE STATE OF WASHINGTON THAT THE FOREOOINO IS TRUE
<br /> � AND CORpECT (eee 1t6 on reveree lor panslliee).
<br /> � � OATE � , ' ,
<br /> � (3) NOTICE OF COMPLIANCE(Chepler 8�.28 RCW) SIGNATURE � � � ' � �
<br /> i II the new ownar(e) ol properly wllh speclal valuallon ae hielodc properly �7�'-1(' ' i"'+';C'�!?�
<br /> wleh(�)lo eonlinue Ihia epeclal veluellon Ihe new owner(e)muet slgn bolow.11 NAME (p���l) �' �
<br /> ' Ih�new owner(s)do(ea)not deeire lo eonlinue euch epaciel veluetion,ell eddl• .���� . �
<br /> Ilon�l Iex cslcul�ted pursuent to Cheplar 8�.28 RCW,ehell 6e due end payoble OATE 3 PLACE OF SIGNINO:��� �' � �' ! '"`�
<br /> j bylheeellerorlranelerorsllhetimeoleele. SP.ECIFY(cirele):granlor/pranleelOranlor'a a0o���4�antee'a e0ar
<br /> � (3) OWNER(S)SIONATURE �
<br /> � Addreee ot reeldence or plece ol bualneee ol penon elpnin0(�Pecily)
<br /> � r� . ..• !{•;•
<br /> I
<br /> � '.'\.1 f.�)���'�_(: 1':�'
<br /> ��..:r '�� ���� '.1�.. �l7' .. . .. . .
<br /> I
<br /> � • OY
<br /> Thelollowin9oplionelqueslioneererequealedbyRCWB2.45.120
<br /> YES NC
<br /> ' �e property et the Ilme ol eele:
<br /> � YES NO e. Doee ConveyanCa involve e Ifede,pertlal
<br /> � Interealcorporaleallillelee,releledperllue. �� 2[
<br /> i �. Sub�ect to alderly,dieebilily,or phyel�el Improvomenl �� Z� 1rue1,racetverehip or en enlete9
<br /> � e.omptlon7 �, le Iha Orantea ac11n0 ea e nominae lor a third �� 2�
<br /> i b. Doea buildinp, II eny, have a hePt pump or soler �� 2� perly9
<br /> heelinp or coalinq ayslemT � , q. Principel usa:
<br /> �, e. Doeslhlsconveyaneedivideecurranlpereelollend7 �❑ 2❑ � Q og�icullurel 2 � condominium 3 � recreallc
<br /> .B��e�lqC�ey� c�r�(1�(Crop or m8tchen1061e 1� 2� 4 � epl(4+ unlla) 60 Induslilal 8 ❑ reaidenli
<br /> ' ��"'FL�QUIR�D 7 � commorciel B ❑ mobilehome 9 ❑ limber
<br /> �,�n� ��n �nnn FOR TREPSURER'S USE ONLY TAXPAYEf
<br /> � F011M REV e �b&7� a�Nrr e� J31�
<br /> . 178KE .CV'EnS, :�,.c:ish f;ml,• iraasurEr , . .., .
<br /> �y ?IIinS .°;.,tiT. -'`.',:`.:,'9::� ��
<br /> �..:... . �, - - NE ,;u;�
<br />
|