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Department of "
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<br />Reven ue �
<br />REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt
<br />Washington State
<br />CHAPTER 82,45 RCW - CHAPTER 458-61A WAC when stamped by cashier.
<br />THIS AFFIDAVIT WILLNOT BEACCEPTED UNLESS ALLAREAS ON ALL PAGES ARE FULLY COMPLETED
<br />❑ Check box if the sale occurred
<br />Only for asks in a single location code on or after January 1, 2020.
<br />PLEASE TYPE OR PRINT
<br />in more than one location woe.
<br />City/Stde'Zip
<br />❑ Check box if partial sale. indicate % sold. List percentaxe of ownership acquired nest to each name.
<br />Name Brent Minor and Mary Minor, a married
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<br />Name CoWy of Kittitas, a political subdivision of the
<br />couple
<br />�
<br />State of Washington and Forterra NW a Washin ton
<br />Mallin Address
<br />g 8001 Naneum Rd
<br />nonpro eor ora on
<br />MailingAddtess 901 5pth Avenue, Suite 2200
<br />d City/8-1zip Ellensburg, WA 98926
<br />21.619.20
<br />City/Stde'Zip
<br />4.222.50
<br />*DelinquentImerest: State $
<br />0.00
<br />Phone No. (including area code)
<br />Phone No. (including area code)
<br />Send all property lox corresspondence to: ❑ Same as Buyen'Cnantee
<br />List all real and personal property tax parcel
<br />account nunbers - check box if personal property
<br />Listassessed values)
<br />Name Brent Minor and M Minor
<br />SEE EXHIBIT "A" ATTACHED ❑
<br />SEE EXHIBIT "A"
<br />MmltngAdaress 8001 Naneum Rd
<br />❑
<br />❑
<br />C,ip Ellensburci, WA 98926
<br />❑
<br />Phone No. (including area code)
<br />Streetaddress ofproperty: 6001 Naneum, nka Naneum Rd and nka Rader Rd., Ellensburg, WA 9(1926
<br />This property is located in Kltlttas County
<br />❑ 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 mare space is needed, you may attach a separate sheet to each page of the affidavit)
<br />AGRICULTURAL CONSERVATION EASEMENT ONLY
<br />SEE ATTACHED EXHIBIT"A" FOR LEGAL DESCRIPTION
<br />Selma Land Use Code(a):
<br />- AgdculWre clawf0ed under current use chapter 84.34 RCW
<br />enter any additional codes:
<br />(Sea bad: of last page for instructions) YES NO
<br />Was the seller receiving a property tax exemption or deferral ❑ Q
<br />under chapters 84.36, 84.37, or 84.38 RCW (nonprofit
<br />organization, senior citizen, or disabled person, homeowner
<br />with limited income)?
<br />Is this m3perty redominantly used for timber (as classified under ❑✓ ❑
<br />84t34A20)? VITA 1or 215�culture (as classified under RCW
<br />n YES NO
<br />Is this property designated as forest land per chapter 84.33 RCW 7 ❑ 0
<br />Is this property classified as current use (o n space, farm and 0 ❑
<br />agricultural, or timber) land per chapter 8434 RCW?
<br />1s this property receiving special valuation as historical property ❑ ❑�
<br />per chapter 8426 RCW?
<br />If any answers are yes, complete as instructed below.
<br />p) 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 mast sign on (3) below. The county assessor must then determine ifthe
<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 dassi-
<br />fication, it will be removed and the compensating or additional taxes will be due
<br />and payable by the seller or transferor at the time of sale. (RCW 84.33.140 or
<br />RCW 84.34.108). Prior to signing (3) below, you may contact your local county
<br />assessor for mon: information.
<br />This land ❑ does ❑ does not qualify for continuance
<br />DEPUIYASSFBSOR DATE
<br />(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)
<br />NEW OWNER(S}. To continue special valuation as historic property, sign (3)
<br />below. If the new owner(s) does not wish to continue, all additional tax calow
<br />lined pursuant to chapter 84.26 RCW, shall be due and payable by the seller or
<br />transferor at the time of sale.
<br />(3) NEW OWNER(S) SIGNATURE
<br />PRINT NAME
<br />List all personal property (tangible and intangible) included in selling price.
<br />If claiming an exemption, list WAC number and reason for exemption:
<br />WAC No. (Section/Subsection)
<br />Reason for exemption
<br />TypeofDocument Deed ofA9ricultural Conservation Easement
<br />Date of Document
<br />Gross Selling Price $ 1.689,000.00
<br />*Personal Property (deduct) $
<br />Exemption Claimed (deduct) S
<br />Taxable Selling Price S 1,689,000.00
<br />Excise Tax State - -
<br />Ilse then $500,000.01 at I.1% $
<br />0.00
<br />From 5500,000.01 to SI,500,000 at 1.29% S
<br />0.00
<br />From $1,500,000.01 to 53,000,000 at 2.75% $
<br />0Op
<br />Above $3,000,000 at3.0"/* $
<br />0.00
<br />Agricultural and timberland at 128% $
<br />21,619.20
<br />Total Excise Tax: State $
<br />21.619.20
<br />0.0025 1 Local S
<br />4.222.50
<br />*DelinquentImerest: State $
<br />0.00
<br />Local S 0.00
<br />*Delinquent Penalty S 0.00
<br />Subtotal $ 25.841.70
<br />*State Technology Fee $ 50
<br />*Affidavit Processing Fee $ 0.00
<br />Total Due $ 25,846.70
<br />A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/0R TAX
<br />-SEE INSTRUCTIONS
<br />n-1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
<br />Signatine of Signature of
<br />Grantor or Gramtor'sAgent Grantee or Grantee's Agent
<br />Name (print)
<br />Date & city of signing
<br />Name (print)
<br />Date & city of signing
<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 a
<br />fine in an amount fixed by the court of not more than five thousand dollars ($5,000.001 or by both imprisonment and fine (RCW 9A10.020([Q).
<br />REV 84 0001a (12/6/19) THIS SPACE - TREASURER'S USE ONLY COUNTY TREASURER
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