HomeMy WebLinkAbout200511090001
1 \11111 111111111111\11111111111\1111111 11111\11111\ \111 ::~~~21~~9~~~~fl1
CITY OF BREMERTON BLA $41 . SS Kit. sap Cel.' WH
WHEN RECORDED RETURN TO:
Bremerton City Clerk
345 6th Street, Suite 600
Bremerton, Washington 98337
Grantor:
City of Bremerton
Property Taxes are paid thru: 1J--3 (-t>5
EXCISE TAX EXEMPT NOV ... 9 2005
Grantee(s): Thomas Cameron, Kent Mercer, Tammy Crawley, Richard Chrisinger, and Duane and
Margaret Baker
Abbreviated Legal Description: Portion ofthe SE V4 and the SW V4 ofthe SE 1/4 of Section 15,
T. 24 N., R. 1 E., W.M., Kitsap County, Washington
Assessor's Tax Parcel ID No(s). 3733-001-001-0005, 3733-001-002-0004, 3733-001-008-0008,
3733-001-009-0007,152401-4-022-2006, and 152401-4-021-2007
DECLARATION OF BOUNDARY LINE ADJUSTMENT
This form allows for the adjustment of boundary lines within the limits of the City of
Bremerton. This adjustment shall not create any additiona110t, tract, parcel or site. This document
does not convey ownership, separate quit claim deeds will be required to complete the Boundary
Line Adjustment. A subsequent survey of the adjusted line shall be recorded with Kitsap County
referencing this document.
Applicant:
City of Bremerton
Applicant's Mailing Address:
345 6th Street, Suite 600
Bremerton
City
Washington
State
98337
Zip
City of Bremerton Boundary Line Adjustment
Page 1 of 10
Dec1arant( s )fawners of Original Parce1( s):
Name Mailing Address City/State/Zip
City of Bremerton 345 6th Street, Suite 600 Bremerton, W A 98337
Thomas Cameron 348 Ford Avenue Bremerton, W A 98312
Kent Mercer 348 Ford Avenue Bremerton, W A 98312
Richard B. Chrisinger 911 S. Cavalier Drive Springfield, MO 65802-2758
Tammy L. Crawley 329 N. Lafayette Avenue Bremerton, W A 98312
Duane Baker (Trustee) P.O. Box 327 Bremerton, W A 98337
Margaret Baker (Trustee) P.O. Box 327 Bremerton, W A 98337
IN WITNESS WHEREOF, the parties hereto have executed this instrument as of the date
first above written.
~
"--
Cary Bozeman, Mayor ofBremerton
~
Thomas Cameron
Ko~~
K;o/ M{rcer '--.. ~.
l1t~ f3 Ck~
Richard Chrisinger
-9~~(Jn.J I{ JU.lJ
Margaret aker
(Notary Acknowledgement on Next Page) .
City of Bremerton Boundary Line Adjustment
Page 2 of 10
1111111111111111111111111111111111 ::~~~2}a~~9~~~~A1
CITY OF BREMERTON
BLA $41. SS Ki t.S<ip Co.. WA
STATE OF WASHINGTON
COUNTY OF KITSAP
)
) ss.
)
On this /3 t:I1 day of ~iULLJ ,200:;, before me a Not'!!)' Public
. . pu . -ex. ~ /Jeer BFJK.eR, TntTImylO/fb1'(EJIl-
III and for the State of Washington, persona yappeared ~~7n~ /rJ'TL./%RiJ (lIlRISt,PqC'/) ; , to (!-~FluJle.,/
me known to be the individual that executed the forego{I?tmgfr' 1:100 acknowledged it to be the
free and voluntary act, for the uses and purposes mentioned in this instrument, and on oath stated that
they are authorized to execute said instrument.
-Notary Seal Must Appear Within This Box-
IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day
and year first above written.
Ci(;;F7h tfJ)~ /.1 ~t!.-J
NOTARY PUBLIC, in and fOH State
of Washington, residing at ~
My appointment expires /~ -/5 -()t"
City of Bremer ton Boundary Line Adjustment
Page 3 of 10
111111111111111111111111111111111111111111111111 ::~~~2}~;~91~~~A1
CITY OF BW1ERTON BLA tot! . SS Kit. sap Co.' WA
STATE OF WASHINGTON
COUNTY OF KITSAP
)
) ss.
)
On this ~ day of 0 (!;/-{) ber ,200 6, before me a Notary Public
inandfortheStateofwashington,perSOnallyappeared~~ boL.eMan I Ua~pr of ~~~
me known to be the individual that executed the foregoing 1 strument, and acknowledged it to be the
free and voluntary act, for the uses and purposes mentioned in this instrument, and on oath stated that
they aF€ authorized to execute said instrument.
h ~ 'lS.
-Notary Seal Must Appear Within This Box-
IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day
and year first above written. I
uholJWCl V ~/1L.
l1Ie 1 VV\CL V S lAI eM
NOTARY PUBLIC, in and for the State
of Washington, residing at ~v~ 'f1fun
My appointment expires ~- di- 61
City of Bremerton Boundary Line Adjustment
Page 4 of 10
111\11 11111 II I I I I \ II 111111 \ \ 11111 IIII III
CITY OF BW1ERTON BLA:i41 , SS
200511090001
P <1qe · 4 of 1 S
llis9/2SS5 SS.2SA
Kit.S<1p Co.. WA
DECLARATION OF BOUNDARY LINE ADJUSTMENT
THIS DECLARATION MADE THIS l~ day of~) "a' f , 2005 by the City
ofBremerton, A Declarant as owner ofthe real property described herein, and by Thomas Cameron,
Kent Mercer, Richard Chrisinger, Tammy Crawley, and Duane and Margaret Baker, Declarants as
owners of the real property legally described herein, who wish to adjust the common property line
between said parcels without creating any additional lot, tract, parcel or site.
CURRENT Legal description ofParcel(s):
SEE ATTACHED EXHIBIT "A"
NEW Legal Description ofParcel(s):
SEE ATTACHED EXHIBIT "B"
I, (We) the owner(s) of all the property described herein do hereby acknowledge and agree to
hold the City of Bremerton harmless in any cause of action arising out of the boundary line
adjustment or recordation of same.
IN WITNESS WHEREOF, we have set our signature(s) this /3'f1t day of ,-tLl1 ~J ,2005.
. -
~~
Owner
~
Owner
.J1( /' /1' i ./ ..
. / VI (j,.:>'-I)/ ()../i:C)-: j(~ ?~
o~ne;WM1e ~..
City of Bremerton Boundary Line Adjustment
Page 5 of 10
\ 111111111111\ 11111\11\ \ 11111\ 11\ III ::~~~,}~99~~~:1
CITY OF BREMERTON BLA $41.GG Kitsap COI WA
- - --- .
ACKNOWLEDGEMENT
On this /3'-t/J day of ~(.L.ILR......J , 200 ~ before me a.N. ot91)' Public in and
. . 7/fm/fl Lt)he~-m/] rl:!-miV /~. . KenT eeIZ
for the State ofWashmgton, pers ally appeared '/Jt.,/4/o1e Ke~, fer . .0.'3 . ~me
known to be the individual that executed the foregoin 1m, 5 . n ,1Ufd1acknowledged it to be the free
and voluntary act, for the uses and purposes mentioned in this instrument, and on oath stated that they
are authorized to execute said instrument.
-Notary Seal Must Appear Within This Box-
IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day
and year first above written.
'd(~)~ / P'.u,V
NOTARY PUBLIC, in and f~e State
of Washington, residing at ~
My appointment expires I g, -/5 -t) b
ACKNOWLEDGEMENT
On this ..::1:bh.- day of {)cJ..-o h e.r-- ,200 S, before me a Notary Public in and
for the State of Washington, personally appearede...a.\"'~ .6Dz.el'\.tA.l\, .yo::lCl r or ~ , to me
known to be the individual that executed the foregoing mstrument, and acknowledged It to be the free
and voluntary act, for the uses and purposes mentioned in this instrument, and on oath stated that #tey
ttI'e authorized to execute said instrument. he.
IS
-Notary Seal Must Appear Within This Box-
IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day
and year first above written. I I
~-J Iu 1rK () V xi 1J.(AlLJ
----rh-e J ma V ~!AI 'e rY\
NOTARY PUBLIC, in and for the State
of Washington, residing at '?Jrfft1'Prfnn WA
My appointment expires ~-~, -OJ
11111I 1111111111 111111
CITY OF BREMERTON
200511090001
Page: 6 of lS
11i&9/2&&5 &8:28A
Ki t.sap Co.. ~~A
BLA $41. &&
EXHIBIT A
Capital Hill Fire Station Site (City of Bremerton)
152401-4-022- 2006
Forest Ridge Park (City of Bremerton)
152404-4-021- 2 007
Thomas Cameron and Kent Mercer
3733-001-001-0005
Richard Chrisinger
3733-001-002-0004
Tammy Crawley
3733-001-008-0008
Duane and Margaret Baker
3733-001-009-0007
City of Bremerton Boundary Line Adjustment
Page 7 of 10
.111111111111111111111111111111111111111111111111 ::~~~2}~?9~~~~A1
CITY OF BREMERTON BLA $41 . && Kit. sap Co.. WA
EXHIBIT B
Capital Hill Fire Station
That portion of the southwest quarter of the southeast quarter of Section 15, T. 24 N., R. 1 E.,
W.M., Kitsap County, Washington, more particularly described as follows:
Beginriing at the northeast corner of said southwest quarter of the southeast quarter; thence
southerly along the east line of said southwest quarter of the southeast quarter to its intersection
with the southerly right of way of 6th Street; thence along said southerly right of way, N
88051 '09" W 5.54 feet to the True Point of Beginning; thence leaving said southerly right of
way, S 1022'14" W 114.43 feet; thence on a curve to the right, the center of which bears N
88037'46" W 182.50 feet an arc distance of 40.64 feet; thence S 14007'42" W 113.00 feet; thence
on a curve to the right, the center of which bears N 75'52'19" W 45.00 feet an arc distance of
212.06 feet; thence S 14007'42" W 5.00 feet; thence N 65049'06" W 143.10 to its intersection
with a line parallel to the east line of said southwest quarter of the southeast quarter and 200
westerly thereof; thence along said parallel line N 1016'41" E 150.00 feet to the said southerly
right of way of 6th Street; thence along said southerly right of way to the True Point of
Beginning.
Forest Ridge Park
That portion of the E 12, SW 1;4, SW 1;4, SE 1/4 AND E 12, SW 1;4, SE 1;4, situate in Section 15,
T.24N., R. 1 E., W.M., Kitsap County, Washington.
Except that portion of the said E 12, SW 1;4, SW 1;4, SE 1;4 conveyed to the State of Washington
under Kitsap County Auditor File Number 9607300048, being more particularly described as
follows:
Beginning at the S 1;4 comer of said Section 15; thence N 1022' 19" E 667.86 feet along the
center section line to the NW comer of the SW 1;4, SW 1;4, SE 1;4 of said Section 15; thence S
88056'5" E 331.84 feet to the NW corner of the E 12 of said SW 1;4 and the True Point of
Beginning; thence continuing along the north line of said SW1/4, S 88056'05" E 257.87 feet;
thence S 1023'14" W 475.25 feet; thence N 88056'05" W 257.81 feet; thence N 1022'47" E
475.25 feet to the True Point of Beginning;
Also except that portion of the SW 1;4 ofthe SE 1;4 of said Section 15 being more particularly
described as follows:
Beginning at the northeast corner of the said southwest quarter of the southeast quarter, also
being the True Point of Beginning; thence southerly along the east line of said southwest quarter
of the southeast quarter to its intersection with the southerly right of way of 6th Street; thence
continuing along said east line to the southwest comer of Lot 10, Block 1 of the plat of First
Addition to Charleston, as recorded in Volume 4 in the book of plats, Page 057, records of Kit sap
City of Bremerton Boundary Line Adjustment
Page 8 of 10
I IUIII Ulll lIllI' '11'1 '1'111 'II IUIUI III UI'I I'll It'l mr~~2~;~~~:~~~A1
CITY OF BREMERTON BlA Soli . tlG - F
County, Washington; thence leaving said east line N 76006'10" W 51.01 feet; thence on a curve
to the right, the center of which bears N 39043'43" W 45.00 feet an arc distance of 183.67 feet;
thence S 14007'42" W 5.00 feet; thence N 65049'06" W 143.10 to its intersection with a line
parallel to the east line of said southwest quarter of the southeast quarter and 200 westerly
thereof; thence along said parallel line N 1022'14" E 150.00 feet to the said southerly right of
way of 6th Street; thence along said southerly right of way to the True Point of Beginning.
Also except for the north 30 feet of the said E Yz of the SW Yi of the SE Yi for road.
Thomas Cameron and Kent Mercer
That portion of the southeast quarter of Section 15, T. 24 N., R. 1 E., W.M., Kitsap County,
Washington, more particularly described as follows:
Lot 1 and the North 20 feet of Lot 2, Block 1 of the plat of First Addition to Charleston, as
recorded in Volume 4 in the book of plats, Page 057, records of Kit sap County, Washington;
Together with a portion of the southwest quarter of the southeast quarter of said Section 15
described as follows:
Beginning at the northwest comer of said Lot 1 and the True Point of Beginning; thence N
88051 '09" W 5.54 feet; thence S 1022'14" W 50.00 feet; thence S 88055'07" E 5.62 to the
southwest comer of the said North 20 feet of Lot 2; thence northerly along the west line of said
plat of First Addition to Charleston to the True Point of Beginning.
Richard Chrisinger
That portion of the southeast quarter of Section 15, T. 24 N., R. 1 E., W.M., Kitsap County,
Washington, more particularly described as follows:
Lots 3 through 7, inclusive and the South 10 feet of Lot 2, Block 1 of the plat of First Addition to
Charleston, as recorded in Volume 4 in the book of plats, Page 057, records of Kitsap County,
Washington;
Together with a portion of the southwest quarter of the southeast quarter of said Section 15
described as follows:
Beginning at northwest comer of said South 10 feet of Lot 2 and the True Point of Beginning;
thence N 88055'07" W 5.62 feet; thence S 1022'14" W 64.42 feet; thence on a curve to the
right, the center of which bears N 88037'46" W 182.50 feet, an arc distance of 40.64 feet; thence
S 14007'42" W 56.77 feet; thence S 88055'07" E 22.92 feet to the southwest comer of said Lot
7, also being the west line of the said plat of First Addition to Charleston; thence northerly along
said west line to the True Point of Beginning.
City of Bremerton Boundary Line Adjustment
Page 9 of 10
I Illlll lllll lIllI' '11'1 '1'\1\ 'II Illl"l III "II' I'll \lll i\1;~~1~;~~~~~01~:
eIT'! OF BREMERTON BLA t4Ult:! '0 P
Tammy Crawley
That portion of the southeast quarter of Section 15, T. 24 N., R. 1 E., W.M., Kitsap County,
Washington, more particularly described as follows:
Lot 8 and the North 10 feet of Lot 9, Block 1 of the plat of First Addition to Charleston, as
recorded in Volume 4 in the book of plats, Page 057, records of Kit sap County, Washington;
Together with a portion of the southwest quarter of the southeast quarter of said Section 15
described as follows:
;.
Beginning at the northwest comer of said Lot 8 and the True Point of Beginning; thence N
88055'07" W 22.92 feet; thence S 14007'42" W 41.06 feet; thence S 88055'07" E 32.05 feet to
the southwest comer of the said North 10 feet of Lot 9, also being the west line of the said plat of
First Addition to Charleston; thence northerly along said west line to the True Point of
Beginning
Duane and Margaret Baker
That portion of the southeast quarter of Section 15, T. 24 N., R. 1 E., W.M., Kitsap County,
Washington, more particularly described as follows:
Lot 10 and the South 20 feet of Lot 9, Block 1 of the plat of First Addition to Charleston, as
recorded in Volume 4 in the book of plats, Page 057, records of Kitsap County, Washington;
Together with a portion of the southwest quarter of the southeast quarter of said Section 15
described as follows:
Beginning at the northwest comer of said South 20 feet of Lot 9 and the True Point of Beginning;
thence N 88055'07" W 32.05 feet; thence S 14007'42" W 15.18 feet; thence on a curve to the
right, the center of which bears N 75052'19" W 45.00 feet, an arc distance of28.39 feet; thence
S 76006'10" E 51.01 feet to the southwest comer of said Lot 10, also being the west line of the
said plat of First Addition to Charleston; thence northerly along said west line to the True Point
of Beginning.
City of Bremerton Boundary Line Adjustment
Page 10 of 10
11\\111 \\1\\ 11111\ \11\1 \1\1\1 \11 1\\I\\l~~ \\I\\~~ I\!I ~n~;:~;:~:ll2:;
CITY OF BREMERTON '
111111111111111111111111111111111111111111111111111111I ::j~~2t~7~~~~R5
CITY OF BREMERTON
QCD $33. ~~ Ki tsap Co.. WA
WHEN RECORDED RETURN TO:
Bremerton City Clerk
345 6th Street, Suite 600
Bremerton, Washington 98337
KITSAP CO~NTY TREASURER EXCISE
11/09/2005
2005EXl1073
Total : $10.00
Clerk's Initial
~
Grantor:
City of Bremerton
Grantee:
Thomas Cameron and Kent Mercer
Abbreviated Legal Description: Portion ofthe SW lf4 of the SE 1/4 of Section 15, T. 24 N.,R. 1
E., W.M., Kitsap County, Washington
Assessor's Tax Parcel ID No. 152401 4 021-20ffl and 152401-4-022-2006
~/A~ -("')01- OtJl- OeD '""
QUIT CLAIM DEED
(Individual)
The City of Bremerton ("Grantor"), a Washington municipal corporation, for and in consideration of
$1,079.00 (One Thousand and Seventy Nine Dollars), receipt which is hereby acknowledged conveys and quit
claims to Thomas Cameron and Kent Mercer their successors and assigns, the following described real estate,
situated in Kitsap County, Washington State.
A portion ofthe southwest quarter of the southeast quarter of Section 15, T. 24 N., R. 1 E., W.M.,
Kitsap County, Washington, more particularly described as follows:
Beginning at the northwest comer of Lot 1, Block 1 ofthe plat of First Addition to Charleston, as
recorded in Volume 4 in the book of plats, Page 057, records of Kit sap County, Washington and
the True Point of Beginning; thence N 88051'09" W 5.54 feet; thence S 1022'14" W 50.00 feet;
thence S 88055'07" E 5.62 to the southwest comer of the North 20 feet of Lot 2, Block 1, of said
plat of First Addition to Charleston; thence northerly along the west line of said plat of First
Addition to Charleston to the True Point of Beginning.
Consisting of 279 square feet.
City of Bremerton Quit Claim Deed
Page I of2
DATE: IO-I-o~
STATE OF WASHINGTON )
) ss.
COUNTY OF KlTSAP )
On this 1% day of ~cl-o Ou , 200~, before me a Notary Public in and
for the State of Washington, personally appeared C.o..~ e:c~I'V\Q..('\, I-\~ or '&("~ME1-b.,to me known to be
the individual that executed the foregoing instrument, and acknowledged it 0 be the free and voluntary act, for the
uses and purposes mentioned in this instrument, and on oath stated that th@)O ~re authorized to execute said
instrument. he. I ~
-Notary Seal Must Appear Within This Box-
IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day
and year first above written.
~tI aN )
Ihf J (Via V 3 vV ern
NOTARY PUBLIC, in and for the State
of Washington, residing at:?lr1'n1Pf.f.r)(\ iN A
My appointment expires ,,---~'c0'-01
APPROVED AS TO FORM:
R GER A. LUBOVICH
City Attorney
City of Bremerton Quit Claim Deed
Page 2 of2
" ,,/I 111111111I 111111
CITY OF BREMERTON
QCD $33 . SS
200511090005
P<ig~: 2 of 2
11/S9/2SS5 S8:3SA
Kit. S<ip Co.' WA
REAL ESTATE EXCISE T AX AFFIDAVIT
PLEASE TYPE OR PRINT CHAPTER 82.45 RCW - CHAPTER 458-61 WAC when stamped by cashier,
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(See back page for instructions)
It
. ~"
DEPARTMENT
OF REVENUE
WASHINGTON STATE
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Mailing Address
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City/State/Zip
Phone No. (including area'code)
Send all property tax correspondence to: rsame as Buyer/Grantee
Name
Mailing Address
City/State/Zip ,
Phone No, (with area code)
II
-;4'2> forA
A-"~AI'e
Street address of property:
This form is your receipt
LL.l
[iJ [: Mailing Address
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~ ~ City/State/Zip ()j.'<::>\io ,~'.... 't/:i\... q ;:;3 ( L_
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Phone No, (including area code) 3c:.c.O - 7 C}'z-o::::,-r>7
List all real and personal property tax parcel account
numbers - check box if personal property
\-~2.4.:&~..,.4;-..et:?;;...;:a~
-z.;TS~' (')(.)\. ~\. DCi:)C;
\ .:. i.: ( i '. ' \ . ( \ ,i ',4.: i ".. ~ '. .
List assessed value( s)
o
o
,0
o
/
I
/
I
\,'--.....
County OR within ~ city of ---=t)r t;' M -f' r-\''Ol>\
This property is located in 0 unincorporated
o Check box if any of the listed parcels are being segregated from a larger parcel.
Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit)
t- ~:.
:.
i~
( "X i'"" ~ l l'
Enter Abstract Use Categories: \
(Please see list on the back page of this form)
If exempt from property tax per chapter 84.36 RCW (nonprofit
organization), include:
Seller's Exempt Reg. No.: ________-.
YES
o
o
Is this property designated as forest land per chapter 84.33 RCW?
Is this property classified as current use (open space, farm and
agricultural, or timber) land per chapter 84.34?
Is this property receiving special valuation as historical property
per chapter 84.26 RCW?
If any answers are yes, complete as instructed below.
(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
NEW OWNER(S): To continue the current designation as forest land or
classification as current use (open space, farm and agriculture, or timber)
land, you must sign on (3) below. The county assessor must then determine
if the land transferred continues to qualifY and will indicate by signing below.
If the land no longer qualifies or you do not wish to continue the designation
or classification, it will be removed and the compensating or additional taxes
will be due and payable by the seller or transferor at the time of sale. (RCW
84.33,140 or RCW 84.34.108). Prior to signing (3) below, you may contact
your local county assessor for more information.
o
This land 0 does 0 does not qualifY for continuance.
DEPUTY ASSESSOR
DATE
(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)
NEW OWNER(S): To continue special valuation as historic property,
sign (3) below. If the new owner(s) do not wish to continue, all
additional tax calculated pursuant to chapter 84.26 RCW, shall be due
and payable by the sdJler or transf~ror at th~ timeof sale.. :. "\."
(3) OWNER(S) SIGNATURE
List all personal ptop~ny(tarigible and intangible) included in selling
price.
NO
If claiming an exemption, list WAC number and reason for exemption:
~
9il
~
WAC No. (Section/Subsection) -.Ac;B - <.ol- 4], 0
Reason for exemption ~ tvt:.k~r.fnJ~ rr 4('O,4""r "".....ltrJ.
~Y''''I.J..J.
\ \
Type of Document
Q\~..+
..
(Jr~\ ~ Dl"'c!
Date of Document
\ !
...'
Gross Selling Price $
*Personal Property (deduct) $
Exemption Claimed (deduct) $
Taxable Selling Price $
Excise Tax: State $
$
$
I I. ".,"")
_ . I, ,". (',
(,
Local
"
. *D&~i-FIttu6m-iR-Wrest:
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State
" L
iLEl6&1-$
t"'- ,
" '
*Delinquent Penalty $
Total Due $ It. (' i'
. ..4... d.... .....
. A MINIMUMFEE~OF $2.iHf I~'.J)UE AS"A PRo'CESSING FEE AND tAX.
*SEE INSTRUCTIONS
I CERTIFY. UNDER PENAL T\rOF'PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of C_-. ,<",'/'JSignature of 1'1..1 C "-
Grantor or Grantor's Agent...."..? '..' . Grantee or Grantee's_~gent ;;;1 f/JAf'PU..4", '''R';7Aii~,I2!~:'1.''(JL..,_
Name (print) (.Inl 1'/ li!(. I,,!("I/n( Name (print) /ltt.:rVV\..'i5 c.-'~~~)..tA'\(:'~:V(.sL.____
Date & city of signing: I; f.. j "'1 \\ Y. i 17\) Date & city of signing: & It ~(It) ;?'" 1:!.(lC.J.t'1...t!J\.f-~
, ~
Perjury: PeJjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more 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 fine (RCW 9A.20.020 (I C)).
REV 84 OOOla (12-20-04) (PO 12.20-04) THIS SPACE - TREASURER'S USE ONLY TAXPAYER
t l{)7?J
1111111 "111 111111111111111111111111111111 1111111111111 t.~,~~; .1o~~0003
L.I T\ _ ur BREMERTON l~CD _ 1 ~.... ~::i.... i:::8~5 88 : 29A
-. .. ~33. ~8 Kl tsap Co., IJA
WHEN RECORDED RETURN TO:
Bremerton City Clerk
345 6th Street, Suite 600
Bremerton, Washington 98337
2005EX11071
Total : $10.00
11"""" ~
KITSAP COUNTY TREASURER EXCISE
Clerk's Initial
Grantor:
City of Bremerton
Grantee:
Tammy L. Crawley
Abbreviated Legal Description: Portion of the SW ~ of the SE 1/4 of Section 15, T. 24 N., R. 1
E., W.M., Kitsap County, Washington
Assessor's Tax Parcel ID No. 152401 4-022-2000 and 152401-4-021-2007
313 ~-lJol- ao~- ooO~
QUIT CLAIM DEED
(Individual)
The City of Bremerton ("Grantor"), a Washington municipal corporation, for and in consideration of
$5,093.00 (Five Thousand and Ninety Three dollars), receipt which is hereby acknowledged conveys and quit
claims to Tammy L. Crawley her successors and assigns, the following described real estate, situated in Kitsap
County, Washington State.
A portion of the southwest quarter of the southeast quarter of Section 15, T. 24 N., R 1 E., W .M.,
Kitsap County, Washington, more particularly described as follows:
Beginning at the northwest comer of Lot 8, Block 1, ofthe plat of First Addition to Charleston, as
recorded in Volume 4 in the book of plats, Page 057, records of Kit sap County, Washington and
the True Point of Beginning; thence N 88055'07" W 22.92 feet; thence S 14007'42" W 41.06
feet; thence S 88055'07" E 32.05 feet to the southwest comer of the North 10 feet of Lot 9, Block
1, of said plat of First Addition to Charleston, also being the west line of the plat; thence northerly
along said west line to the True Point of Beginning
Consisting of 1,099 square feet.
City of Bremerton Quit Claim Deed
Page 1 of2
STATE OF WASHINGTON
COUNTY OF KITSAP
DATE: ID-i-OS
)
) ss.
)
. On this ~ day of nO tobe Y" ,2005-, before me a Notary Public in and
for the State of Washington, personally appeared e11-rl! '"2o'7.f M.6.r1., H~ o.r J?yp M~V'"'-\-r.,C\to me known to be
the individual that executed the foregoing instrument, and acknowledged to be the free and voluntary act, for the
uses and purposes mentioned in this instrument, and on oath stated that they ar€ authorized to execute said
instrument. he... IS
-Notary Seal Must Appear Within This Box-
IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day
and year first above written.
APPROVED AS TO FORM:
~ jkotJ/j(Q vi xf~
'"
---r-h'f JrvlfIJ v.:] V\/em
NOTARY PUBLIC, in and for the State
of Washington, residing at6r PMfrl-of\
My appointment expires \. ~ - ;;)/-0 1
wit
City of Bremerton Quit Claim Deed
Page 2 of2
11111111111111111111111111111111111111
C In' OF BREMERTON QCD $3~: . &&
200511090003
Paqe: 2 of 2
lli&9!2&&5 &8:29A
Ki tsap Co.. WA
REAL ESTATE EXCISE TAX AFFIDAVIT
PLEASE TYPE OR PRINT CHAPTER 82.45 RCW - CHAPTER 458-61 WAC when stamped by cashier.
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(See back page for instructions)
City/State/Zip
, Phone No. (with area code)
II Street address of property: ~'29 JJ, Lr....{..""..r'.":!tte. ,A',e
This property is located in 0 unincorporated
o Check box if any of the listed parcels are being segregated from a larger parcel.
Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit)
DEPARTMENT
01' REVENUE
WASHINGTON STATE
e>:::
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Mailing Address
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City/State/Zip
Phone No. (including area code)
Send all property tax correspondence to: 0 Same as Buyer/Grantee
"-""-."~~-,-",",<,..,.,,,-..,,,, .
This form is your receipt
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Mailing Address ':"'(} c: i ,...J \ ('j V, . ,; Hf' ItVi?
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City/StatelZip'(;:)\ {ir\ (, I J {l \ l~O', . L! ~;\ ~) 1+
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..;A,l:'! ).. Lf /"j. { 5 ! I l
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Phone No. (including area code)
List all real and personal property tax parcel account
numbers - check box if personal property
1~1Aot . 4 ,62 \ . JoOt
?;l-z.,-r,. \C)O\' ex>5' cxx''O
List assessed va e( s)
o
o
o
o
i
l"
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County OR within ~ city of 1Sr ("',Ai/!! riT1A,
\
f"'"
Enter Abstract Use Categories: I
(Please see list on the back page of this form)
If exempt from property tax per chapter 84.36 RCW (nonprofit
organization), include:
Seller's Exempt Reg. No.: _________.
YES
o
o
Is this property designated as forest land per chapter 84.33 RCW?
Is this property classified as current use (open space, fann and
agricultural, or timber) land per chapter 84.34?
Is this property receiving special valuation as historical property
per chapter 84.26 RCW?
If any answers are yes, complete as instructed below.
(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
NEW OWNER(S): To continue the current designation as forest land or
classification as current use (open space, fann and agriculture, or timber)
land, you must sign on (3) below. The county assessor must then determine
if the land transferred continues to qualify and will indicate by signing below.
If the land no longer qualifies or you do not wish to continue the designation
or classification, it will be removed and the compensating or additional taxes
will be due and payable by the seller or transferor at the time of sale. (RCW
84.33.140 or RCW 84.34.108). Prior to signing (3) below, you may contact
your local county assessor for more information.
o
This land 0 does 0 does not qualify for continuance.
DEPUTY ASSESSOR
DATE
(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)
NEW OWNER(S): To continue special valuation as historic property,
sign (3) below. If the new owner(s) do not wish to continue, all
additional tax calculated pursuapt to chapter 84.26 RCW, shall be due
and payable by the si#ller or tran"sferor at th~ time of sale. . .. '
.- - ,-~-,' , ~,
(3) OWNER(S) SIGNATURE
,_ .,- .~~ /~~-,7
List all personal property (tangible and intangible) included in selling
price.
NO
If claiming an exemption, list WAC number and reason for exemption:
~
5l
WAC No. (Section/Subsection) ---aSB. tol . 4? ..)
Rmo" fo< ",mp"O" -f4A~r -1._ ., c,-" "'" .-1.\
r.....A/_tA
. \
Type of Document
t':>,,,',:+-
... 'Ii
L.~\M 1\,,("'/:\
Date of Document
I.
"
Gross ~elling Price $
*Personal Pp~erty (deduct) $
..-
E~mp~jm< Claimed (deduct) $
V'Taxable Selling Price $
Excise Tax: State $
Local $
\ ~_ :. }: . I,
* E>eHnquenHnterest:-7......Sta-t&- $
" , r~, <. Lo.cal $
*Delinquent Penalty $
Total Due $
.'-,
'~-. -~
'. (
i.' i:
" .c,.\ci........ .......,4 _,_~_...._.;i:._. . . " c . '. .. .
A MINIMUM FEE"OF $2.00 IS;DUE AS A PROCESSING FEE AND TAX.
*SEE INSTRUCTIONS
...-"
..-.., ~. ,("
I CERTlfy'UNDE'R PE!',I:;\L Tyj)F; PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
. >. .-,"
" :e~rA/ r/ (/"'-_._.. ~;::~;'.~fG""t",, Ag,.t Ii /xI/I / / /, l! ,"" 'u/:> I
7 e"I',!,-! i1ij'(c.:-/ Name (print) /1//:" /(.l}~tJ/V,i/-./iV('j/~A(({ r'
'lit. "Hh", \ Date & city of signing: (:;/rt! 1/) . it'Y'r) /:;V~ i r ;Iii,
/ ;'. r:~" __.'"'" / .- ~ "-'"
Perjury: Petjury is a class C felony which is punishable by imprisonment in the state correctional institution for ~ maximum term of not more 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 fine (ReW 9A.20.020 (IC)),
REV 84 000Ia(12.20-04)(PD 12.20-04) THIS SPACE - TREASURER'S USE ONLY TAXPAYER
Signature of
Grantor or Grantor's Agent ,~
Name (print) :1 (',~. '. i I) /
\
Date & city of signing: \.
\ l 011
1111111111111111111111111111111111111111111111111111111 :~j~~21~9'~~~A4
C!TY OF BREMERTON QCD $33 . GG Kit sap Co) WA
WHEN RECORDED RETURN TO:
Bremerton City Clerk
345 6th Street, Suite 600
Bremerton, Washington 98337
2005EXl1072
Total : $10.00
11/09/2005
Initial~~~___
KITSAP COUNTY TREASURER EXCISE
Clerk's
Grantor:
City of Bremerton
Grantee:
Richard B. Chrisinger
Abbreviated Legal Description: Portion of the SW 1J4 of the SE 1/4 of Section 15, T. 24 N., R. 1
E., W.M., Kitsap County, Washington
Assessor's Tax Parcel ID No. 152401-4-022-2006 and 152401-4-021-2007
3J.~J.. -()f'lI-{'){)2- coaL!
QUIT CLAIM DEED
(Individual)
The City ofBremerton ("Grantor"), a Washington municipal corporation, for and in consideration of
$2,826.00 (Two Thousand Eight Hundred and Twenty Six Dollars), receipt which is hereby acknowledged
conveys and quit claims to Richard B. Chrisinger his successors and assigns, the following described real
estate, situated in Kitsap County, Washington State.
A portion of the southwest quarter of the southeast quarter of Section 15, T. 24 N., R. 1 E., W.M.,
Kitsap County, Washington, more particularly described as follows:
Beginning at the northwest comer of the South 10 feet of Lot 2, Block 1 of the plat of First
Addition to Charleston, as recorded in Volume 4 in the book of plats, Page 057, records of Kit sap
County, Washington and the True Point of Beginning; thence N 88"55'07" W 5.62 feet; thence S
1 "22' 14" W 64.42 feet; thence on a curve to the right, the center of which bears N 88"37'46" W
182.50 feet, an arc distance of 40.64 feet; thence S 14"07'42" W 56.77 feet; thence S 88"55'07"
E 22.92 feet to the southwest comer of Lot 7, Block 1, of said plat of First Addition to Charleston,
also being the said west line of the plat; thence northerly along said west line to the True Point of
Beginning.
City of Bremerton Quit Claim Deed
Page 1 of2
Consisting of 1,606 square feet.
STATE OF WASHINGTON
COUNTY OF KlTSAP
DATE: IO-l-ol
)
) ss.
)
On this l % day of Or t--o te.r ' 200 5 , before me aN otary Public in and
for the State of Washington, personally appearedf.a.~ 1:::D"U'..f\tA.A I k~r nP DN'tV\l"'rh:n to me known to be
the individual that executed the foregoing instrumen , and acknowledged' to be the free and voluntary act, for the
uses and purposes mentioned in this instrument, and on oath stated that they are authorized to execute said
instrument.
-Notary Seal Must Appear Within This Box-
IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day
and year first above written.
~~(~
'"
JlJf'JJrna \I Swevvl
NOTARY PUBLIC, in and for the State
of Washington, residing at'.bremPMr'I
My appointment expires ,-:;; - ~ / - OJ
WA
City of Bremertoll Quit Claim Deed
Page 2 of2
111111111111111111111111111
CITY OF BREMERTON QCD $33 . ~~
200511090004
P<lge: 2 of 2
11!~9!2~~5 ~8:3~A
Ki tS<lp Cell WA
REAL EST ATE EXCISE T AX AFFIDAVIT This form is your receipt
PLEASE TYPE OR PRINT CHAPTER 82.45 RCW -~CHAPTER 458-61 WAC when stamped by cashier.
THIS AFFlDA VIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(See back page for instructions)
~
~ ~ MailingAddress cAe:;- <.a-\~ <rl-. \ ~~Ap- toCD
~2 -
[ij <( fJ \ 1/\ A C.CJ7?.' -~l
tIl 5 City/State/Zip 't-:;>\ e:,<t(l-;;OA \ ~ _~ JD.2~ -
Phone No, (including area code) l,\OO. 41~. c;-z..,O
Send all property tax correspondence to: 1ft Same as Buyer/Grantee
Name
Mailing Address
City/State/Zip
Phone No, (with area code)
II Street address of property:
This property is located in 0 unincorporated
o Check box if any of the listed parcels are being segregated from a larger parcel.
Name
C h Y'I'S ; nae~Y-
J
Ii;: eM Y d
B
u..l
~u..l
u..l f- Mailing Address
>-2
55 ~ City/State/Zip
o
;! ;'
( "
i/ '/ ,:'"'
Phone No. (including area code) i
List all real and personal property tax parcel account
numbers - check box if personal property
1<;140\. A. ('.;n.. 2Q,)l", 0
\~240l. 4. 011 . 2<:.01 0
s1-S~ .0.')\. oo~. 0"')04 0
o
~! "
/'
List assessed value( s)
"', \.../ { )
''''i7
County OR within ~ity of Dt C .~ rtoA
Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit)
'K r'f { r
Enter Abstract Use Categories: \
(Please see list on the back page of this form)
If exempt from property tax per chapter 84.36 RCW (nonprofit
"org,mization), include:
Seller's Exempt Reg. No.: _________.
YES
o
o
Is this property designated as forest land per chapter 84.33 RCW?
Is this property classified as current use (open space, fann and
agricultural, or timber) land per chapter 84.34?
Is this property receiving special valuation as historical property
per chapter 84.26 RCW?
If any answers are yes, complete as instructed below.
(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
NEW OWNER(S): To continue the current designation as forest land or
classification as current use (open space, farm and agriculture, or timber)
land, you must sign on (3) below. The county assessor must then determine
if the land transferred continues to qualify and will indicate by signing below.
[fthe land no longer qualifies or you do not wish to continue the designation
or classification, it will be removed and the compensating or additional taxes
will be due and payable by the seller or transferor at the time of sale, (RCW
84,33.140 or RCW 84.34,108). Prior to signing (3) below, you may contact
your local county assessor for more information.
o
This land 0 does 0 does not qualify for continuance.
DEPUTY ASSESSOR
DATE
(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)
NEW OWNER(S): To continue special valuation as historic property,
sign (3) below. If the new owner(s) do not wish to continue, all
additional tax calculated pursuant to chapter 84.26 RCW, shallbe due
and payable by the s((tler 01; transfltor a,t th,y time of sale., '}~;
(3) OWNER(S) SIGNATURE
List all personal property (tangible and intangible) included in selling
pnce.
NO
If claiming an exemption, list WAC number and reason for exemption:
WAC No. (Section/Subsection) A~- <0\ - 41..0
Reason for exemption \"I....jl..c,,+ef ..tt'n."\ 6 4~f /lv"lP,,d...J
Av.... ALu
1 .\
~
~
~
Type of Document
G\.,+
~
I] ,
C\.r,,',AA \\:.("'{,
Date of Document
Gross Selling Price $
*Personal Property (deduct) $
Exemption Claimed (deduct) $
Taxable Selling Price $
Excise Tax: State $
Local $
\ ,
*.geHn'qttent-fnterest:-~ $
!", I beeab$
( ""1. '\
*Delinquent Penalty $
Total Due $ \ i
", _ _.~;- :.;J.. ' ;:"\-'-, . '_;"
A MINIMUMFEE'JOP$2.00 iSDUE AS'A PROCESSING FEE AND TAX.
*SEE INSTRUCTIONS
.._, r"'~" .;1"
I CERTI~YUNDER PEN~LTY9F PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of / .';(;;;)'':'::';;:;:~---''''''''''''''-''''Signature of/
Grantor or Grantor's Agent L_-"'<!..'~"l,// /,' i,./' Grantee or Grantee's Agent f.' .'
Name (print) (I Ci \ I \ I');{' 'ct) II' (, i i. t\ i ., , ! ( ( Name (print) ,,i'1
Date & city of signing: . ~ \, Ie r.
j \; ~_.
('-t?) 1\
l-
l
;",; '..;;';" .,' :_j 1.
l/,/ " /
Date & city of signing:
Perjury: PeJjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more 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 fine (RCW 9A.20.020 (I C)).
REV 84 OOOia (l2-20-04)(PD 12-20-04) THIS SPACE - TREASURER'S USEONL y TAXPAYER
I \ .C"'" ...........-J7/~.
\ -) G-
111111111111111111111111111111111111111111111111111 ::J~~1}i;~'~~~A2
CITY OF BREMERTON QCD $33 . SS Kit sap Co.. WA
WHEN RECORDED RETURN TO:
Bremerton City Clerk
345 6th Street, Suite 600
Bremerton, Washington 98337
KITSAP COUNTY TREASURER EXCISE
11/09/2005
2005EX11070
Total : $10.00
Clerk's Initial
1ttQ
Grantor:
City of Bremerton
Grantee:
Duane and Margaret Baker
Abbreviated Legal Description: Portionofthe SW Y4 of the SE 1/4 of Section 15, T. 24 N., R. 1
E., W.M., Kitsap County, Washington
Assessor's Tax Parcel ID No. 152401-4-022-2006 and 152401-4-021-2007
3-, ;),,~ - aD \ - (J{Jot - non,
QUIT CLAIM DEED
(Individual)
The City of Bremerton ("Grantor"), a Washington municipal corporation, for and in consideration of
$6,869.29 (Six Thousand Eight Hundred Sixty Nine Dollars and Twenty Nine Cents), receipt which is hereby
acknowledged conveys and quit claims to Duane and Margaret Baker their successors and assigns, the
following described real estate, situated in Kitsap County, Washington State.
A portion of the southwest quarter of the southeast quarter of Section 15, T. 24 N., R. 1 E., W.M.,
Kitsap County, Washington, more particularly described as follows:
Beginning at the northwest comer of South 20 feet of Lot 9, Block 1, of the plat of First Addition
to Charleston as recorded in Volume 4 in the book of plats, Page 057, records of Kit sap County,
Washington, and the True Point of Beginning; thence N 88055'07" W 32.05 feet; thence S
14007'42" W 15.18 feet; thence on a curve to the right, the center of which bears N 75052'19" W
45.00 feet, an arc distan~e of28.39 feet; thence S 76006'10" E 51.01 feet to the southwest comer
of Lot 10, Block 1, of said plat of First Addition to Charleston, also being the west line of said
plat; thence northerly along said west line to the True Point of Beginning.
City of Bremerton Quit Claim Deed
Page I of2
Consisting of 1,757 square feet.
DATE: IC~-I-D5
STATE OF WASHINGTON
)
) ss.
)
COUNTY OF KITSAP
On this ~ day of VeJ.o hfl v"
for the State of Washington, personally appeared N 0 ( or ( \-on to me known to be
the individual that executed the foregoing instrumen , and acknowledgea it to be the free and voluntary act, for the
uses and purposes mentioned in this instrument, and on oath stated that they aro authorized to execute said
instrument. ne i~
-Notary Seal Must Appear Within This Box-
IN WITNESS WHEREOF, I have hereunto set my hand and official seal the day
and year first above written. I f
~J2 P /If (j! II )1w n{ )
'Jhl(J } (1// () V (\{ w e ()I]
NOTARY PUBLIC, in and for the State
of Washington, residing at ,!jrPWlfrlovt W;1
My appointment expires \ ~ -;) l-ol
APPROVED AS TO FORM:
City of Bremerton Quit Claim Deed
Page 2 of2
.11\\111\\1\\ 11111\ \11\\ \1\11\ \\1 1\\1\\\ ~~ \\11\ ~~ I}}I ~TI~;:~;~~~~~O'::
CITY OF BREMERTON ~ l. .
REAL EST ATE EXCISE T AX AFFIDAVIT
PLEASE TYPE OR PRINT CHAPTER 82.45 RCW - CHAPTER 458-61 WAC when stamped by cashier.
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(Seeoaok page for instructions)
DEPARTMENT
m' REVENUE
WASHINGTON STATE
~
~ ~ Mailing Address '-?At:; L?t~ C:-*, '- .c:t,:,'-\("'.- lr::;OO
~ ~ City/State/Zip -Y":l:,e iY",d'n~ \f:../A 3<3,>Sl
Phone No. (including area code) -:.t ,.."n . 4'rs. C; 210
Send all property tax correspondence to: ~ Same as Buyer/Grantee
Name
rvt~iling Address
City/State/Zip
-~ ..........
Phone No. (with area code)
II Street address of property:
This property is located in 0 unincorporated
o Check box if any of the listed parcels are being segregated from a larger parcel.
This form is your receipt
next to name.
Name D', \ ), r.k Y' ~ B Q. Ie e.. V"
~Ovlj0 ~e,L-B/) ke,(
Mailing Address \.. ", ( ,'. V . ,
L.Ll
0:::L.Ll
L.LlE-
>-2
55~
o
City/State/Zip \
I ~ (, '
1'-,. .
~ \;' _.,~,
)
,. .
List assessed value(s)
(
I .
""_F;( 1
Phone No. (including area code) ,
List all real and personal property tax parcel account
numpers~- check box if personal property
/-;14 at . -'\ . CYll . "} Of) 1 0
, "- -../
~->~.aol.co9.CYXn 0
o
o
County OR within ~City of -g"'-:"tIP ,.+vA
Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit)
: t
.\
I,
/'''''.
Enter Abstract Use Categories: \
(Plea~e see list on the back page of this form)
I(exempt from property tax per chapter 84.36 RCW (nonprofit
organization), include:
Seller's Exempt Reg. No.: _________.
YES
o
o
Is this property designated as torest land per chapter 84.33 RCW?
Is this property classified as current use (open space, farm and
agricultural, or timber) land per chapter 84.34?
Is this property receiving special valuation as historical property
per chapter 84.26 RCW?
If any answers are yes, complete as instructed below.
(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
NEW OWNER(S): To continue the current designation as forest land or
classification as current use (open space, farm and agriculture, or timber)
land, you must sign on (3) below. The county assessor must then determine
if the land transferred continues to qualify and'will indicate by signing below.
I f the land no longer qualifies or you do not wish to continue the designation
or classification, it will be removed and the compensating or additional taxes
will be due and payable by the seller or transferor at the time of sale. (RCW
84.33.140 or RCW 84.34.108). Prior to signing (3) below, you may contact
your local county assessor for more information.
o
This land D does D does not qualify for continuance.
DEPUTY ASSESSOR
DATE
(2) NOTICE OF COMPLIANCE (HISTORIC PROPER1'\)
NEW OWNER(S): To continue special valuation as histpric property,
sign q) below. If the new owner(s) do not wish to continue, all
additional tax calculated pursuant to chapter 84.26 RCW, shall be due
and payable by the s~Her or transferor at th~ time of sale." ,
(3) OWNER(S) SIGNATURE
./
List all personal property (tangible and intangible) included in selling
pnce.
NO
~
~
If claiming an exemption, list WAC number and reason for exemption:
WAC No. (Section/Subsection) 4S?)'lo\.420
Reason for exemption 1" f tAAS+f'" ( ~rn" fA ('10,>/1"'(.A .Mi"A.~. t .
~.~AC""'"
\ \
Type of Document
Q'~'lt
I!
(Jr:, ,t.\
~eJ
Date of Document
, :
I i
~ ""'c.Ti..~,, ~,...".-;.., .,.... . . - .... ....
AMINiMUM FEE OF $2.00 IS'DUE AS A PROCESSING FEE AND TAX.
*SEE INSTRUCT10NS
1
.
\ \ C)-'/ [:)
I CERTIFY UNDER PEl'IAETYOF PI1:RJURY THAT THE FOREGOING IS TRUE AND CORRECT.
.>',:;..
Signature of, .. . t ...7
Grantee or Gra~~ee's Agent;;}/t:,//!(.,;..,_ ,
/ 1 J I ,t---r "f f" /" J l,~':-i rl h.,..-f,.,,. ('~?
Name (print) l,tj l/ :'1 /\ ,~: I . '" r / III I P f C
. .... ~'I/J? l1e::;.~ (:~~,. ,,1,'_.,.. ,>,i .,/",.rr/.. ...,
Date & cIty of slgnmg: C.,. J ({. {}../ to'" { . -. 0,.". ~/ lr-'l-.'
Gross'Selling Price $
/
*personaliroperty (deduct) $
ExemNiofl Claimed (deduct) $
\~xable Selling Price $
Excise Tax: State $
Local $
i (I...:';!" . ~ ' '. \ ;.
*9~I+nquent-Iu.t&l'~:s~t@- $
" 66ear. $
*Delinquent Penalty $
Total Due $
Signature of /
Grantor or Grantor's Agent' .,' ?'. '[.,.,:/
Name (print) ,I, I (./ : /-, , "
j
Date & city of signing: [I.. ,
1"
~. \.
.' f
" .:' i Ii'
Perjury: PeJjury is a class C felony which is punishable by imprisonment'in the state correctional institution for a maximum term of not more 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 fine (RCW 9A.20.020 (I C)).
REV 84 OOOla (12-20-04) (PO 12-20-04) THIS SPACE - TREASURER'S USE ONLY TAXPAYER