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Deoa'rment "i /31Reilgn ue ( (: REAL ESTATE EXCISE TAx AFFIDAVIT rhis rorm is your receiptWoshington State CHApTER 82.45 RCW - CIIApTER 458-614 WAC when stamped by cashier.THIS AFF'IDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE F'ULLY COMPLETED()nly f<rr s*l*s in a siuglc lcc;ltioa codr on or arttrr.l*nu*rl' 1.2{}:{}.U Check box rt rhe sale occurred PLEASE TypE OR PRINTin more than one location code.n Check box ifList assessed value(s)0.000.000.000.00Name Kittitas County, a subdivision of the State ofWashinotonMailingAddress 411 North Rubv Street. Suite '1citvlstate/zip Hlensburg, WA gg926Phonc No. (including arca codc) (5Og\ 962-7523List all real and personal propeny tax parcelaccount numbers - check box ifpersonal plopemytr962113F]*2;2={r.9,UMailingAddress 119 West First StreetPhonc No. (including arca codc) /qoq'l 674-2?62WA 98922CitylStatelZip Cle ElumName The Citv of Cle Elum. a Washinqtonmuniciplal corporationdr9426eO! **o all property tax couespon<Ience to: g same as BuyericranteePhone No. (including area code)NameMailing AddressCity/St^telZipindicatesold.Listofnert to each name.Street address ofproperty: NKAThis propcrty is locatcd in Cle Elum ElE Check box if any of the listed parcels me being segregated tiom arother parcel, are pari of a boundary line adj ustnrent or parcels being nrerged.Legal description ofproperty (ifmore space is needed, you may attach a separate sheet to each page ofthe affidavit)Parcel 2 of that certain Short Plat filed in Book L of Plats, Page 234, under Auditor's File No. 20211Q14O022, records of KittitasCounty, Washington.Select Land Use Code(s):Iist all personal property (tangible and intangible) included in selling price.N/Aenter any additional codes(Seebackoflastpageforinstructions) YES NO\\'as the seller receiving a properb- tax exemption or deferral tr Eunder chapters 84.36,84.37, or 84.38 RCW (nonprofitorganization, senior citizen, or disabled person, homeou'ner*'ith limited income)?Is this property predominantly used for tinrber (as classified under ! @RCW 84.34 and 84-33) or agriculture (as classilied under RCW84.34.020)? See ETA 3215f YES NoIs this property designated as forest land per chapter [14.3:i RCW? n E]Is this propertv classified as current use (open space, farm and tr tragricufturil. oi timber) land per chapter s.f.r+ Acti:Is this property receiving special valuation as historical propeny tr trper chapter 84.26 RCW?lf any answers are yes, complete as instructed below.(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)NEW OWNER(S): To continue the cunent designation as ibrest land orclassification a^s current use (open space, fanu and agliculture, or timber) land"you must sign on (3) below. The county assessor must then detennine ifrheland transfered continues to qualifu and rtill indicate by sigriing belou'. If dreland no longer qualifies or you do not wish to continue the designation or classi-fication, it will be removed and the compensating or additioual tues will be dueand payable by the seller or translbror at the tirre of sale. (R(.w 84..13.140 orRCIW N4.34. I 0S). Prior to signing (3) belori', you may contact your local corur$rassessor fbr more information.This land ! does I does not qualily for oontinuancre.DEPUTYASSESSOR DATE(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)NEW OWNER(S): To continue special valuatiou as historic property, sign (3)below. lfthe new ow'ner(s) does not u'ish to continue, all additional tax calcrr-lated pusualt to chapter 8-1.?6 Ii.C\\i shall be due and payable by the seller ortransferor at the time ofsale.(3) NEW OWNER(S) STGNATUREPRINT NAMEIf claiming an exemption, list WAC number and reason for exemption:WACNo. (Section/Subsection) 458-61A-205Reason lbr exemptionGovernmentalType ofDocumentDate of DocumentQuit Claim DeedGross Selling Price $Personal Properry (deduct) $Excmption Claimcd (dcduct) $Taxable Selling Price $Excise Tax: StateLess than $500,000.01 at l.l% $From $500,000.01 to $1,500,000 at 1.28% $From !i1,500,000.01 to $3,000,000 at 2.75% $Above $3,000,000 at 3.0% $Agriculnual and tirnberland at 1"28% $Total Excise Tax: State $0.0025Local $*Dclinquent Interest: State $Local $rDelinquent Penalty $Subtotal $*StateTechnologyFee $*Affidavit Processing Fee $Total Dle $o_oo0.000_o00.000.000.00o00noo0.00nno0.00ooo0.00o.oo0.005no5.0010.00A }IINIMUI\{ OF $1O.OO IS DUE IN Ff,E{S) AND/OR TAX*SEE INSTRUCTIONSI CERTIF"I'UNDER PENALTYOF'PERJURYTHAT THE FOREGOING IS TRUE AND CORRECTSimature ofGiantor or Grantor's AgentSienarure ofGiantee or Grantee'sName (print) JayMcGowan. MavorName (print)ChairDate & city of signingDate & c.ity of signing , I?,, I11,19L,L,'perjury: perjury is a class C f'elony which is punishable by imprisonment in the state correctional institution for a marimum term of not more than five years, or by afine in an amount fixed by the couft of not more than five thousand dollart ($5,000.00), or by both implisonment and fine (RCW 9A,20.020( I C)).- Governn"l€ntal servicesREV 84 0001a (12i6l19)TI{IS SPACE - TREASURER'S USE ONLYCOUNTY TREASLIRER