|
RDeparunenr of ,a.
<br />evenue'~
<br />Washington State
<br />REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt
<br />PLEASE TYPE OR PRINT CHAPTER 82.45 RCW -CHAPTER 458-6! A. WAC when stamped by cashier.
<br />THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
<br />(See back oflast page for instructions)
<br />W'--"cc" uux II pa, ua, ~,..,c. 111umn c ,o sold. List petccni.ige of ownershi p ac qu ired ncx1 to each name.
<br />0,: ~~
<br />@~ (/)d
<br />Wasbiontan
<br />Mailing Address 411 North Ruby St reet . Suite 1
<br />City/State/Zip EHen sbura WA 98926
<br />Phone No. (including area code ) (5Q 9) 9'62-75 23
<br />0,: til
<br />'1l f--,
<br />~~ '° C!:)
<br />Name The Cit
<br />comorati co
<br />Phone No , (including area code )
<br />Send all property tax correspondence to: 0 Sarne as Buyer/Grantee List all real and personal property tax parcel account
<br />numbers -check box if personal property
<br />Name ________________________ _
<br />Mailing Address ____________________ _
<br />City/State/Zip ____________________ _
<br />Phone No. (including area code.,_ ______________ _
<br />II Street address of property: No Address Assigned, Cle Elum, WA
<br />This property is located in Kittitas County
<br />6 93835
<br />D 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.
<br />Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit)
<br />Lots 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 and 14, Block 1, Connels Addition to Cle Elum, recorded in Book 2
<br />of Plats, Page 21, records of Kittitas County, Washington
<br />Select Land Use Cod_e(s):
<br />91 -Undeveloped land (land only)
<br />enter any additional codes:. _____________ _
<br />(See back of last page for instructions)
<br />YES NO
<br />Was the seller receiving a property tax exemption or deferral under D 0
<br />chapters 84.36, 84.37, or 84.38 RCW (nonprofit organization, senior
<br />citizen, or disabled person, homeowner with limited income)?
<br />Is this property designated as forest land per chapter 84.33 RCW?
<br />Is this property classified as cwrent use ( open space, farm and
<br />agricultural, or timber) land per chapter 84 .34 R CW?
<br />Is this property receiving special valuation as historical property
<br />per chapter 8426 RC W?
<br />If any answers are yes, complete as instructed below.
<br />YES
<br />D
<br />D
<br />D
<br />NO
<br />0
<br />0
<br />0
<br />(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)
<br />NEW OWNER(S): To continue the current designation as forest land or
<br />classification as current use (open space, farm and agriculture, or timber) land,
<br />you must sign on (3) below. The county assessor must then determine if the
<br />land transferred continues to qualify and will indicate by signing below. If the
<br />land no longer qualifies or you do not wish to continue the designation or
<br />classification, it will be removed and the compensating or additional taxes will
<br />be due and payable by the seller or transferor at the time of sale. (RCW
<br />84.33.140 or RCW 84.3 4.108). Prior to signing (3) below, you may contact
<br />your local county assessor for more information.
<br />This land D does D does not qualify for continuance.
<br />DEPUTY ASSESSOR DATE
<br />(2) NOTICE OF COMPLIANCE (IIlSIORIC PROPER1Y)
<br />NEW OWNER(S): To centlnue s pecial vaiualio·n as historfo property,
<br />~ig n (3) belo \~. If the new ownor(s) doe!i 1\ot wish to continue, all
<br />add itional tnx calculated pursl.lant to chapter 84.26 RCW, sha11 be due and
<br />payable by the seller or transferor at the time of sale.
<br />(3) OWNER(S) SIGNATURE
<br />PRINT NAME
<br />List all personal property (tangible and intangible) included in selling
<br />N/A
<br />If claiming an exemption, list WAC number and reason for exemption:
<br />WAC No. (Section/Subsection) WAC 458-61A-205(1)
<br />Reason for e x emption _______________ _
<br />Transfers from Governmental Entities
<br />Type of Document _Q..,...;_u_it_c....cla_im'--D::....:.e-=e-=d'--------------
<br />Date of Document __________________ _
<br />Gross Selling Price $ 0.00
<br />*Personal Property (deduct) $ 0 .00
<br />Exemption Claimed (deduct) $ 0.00
<br />Taxable Selling Price $ 0 .00
<br />Excise Tax : State $ 0.00
<br />0.0025 [ Local $ 0.00
<br />*Delinquent Interest: State S 0 .00
<br />Local S 0.00
<br />*Delinquent Penalty $ 0.00
<br />Subtotal $ 0 .00
<br />*State Technology Fee $ 5 .00
<br />* Affidavit Processing Fee $ 5 .00
<br />Total Due$ 10.00
<br />A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
<br />*SEE INSTRUCTIONS
<br />I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
<br />Signature of -~-f)___-Signature of a~~
<br />Grantor or Grantor's Age o~ J Grantee or Grantee's Agent
<br />1
<br />~ -~
<br />Name (print) Cory Wri g ht Name (print) r?obv-T Orna.ns .
<br />Date & city of signing: a/z_/Jt,\ fu e,.J.:£$,,.A? C,,, Date & city of signing: 6 -2.b-}Cf ll/e.11~c;/
<br />Perjury: Perjury 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
<br />a fine in an amount fixed by the court of not more than five thousand dollars ($5,000 ,00 ), or by both imprisonment and fme (RCW 9A.20.020 ( l()).
<br />REV 84000la(09/06/17) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER
|