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CDepartnwm o( <br /> CV�Ue REAL ESTATE EXCISE TAX AFFIDAVIT <br /> iLi�lorm is your recei�� <br /> ri.iwsenmisoarHvrr CIIAI'l1iRR: ISRCW-CIiAPTER45&61AWAC whrnstnmpcdbycashier. <br /> TIIISAFFIDA\'ll'N'II.I,NOTOL'ACCF.ITF.DUNLFSSAI.I.ARI:ASOf1A1.I.PACESANEFUI.LYCOMPLEfED ll .I L ��. (r <br /> (SaWckoflutrygeforimmrtliom) �C 0 <br /> ❑ChakMaif ulialulenf Ifmulli lemmm liil t�wfoxnmhi nexnomme. <br /> .Name .74Unc�1).C�� l�.r�lle� l.�l �.LC N�mc�_�fv !` .EK'��. � <br /> ,� �1 w P�, L i- uJnr,F� �. ff. <br /> .wi1 ALilinpMLUu��� 1 u� �G�� J w M�ilin�AJdmi .�a_'NU -J/i_i'1��..` JY <br /> �� rarrsuivr.�� l VC d 1 1 lJ A . �'1�2 � �� �� CirylS�id7.ip_�✓C�^n J ✓tl'�i!� <br /> V <br /> PhnneNa(induJing�rtacodc) 'I:� ��(� �YJ'I� PLoncNo.INcWdinFamaca!:) 9�-".-=1'O��-' <br /> Frnd a�l pmpeny t�s�ortopndeMe In:�Same m�vyer/Umnta List JI ml anJ�nnvl pm�ny la�Mrtcl¢rnum I.in aauasN value(�) <br /> �mx„-�nnt no.�rx�w�.,i r��rcr <br /> Namc ' nn_;�1.4"l.-U4 -Ol�'Q�o Q <br /> M,i�mFnamen � P.�.li�n eh'� p _ '! ' � ' % <br /> ciry';9u�<.Iip �40////RCr;?:D/G/ O'O////b"OV� n/ <br /> PhonrN�, ,mcludins�RacNel �eo//U6v:^nr.cio2 �'i///Soon,� 02 i � <br /> JN/8aa'✓•c/e3-�u <br /> Os�«<„aa«,�or��o��nr:_(c2L��—�'Pinie--—Ur b�L! 0 0 7 �¢_dp////fJOCC•OU20Q- <br /> TM1i�pmpn�y ia loc�icd in�unmcomumiN CounryOR wiiAie 0 airy nf I=JC.� 1 i <br /> �Ch.<k Ma if ony uf iAe IinN rymels arc tsin6�BRgmN fmm a heger pved. <br /> Lcgal dmaipUnn of praperry(if more�psse is naJed.You ma �uach o Rcpan¢sheel�o och page pf�he�Rid�vil) <br /> ��.-l.. �r.l� -. r J �(rci� -�: t-l•� �c.11aU..�S 1X'Sct .h•�� J�oVafi�/ <br /> LvZ Il. 'LlrKlc c/ Lcver��� 1{�tIS O.v,S�w 1V0. , � f�7 PCr j�lat <br /> �„ �c P i n+> , an5a �� . 1:c�crd s o f <br /> �irc.,�frtCl� �.. V!rl�n.c ' <br /> Snul.u�"• �1. . Coun+� WASI..�ji� �7 / <br /> �i /s(`r.�{rnli .il ,'--� ��1- \ �G�. /��` (<.//.} <br /> �linler Abstract Use Calegories:�1_µJ—__ List all personal propeny(qngible anJ imangi6le)includnt in selling <br /> 1 ' pri<e. <br /> (Sec back nf lact page fur instrv<lions) <br /> YCS fi0 <br /> Is tLis m cn cxam t fn�m m n laz If claiming an enemption,list WAC number unJ aas+n for enemplion: <br /> r r r r v r� r MrcM1oplcr ❑ d( A <br /> F4.)b HCN'(nonpmfil organiralion)? WAC Na(Section/Subsec�ion) T SO'G'��- �'�� <br /> YCS NO <br /> Reasonforexemption Ti^en�l�i^ nff�' J�� <br /> Lvihi�pn�atyARi�aialnc(reaLvvl�vchqvali7J3RCN7 ❑ ��y l� ll.ft �i� Jji_�[��, n�- I'✓n�i <br /> l���i�lnirnyda�u(mlav�mlu�c(nl�rn.l�xs.fiumanl ❑ V]. � ��— <br /> a�ii�duu:J,�x�inhi)Lv�l p-�d�'µxcr IU3i? — <br /> �����mi�+'Yn�'�+�NFHt�����u�����a�M'f'�Y � � TypcofDocumenl Jf� fL./i�rv��L/'��fu D� <br /> R��ItyuaNJ26RC117 —�- <br /> If:uiy:mMcn:vc)nmry�inca�irov�x'nrlMbw. DateofDocumenl �- ' JO� zUOP <br /> pIN077CT:OFC�]'17�U,�vq:lFT)Hftii'IMl10RC11RItFTTUSt� GrwsScllingPrice S� <br /> NIiWOR7JG1l�S�:TncnnlinueJiem�mitdai�utitmas�o�allatxtor •personalProperty(JeducQS 0� <br /> eI>c�ificatinn nv n�rnnt u�e(��W«.Lm�anJ ay�indwrt.crc timbcr) <br /> Imidpoummisi7�nan(J�IMInw.'Ihccuunrync�ivrcmuslihcnJnrnnin< <z<mptionClaimed(Jcduct) S,� <br /> if�helan�lvm�fmntcontimrcsmqa�li(ymuluillinJiw¢6ysi�inglclow�. TanableSellingPrice S � <br /> IfOm�andnolongcry�uliGcsor)xmJonot��i>htocanlinucd¢de.iiNwtion . <br /> mcl.�csificatinn,il�alllarcnwvnlandlhemmpcnvungrc�Mliiimullata GzcrseTax:StarcS� <br /> will ta due Md ry�able Fy O�c scllcr or tr.uidcmr ai tlw lime of.de(NCl1' Loml 5� <br /> F13J.Id0orHClYWl.i4.IU31.�n<rclosi��ingQ)M1elox•.y�wmaymnLxl •DelinqucNlntcrosC SImeS � <br /> yiwr lucal cuunty aacsv�r fnr mure infumw�inn. <br /> i.���i s r <br /> This'land ❑d�ws �duesnm qualifyfmcuminumce. •UclinqueNl'enally5y� <br /> —_ Subtolal 5 (� <br /> 11P1'Ull'nSSISSOR Untti —� <br /> �:16OI'ICl:OF'CUMI'll,\NCF.QIISIYINICPN01'f7111� 'S�nteTechnologyPee S 5.00 <br /> NLW ON'NGNISI'Tu coNinnc special raluatinn os hivnnc propcnY. 'Affidavit Processing P<e S <br /> slGn�1)hrlow�.If the ncw owneq..)do imt wi�h lu continuc,ail Toml Due S��� <br /> aJditmnal un calculaled pursuanl ln chapia%•i'_G RC\V.shall bc dut . <br /> acJ payaMa lp��he seller ot t�ansfcmr at�h<Iime of vle. <br /> (J) O\\'NF:R�ti)tiIGNATUIIE ������������U!510.001511UF.1�FF.f:(S�ANDION TAS <br /> •SCGINSTRUCTIONS <br /> ----- rarvrnnur: <br /> � ICf:lll'IF1'I��}�}J _iPi:Y,\{.iV<)F • HkYf7UTT11F.FORF.GUINGI5TN1iF.ANDCORNECf. <br /> /i`� <br /> Signatureo( �'/ Signatureuf • �: <br /> nn (� 1 � 7 �' <br /> CrnnlnrmCronlnr'iAGrnl_ F}8t� CnmmorGruntec'sAFenC- • <br /> Nnm<(prinq "•1�_�tc �- Nome(prinq�_�i,•� ,(t�'_._�.F_� <br /> Ua�e.hatynfsigning: I� ��`t t:�t r.ve,��+ n���a��eYar�����s: ��-/¢� 2(1// �'(' r�. <br /> Perjury:Pe+jury is a clsv C felony xhich i�puniduble by im�rittmmrnt in ihe swte corrtctimW irtailurinn for a muimum tem�nfirot mofe Ihin fire yeua,or b� <br /> nfincmanamaunifi�nlM'�<counof�rotmrne�hvifi�eda�m+fxldollars(T3.000.00).whybu�hlri�i'Ymm_rntanifine CW9A;OO:U(ICI� )_ <br /> YZa98 <br /> a�s�•x�aw�alor.ro✓on� TIIISSPACG-TREASURGIt'SUSGQfilnk'ra for rar p�pent. iA%PAVER <br /> _. . . . � .� � �1� � <br /> ✓ <br />