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QCD-Lot 1 recorded Sno Co. 202007080338122>77Cj When Recorded Return To: 0 0 0 Leigh Bennett Bennett & Bennett, PLLC CONFORMED COPY * ` III�II�II�IIIIIIII����II�I�II�IMII�I� 400 Dayton St, Suite A 202007080338 0 Edmonds, WA 98020 QUIT CLAIM DEED Rec: $105.50 7/8/2020 10:29 AM 3 PG CO o c SNOHOMISH COUNTY, WA N T co >' 0 e- N O DOCUMENT TITLE: Quit Claim Deed LO 0. w Y U c � GRANTORS: Evans, Reginald J.A., and Evans, Elizabeth L., husband and wife z° m GRANTEES: Evans, Simon J. and Evans, Marne C., husband and wife LEGAL DESCRIPTION: THE EAST 90.00 FEET OF LOT 2, EAST EDMONDS ACRES DIVISION NO. 2, ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 12 OF PLATS, PAGE 66, RECORDS OF SNOHOMISH COUNTY, WASHINGTON; (ALSO KNOWN AS LOT I OF EVANS SHORT PLAT PLN2018-0037, UNDER RECORDING NO.202006045012). ASSESSOR'S TAX PARCEL NOS.: 00431200000201 (includes other parcel yet to be segregated) REFERENCE NOS. OF DOCUMENTS RELEASED OR ASSIGNED: n/a QUIT CLAIM DEED THE GRANTOR, REGINALD J.A. EVANS and ELIZABETH L. EVANS, husband and wife, for and in consideration of love and affection, conveys and quit claims to SIMON J. EVANS and MARNE C. EVANS, husband and wife, any and all interest in and to the following described real estate, situated in the County of Snohomish, State of Washington, together with all after acquired title of the grantor therein. THE EAST 90.00 FEET OF LOT 2, EAST EDMONDS ACRES DIVISION NO. 2, ACCORDING TO THE PLAT THEREOF Py BENNETT & BENNETT, PLLC • ATTORNEYS AT LAW 400 Dayton, Suite A • Edmonds, Washington 98020 • (425) 776-0139 RECORDED IN VOLUME 12 OF PLATS, PAGE 66, RECORDS OF SNOHOMISH COUNTY, WASHINGTON; (ALSO KNOWN AS LOT 1 OF EVANS SHORT PLAT PLN2018-0037, UNDER RECORDING NO.202006045012). *Basis of gift is for Medicaid qualification purposes delineated in paragraph 2.15 of REGINALD J.A. EVANS' Durable General Power of Attorney, dated March 13, 2015, and recorded under Snohomish County Auditor's File No. 202006150072. DATED this Z- day of 34 ti , 2020. REGINALD J.A. EVANS, By Simon J. Evans, his attorney -in -fact 4 EtIZABETH L. EVANS STATE OF WASHINGTON ) ss COUNTY OF SNOHOMISH ) I certify that I know or have satisfactory evidence that SIMON J. EVANS signed this instrument, on oath stated that he was authorized to execute the instrument and acknowledged it, as the Attorney -in -fact of REGINALD J.A. EVANS, to be the free and voluntary act of such party for the uses and purposes mentioned in the instrument. DATED this LrA day of�-I& Iq , 2020. aab stir. MY t'.ONNSSIQN FJlMM MARCH S, 2024 Notary Public in and for the Sta a of Washington Residing at don A4 r1 s My commission expires: kb/clients/Evans-Reginald-Elizabeth epQCD-Lot l /6/30/2020 Page 2 BENNETT & BENNETT, PLLC • ATTORNEYS AT LAW 400 Dayton, Suite A • Edmonds, Washington 98020 - (425) 776-0139 STATE OF WASHINGTON ) ss COUNTY OF SNOHOMISH ) I certify that I know or have satisfactory evidence that ELIZABETH L. EVANS signed this instrument and acknowledged it to be her free and voluntary act for the uses and purposes mentioned in the instrument. --. DATED this � day of �Ja 72020. State of Washing LMGH BENNETI LICENSE #t S759 MY COMMISSION Ex MARCH S, 2024 U4 3 Notary ublic in and for the State of Washington Residing at fti My commission expires: kb/clients/Evan,,,-Reginald-Elizabeth epQCD-Lot 1/6/30/2020 Page 3 BENNETT & BENNETT, PLLC - ATTORNEYS AT LAW 400 Dayton, Suite A • Edmonds, Washington 98020 - (425) 776-0139 Department of Revenuet REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt Washington State CHAPTER 82.45 RCW - CHAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALLAREAS ON ALL PAGES ARE FULLY COMPLETED ❑ Check box if the sale occurred Only for sales in a single location code on or after January 1, 2020. PLEASE TYPE OR PRINT in more than one location code. ❑ Check box if partial sale, indicate % sold. List nercentaee of ownershin nenuired next to eaeh nnme- Name Reginald J.A. Evans & Elizabeth L. Evans,7Name Simon J. Evans and Marne C. Evans, husband husband and wife and wife x w MailingAddress 2002083rd Avenue West Mailing Address 20020 83rd Avenue West city/State/Zip Edmonds, WA 98026 City/State/Zip Edmonds, WA 98026 Phone No. (including area code) (425) 774-1988 Phone No. (including area code) 734 846-6181 Send all property tax correspondence to: m Same as Buyer/Grantee List all real and personal property tax parcel List assessed value(s) account numbers - check box if personal property Name 00431200000201 El 712,800.00 (1.0. p) ❑ Mailing Address City/State/Zip Phone No. (including area code) ❑ Street address of property: 20018 83rd Avenue West, Edmonds, WA 98026 This property is located in Edmonds ❑ Check box if any of the listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged. Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit) See attached Exhibit A Legal Description Select Land Use Code(s): 11 - Household, single family units enter any additional codes: Land Use 111 (Sce back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral ❑ Q under chapters 84.36, 84.37, or 84.38 RCW (nonprofit organization, senior citizen, or disabled person, homeowner with limited income)? Is this ppropperty predominantly used for timber (as classified under RCW 84.34 and 84.33) ❑ Q or agriculture (as classified under RCW 84.34.020)? See ETA 3215 YES NO Is this property designated as forest land per chapter 84.33 RCW? ❑ ❑✓ Is this property classified as current use (open space, farm and ❑ ❑r agricultural, or timber) land per chapter 84.34 RCW? Is this properrttyy receiving special valuation as historical property El ❑✓ 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, fans and agriculture, or timber) land, you roust sign on (3) below. The county assessor must then determine if the land transferred continues to qualify and wall indicate by signing below. If the land no longer qualifies or you do not wish to continue the designation or classi- fication, 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. This land ❑ does ❑ 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 owncr(s) does not wish to continue, all additional tax calcu- lated pursuant to chapter 84.26 RCW, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE PRINT NAME List all personal property (tangible and intangible) included in selling price. None. If claiming an exemption, list WAC number and reason for exemption: WAC No.(Section/Subsection) 458-61A-201(B)(1) Reason for exemption Gift for no consideration Type of Document Quit Claim Deed Date of Document 1 'Z I Zu Gross Selling Price $ *Personal Property (deduct) $ 0.00 0.00 Exemption Claimed (deduct) $ 0.00 Taxable Selling Price $ 0.00 Excise Tax: State Less than S500,000.01 at 1.1% $ 0.00 From $500,000.01 to $1,500,000 at 1.28% $ 0.00 From $1,500,000.01 to $3,000,000 at 2.75% Above S3,000,000 at 3.0% $ 0.00 Agricultural and timberland at 1.28% $ 0.00 Total Excise Tax: State $ 0.00 0.0050 1 Local $ 0.00 *Delinquent Interest: State $ 0.00 Local $ 0.00 *Delinquent Penalty $ 0.00 Subtotal $ *State Technology Fee $ *Affidavit Processing Fee $ Total Due $ A MINIMUM OF S10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS n I CERTIFY UNDER P!Zg E RY T11aT THE FOREGOING IS TRUE AND CORRECT �--� x Signature of Signature of Grantor or Grantor's Agent x �Z. rah Grantee or Grantee's Agent x Name (print) Reginald J.A. Evans y Simon J. Evans, his AIF and Name (print) Simon J. Evans and Marne C. Evans, husband and wife Date & city of signing I,y Date & city of signingZy aiw"t-'A Perjury: Perjury is a class C felony which is punishable by imprisonment in the sta No. 11154121 7/8/2020 8:07 AM 10.00 fine in an amount fixed by the court of not more than five thousand dollars Thank you for your payment. 0.00 5.00 10.00 REV 84 0001 a (12/6119) 12, Z6 77y THIS SPACE - TREASU BRUCE EXHIBIT A LEGAL DESCRIPTION THE EAST 90.00 FEET OF LOT 2, EAST EDMONDS ACRES DIVISION NO. 2, ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 12 OF PLATS, PAGE 66, RECORDS OF SNOHOMISH COUNTY, WASHINGTON; (ALSO KNOWN AS LOT 1 OF EVANS SHORT PLAT PLN2018-0037, UNDER RECORDING NO.202006045012). State of Washington REAL ESTATE EXCISE TAX Department of Revenue Miscellaneous Tax Section PO Box 47477 SUPPLEMENTAL STATEMENT OlympiaWA98504-7477 (WAC 458-61A-304) This form must be submitted with the Real Estate Excise Tax Affidavit (FORM REV 84 0001 A for deeded transfers and Form REV 84 0001 B for controlling interest transfers) for claims of tax exemption as provided below. Completion of this form is required for the types of real property transfers listed in numbers 1-3 below. Only the first page of this form needs original signatures. AUDIT: Information you provide on this form is subject to audit by the Department of Revenue. In the event of an audit, it is the taxpayers' responsibility to provide documentation to support the selling price or any exemption claimed. This documentation must be maintained for a minimum of four years from date of sale. (RCW 82.45.100) Failure to provide supporting documentation when requested may result in the assessment of tax, penalties, and interest. Any filing that is determined to be fraudulent will carry a 50% evasion penalty in addition to any other accrued penalties or interest when the tax is assessed. PERJURY: Perjury is a class C felony which is punishable by imprisonment in a 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 (l Q. The persons signing below do hereby declare under penalty of perjury that the following is true (check appropriate statement): 1. ❑ DATE OF SALE: (WAC 458-61 A-306(2)) I, (print name) certify that the (type of instrument), dated _ was delivered to me in escrow by (seller's name). NOTE: Agent named here must sign below and indicate name of firm. The payment of the tax is considered current if it is not more than 90 days beyond the date shown on the instrument. If it is past 90 days, interest and penalties apply to the date of the instrument. Reasons held in escrow Signature Firm Name 2. GIFTS: (WAC 458-61 A-201) The gift of equity is non-taxable; however, any consideration received is not a gift and is taxable. The value exchanged or paid for equity plus the amount of debt equals the taxable amount. One of the boxes below must be checked. Both Grantor (seller) and Grantee (buyer) must sign below. Grantor (seller) gifts equity valued at $ to grantee (buyer). NOTE: Examples of different transfer types are provided on the back. This is to assist you with correctly completing this form and paying your tax. "Consideration" means money or anything of value, either tangible (boats, motor homes, etc) or intangible, paid or delivered, or contracted to be paid or delivered, including performance of services, in return for the transfer of real property. The term includes the amount of any lien, mortgage, contract indebtedness, or other encumbrance, given to secure the purchase price, or any part thereof, or remaining unpaid on the property at the time of sale. "Consideration" includes the assumption of an underlying debt on the property by the buyer at the time of transfer. A. Gifts with consideration I. ❑ Grantor (seller) has made and will continue to make all payments after this transfer on the total debt of $ and has received from the grantee (buyer) $ (include in this figure the value of any items received in exchange for property). Any consideration received by grantor is taxable. 2. ❑ Grantee (buyer) will make payments on % of total debt of $ for which grantor (seller) is liable and pay grantor (seller) $ (include in this figure the value of any items received in exchange for property). Any consideration received by grantor is taxable. B. Gifts without consideration 1. ❑V There is no debt on the property; Grantor (seller) has not received any consideration towards equity. No tax is due. 2. ❑ Grantor (seller) has made and will continue to make 100% of the payments on the total debt of $ and has not received any consideration towards equity. No tax is due. 3. Q Grantee (buyer) has made and will continue to make 100% of the payments on total debt of $ and has not paid grantor (seller) any consideration towards equity. No tax is due. 4.0 Grantor (seller) and grantee (buyer) have made and will continue to make payments from joint account on total debt before and after the transfer. Grantee (buyer) has not paid grantor (seller) any consideration towards equity. No tax is due. Has there been or will there be a refinance of the debt? ❑ YES Q NO (If yes, please call (360) 534-1503 to see if this transfer is taxable). If grantor (seller) was on title as co -signor only, please see WAC 458-61 A-215 for exemption requirements. The undersigned acknowledge this transaction may be subject to audit and have read the above information regarding rec=r e'u4 and evasion penalties. x p O Granto s Signature Date Grantee's Signature Date Reginald J.A. Evans By: Simon J. Evans his Attorney -in -fact Simon J. Evans and Mame C. Evans Grantor's Name (print) & Elizabeth L. Evans Grantee's Name (print) 3. ❑ IRS "TAX DEFERRED" EXCHANGE (WAC 458-61 A-213) I, (print name) , certify that I am acting as an Exchange Facilitator in transferring real property to pursuant to IRC Section 1031, and in accordance with WAC 458-61 A-213. NOTE: Exchange Facilitator must sign below. Exchange Facilitator's Signature Date Exchange Facilitator's Name (print) For tax assistance, contact your local County Treasurer/Recorder or visit http://dor.wa.gov or call 360-534- I503. To inquire about the availability of this document in an alternate format, please call 360-705-6705. Teletype (TTY) users may use the Washington Relay Service by calling 711. REV 840002ea(6/25/19) COUNTY TREASURER