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RA$dffift(e REAL ESTATE ExcrsE TAXAFFTDAVTT rhisrormisyourrece\rtWashington State CHApTER g2.45 RCW - CHApTER 45g-6lAWAC when stamped by cashier.THIS AFF'TDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETEDtr Check box if the sale occurred ()nl.r for sal*s in a siilgle locatioa codr: on oL nfter .Ianuar-v 1. 2{}2{},in more than one location code. PLEASE TYPE oR PRINTtr Check box ifo//osold.Listofnext to each name,Street address of property: 1009 East Third, Cle Elum, WA 98922This propcrty is locatcd in Cle Elum ElEl Check box ifany ofthe listed parcels are being seglegated liom another parcel. are part ofa boundary line a justment or parcels being mergedLegal description ofproperty (ifmore space is needed, you may attach a separare sheet to each page ofthe affidavit)Lots 14, 15, 16, and 17, Block 27, HAZELWOOD ADDITION, TO THE TOWN (NOW CITY) OF CLE ELUM, in the County of Kittitas,State of Washington, as per plat thereof recorded in Book 2 of Plats, Page 23, records of said County.Select Land Use Code(s):Iist all personal property (tangible and intangible) included in selling price.N/Aenter any additional codes:(See back of last page for instructions)\[las ttre seller receiving a property tax exemption or deferralunder chapters 84.36,84.37, or 84.38 RCW (nonprofitorganization, senior citizen, or disabled person. homeownerwith limited income)?If claiming an exemption, list WAC number and leason for exemption:WACNo. (Section/Subsection) 458-61A-205Reason for exemptionGovernmentalType of Document Quit Claim DeedDate of DocumentGross Selling Price $Personal Pr-operry (deduct) $Excmption Claimcd (dcduct) $Taxable Selling Price $Excise Tax: StateLess thau $500.000.01 at l.l% $From $500,000.0 I to $ I ,500,00d at I .18'2" $From Xi1,500,000.01 to $3,000,000 at2.75% $Above $3,000,000 at 3.0% $Agricultrual and tirnberland at 1.28% $Total Excise Tax: State $0.0025Local $*Delincluent Interest: State $Local $tDelinqueut Paralty $Subtotal $*StateTechnology Fee $*Affidavit Processing Fee $Total Due $A I\TINIMUM OF S1O.OO IS DIJE IN FEE(S) AND/OR TAX*SEE INSTRUCTIONSISTRUEAND CORRECTYES NOIs this property predominantly used for timber (as classified under [ @RCW 84.34 and 84.33) or agriculture (as classilied under RCW84-i4.02O)? See ETA 32I5rIs this property designated as forest land per chapter 84.3,1 RC!Y?Is this property classified as current use (open space, farm andagricultural, or timber) land per chapter 84.34 RCl\ ?Is this property receiving special valuation as historical propertyper chapter 84.26 RCW?YES NOtrtrtrtrtrtrlf any answers are yes, complete as insm;cted belou'.(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)NEW OWNER(S): To continue the cunent designation as ibrest land orclassification as current use (open space, fann and agriculture, or timber) land"you must sign on (3) below. The county assessor must then detennine iftheland Eansfeued contiiues to qualifu and u'ill indicate by sipriing belou'. If theland no longer qualifes or you do not wish to continue the designation or classi-ficatiou, it will be removed and the compensating or additiorial taxes will be dueand payable by the seller or tralstlror at the time ofsale. (RCw 84..i:).140 orRCW 84.34.i03)- Prior to signing (3) belorr', yor may contact your local corurt5rassessor tbr more information.This land I does ! does mt qualiS for oontinuiurc,e.DEPUTYASSESSORDAlE(2) NOTICE OFCOMPLIANCE (IIISTORIC PROPERIY)NEW OWNER(S): To continue special raluatiou as historic property, sign (3)below. lfthe new orvner(s) does not wish to continue, all additional tax calcu-lated pursuaut to chapter 84.26 ltC\li shall be due and payable by the seller ortransferor at the time of sale.(3) NEW OWNER(S) STGNATTTREPRINTNAMEI CERTIF^T UNDER PEN0.000.000.000.000.000.000.000.000.000.000.000.00o.000.005.005.0010.00Sisnature ofGiantor or Grantor's AgentSisnaru.re ol'Giantee or Grantee's AgentName (print)ChairName (print) Jay McGowanDate & city of signingDate & city of signingPerjury: Perjury is a class C fblony which is punishable by imprisormrent in the state correctional institution for a ma.rimum term of not more than fir'e years, or by afine in an amounr fi-red by the court of not more than five thousand dollars (S5,000.00), or by both imprisonnent and fine (RCW 9A.20.020( lC)).qoL!FlzHSC,Send all property tax cor:respondence to: @ Same as Bu-ver,€ranteeNamePhone No. (includurg area code)Mailing AddressC'Lry/St^te/ZipMailingAddress 411 North Ruby Street,City/State/Zip Ellensburg, WA 98926Phonc No. (including arca codc) (5!$ 962-75231Name Kittitas County, a subdivision of theState of Washingtonrl]e,FulF>zf,<6,&oList all real and personal propeny t'qx parcelacoount numbers - check box ilpersonal properrys03134 tr8931 34trPhonc No. (including arca codc) (SOg\ 674-2262119 West First StreetCle trhrm \A/A98922Mailing AddressCitylSratelZipn muncorporationName The City ofList assessed value(s)0.000.000.000.0037 - Governmental servicesREV 84 0001a (1216/19)THIS SPACE - TREASURER'S USE ONLYCOTINTYTREASURER
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