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<br />PLFASE TYPE OR FRINf REAL FSTATE EXCISE TAX AFFIDAVIT
<br />PLEASC SEE REVERSE Form No. 84 OOOIA
<br />CHAI'fLR 82.45 RCW • CHAPCER 458fi1 WAC
<br />For Usc a1 CountY Tmzsurcr's Officc
<br />(Use Frorm No. B4-0ODIB for Re{�oning Transfcrs of Conlmlling Inlc�cs� o( Enliry Owncrship l0 1he C
<br />TfIIS AFFIDAVIT K7LL NOT IIE ACCEPI'ED UNLFSS ALL ARFAS 1-7 ARE FULLY
<br />a
<br />This fortn is your tcccipt u'hcn siampcd
<br />by cashicr.
<br />of Rc�cnue)
<br />i,r,sllo !trinkrann nnd I� Namc �ity o4 I:uerott
<br />—Qun i��g�;cna os Attri: It�nl e'ro�crtv i�ivision
<br />�a
<br />��si�i 11�9 I� 77tl� St.
<br />y .,ca c � � ��'
<br />v Cily Stam Zip
<br />ADDRESS TO SEND ALL PROPERTY TAX RELATED CORR65PoNDENCE
<br />Namc n� �tsu i��n
<br />Sucet
<br />Cilv/Slam
<br />Zip
<br />m `�
<br />Strcct
<br />3200 Cocl�ir Strcut
<br />ra� livetvtt 1A 33°O1
<br />City Statc Zip
<br />ALL TAX PARCEL NUMBERS �p Utm 7itE�.SVRU't PL�� :
<br />',�SSPSSf:O�VALLE IP TAX:tXEMP7�..
<br />��ana..•i-��an-inni rin:�� ; ,
<br />� LEGAL DESCRIP'CION OF PROPLItTY SITUATGD IN O UNINCORPORATED COUNTY CQ OR IN CiiY OF %'-verett
<br />5;!?d :th ^.•�e. +V., L:vc:ctt `.!A il8'.304
<br />Strcct Addrcss (if property is im�rovcd):
<br />.�i�t n•�rfion oi ttia . f:� of tlie. ;il�'j ��t 9o;:rio,� 13, 'fn;vna{ilp 2H, !intine 4 i?x:�t, !.7.' I. l:•1np,
<br />Sauthe:i.+tcrl;i ��f ,he #nlluwin�; .i,:ru:rlir.ul line: Cunun�:nct�•g :d the Jouthauat curncr o! sald
<br />snbdivlainn; tli;:nc.c t:OU"�Q4�,�"G �il�inF; th:i IS�int linr_ thoreo; for 1;i0.OH R:et; thcuir.�� 3i3:1`07'Yti"'.1
<br />l�urnllel •,�itti tiic Snuth lin�� ril sut�t ::itbcHviai��ii�l�i.031 foct tc� ttie tVeat rtE;lit-nP-��;u;� lin�: of 4t1�
<br />Avcnu�: Nent: tli�uco i00�'�S�ati"�l Pu.50 fn::t to i'ta ': rua Polrtt nf itr,};inntnc; ofsnid linr,; t}i,:�i�e
<br />S4,Y`4�':�,h"5l 19.i5if.n:t to tl�a South�:rly ri�,�ht-:�f-cr:iy 1Li�i u2 100th Strnat +outhwcrt, thc
<br />tercilnu:i :,f aaicl liri��.
<br />Is this propcny currcnlly: YGS NO
<br />Classi6cd or dcsignatcd as (orest Iand7 ❑ �.
<br />Chaptcr 84.33 RCW
<br />Classificd as currcnt cu land (opcn spacc, (arm ❑ Q
<br />and agricultural, or umbcr)? Chaptcr 8434 RCW
<br />Excmpt from property tax as a nonprofit ❑ �
<br />atganization7 Chapler 8436 RCW
<br />Sclicr's Gxcmpl Rcg. No. _ _ _ _ — — — — —
<br />Rccciving spcciai valuation as hisloric � Q'
<br />pmperty undc(1 Chaptcr 84.25 RCW -
<br />Property Typc: I7; land only ❑ land wiih ncw building
<br />❑ land with prcviously uscd building ❑ land with mobilc homc
<br />❑ timbcr only ❑ building only
<br />Prineipal Use: ❑ Apt (4 + uniQ C9 rc:idential
<br />❑ tim6cr ❑ agriculmral G commcrciallindustrial
<br />❑ othcr
<br />`(Q N01'ICE OF CONTINUANCL (RCW 84.33 0� RCW 84J4)
<br />If lhc ncw owncr(s) of land that is classificd or dcsignarcd as wrrcnt uu
<br />or forest land wish to continuc the classiFication or dcsignation of sucii
<br />land, ihe ncw owner(s) must sign bclow. I(thc ncw owncr(s) do nol dcsirt;
<br />W continue such classif cation or dcsignation, all compcnsating or additional
<br />faz caiculatcd pursvant tc RCW 8433.120 and 140 or RCW 8434.106 shali
<br />be duc and pryablc by thc scllcr or transfcror at thc timc o( salc. Thc counry
<br />assessor must dctcrminc i[ thc land transfcrrcd qualifics to con�inuc
<br />classificalion or dcsignation and must so indicaic bclow. Signatures do
<br />not ncccssarily mcan thc land will rcmain in classification or dcsignation.
<br />If it no longcr qualifics, it wili bc rcmovcd and thc wmpcnsating laxcs
<br />will bc applicd. All ncw owncrs must sign.
<br />This land ❑ docs O'docs not qualify (or continuance.
<br />Dam
<br />DCPUTY ASSESSOR
<br />(2) NOTICG OF COMPL[ANCC (Chsp;cr 84.26 RCW)
<br />If thc ncw owncr(s) of property with spccial valuation as historic propcny
<br />wish m continue this spccial valuation ihc ncw owncr(s) must sign bclow.
<br />If thc new owncr(s) do not dcsirc lo continuc such spccial valualion, ait
<br />additional tax calcuiatcd pursuanl to Chaptcr 84.26 RCW, shall bc duc
<br />and payablc by thc scllcr or transfcror at thc timc of salc.
<br />(3) O�VNER(5) SIGNATURE
<br />Dcscription o[ tangiblc personal propcny if includcd in salc ((urniturc,
<br />applianccs, ctcJ
<br />n/«
<br />If cxcmpGon claimuf, list �n�bed,��d czplanaiion.
<br />WAC No. (Scc/Sub) (�n�t _L_:"���fnrn tn nr
<br />�
<br />Ezplanalion �' `�1nr i� rl v����t i �
<br />�Yfx of Documcnt cintnfni•.• n�,���py•�i r i1Pnl1
<br />12/13/99
<br />Datc of Documcnl
<br />Gross Salc Pricc 5 ��
<br />Pcrsonai Property (dcduct) S
<br />1'axablc Saic Pricc S
<br />Ezcisc Tax S�atc S
<br />I.acal S _
<br />Ddinqucnt Imcrcst: Stam S
<br />Local S
<br />Dclinqucnt Pcnalty: Stam S
<br />Toul Due S
<br />3RL• IS A E2.00 FGL FOR PROCLSSING 7HiS FOHM IF NO TAX IS DUE
<br />AFFIDAVIT
<br />I ccrtify undcr pcnalty of perjury undcr thc laws of thc sfatc of
<br />Washington lhat the foregoing is true and correct.
<br />Signawrc of . ., �; i , '.,�:���'�, -
<br />Grantor/Agent x - �' -
<br />Namc(print) X � �•:'Q,���I� '✓f �.'lti:'�t`.���>7J`�
<br />Dam & Placc of Signing� — � ��'� � �%' '�' -
<br />Signamrc oC Lp �-� � �
<br />Grantec/Agent : ��•`f ' �:.� Y;,`C)1�L'? -
<br />� ✓
<br />Namc (Print) i� i � i J�i/!'.jt�l �".� `-� _
<br />Datc & Place of Signing •-�l/�^�-%`� •� ;` t.' ��
<br />�P�TUgy;,,p,e�cj�ry-�i cI��J� felony which is punishable by imprisonment in a state corrcctional institution for a maximum
<br />ofrnbt4si�1� thar� �C }�e�( or by a fi�c in an amount fixed by thc court of not morc than fivc thousand dollars ($5,000.00),
<br />o�By.(1AIhT���d�ifn rti and�inc (RCW;9A.20.020 (1C)).
<br />FOR TRGASURCR'S USG ONLY TAXPAYER
<br />�pR 17 1995
<br />FORM RE 84 OUOIA (12-93) (PD 3•28•94)
<br />MIRKE SIEVENi, Seol�omis6 (eunly ivatutt�
<br />` i�c�:'�`.� FI91�T ii;,,;�?.''�` FE� �.tfi_^
<br />By� ' Depuly � "
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