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Department of Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61 A' <br />Revenue(C Only for sales in a single location code on or after July 1, 2022, <br />Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. <br />ForM 84 0001 a This form is your receipt when stamped by cashier. Please type orprint. <br />[] Check box if partial sale, indicate% sold. <br />1 Seller/Grantor <br />Name Kittitas County <br />Attn: Board of County Commissioners <br />Mailing address 205 W 5th Avenue Suite 108 <br />City/state/zip EllensburgWA 98926 <br />Phone (including area code) 509-962-7508 <br />3 Send all property tax correspondence to: 0 Same as Buyer/Grantee <br />This property is looted in Klttl <br />[] Check box if any of the lined <br />List percentage of ownership acquired next to each name. <br />2 Buyer/Grantee <br />Name Washington State Department of Ecology <br />State Trust Water Rights Program <br />Mailing address 1250 W Alder Street <br />City/nate/zip Union Gap, WA 98903 <br />Phone (including area code) 509-575-2490 <br />List all real and personal property tag <br />parcel account numbers <br />13495-$205,400 <br />13497-$579 670 <br />Personal <br />Assessed <br />property? <br />value(s) <br />❑ <br />$ 0.00 <br />❑ <br />$ 0.00 <br />❑ <br />$ 0.00 <br />(for unincorponoted locations please select your county) <br />nher parcel. are Dart of a boundary line adh,amum.,r...... i. tie: <br />Le al description of woolart,if you need mores ace, attach a separate sheet to each page of the affidavit). <br />See Attached "Exhibit A" <br />(8u - Water or Mineral rights <br />Enter any additional codes <br />(see back of last page for instructions) <br />Was the seller receiving a property tax exemption or deferral <br />under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior <br />citizen or disabled person, homeowner with limited income)? [] Yes 0 No <br />Is this property predominately used for timber (as classified <br />under RCW 84.34 and 84.33) or agriculture (as classified under <br />RCW 84.34.020) and will continue in it's current use? ayes and <br />rhe transfer involves muk'pk parcels with di&rentclassifiodons, <br />mmpletethe predomine P kuWtpr(seeimtroctiorts) []Yes ONO <br />6Isthis property designated asfarestland per RCW 84.337 []yes ONO <br />Is this property classified as current use (open space, farm <br />and agricultural, or timber) land per RCW 84.34? []YesONO <br />Is this property receiving special valuation as historical <br />property per RCW 84.267 ❑ Yes O No <br />If any answers are yes, complete as instructed below. <br />(1) NOTICE OF CONTINUANCE (FOREST UIND OR CURRENT USE) <br />NEW OW NER(S): To continue the current designation as forest land <br />or classification as current use (open space, farm and agriculture, or <br />timber) land, you mug sign on (3) below. The county assessor must then <br />determine if the land transferred continues to qualify and will indicate <br />by signing below. If the land no longer qualities or you do not wish to <br />continue the designation or classification, it will be removed and the <br />compensating or additional taxes will be due and payable by the seller <br />or transferor at the time of sale (RCW 84.33.140 or 84.34.108). Prior to <br />signing (3) below, you may contact your local county assessor for more <br />information. <br />This land: El does [] does not qualify for <br />continuance. <br />assessor signature Date <br />(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY) <br />NEW OWNER(S): To cominue special valuation as historic property, sign <br />(3) below. If the new owners) doesn't wish to continue, all additional tax <br />calculated pursuant to RCW 84.26, shall be due and payable by the seller <br />or transferor at the time of sale. <br />(3) NEW OWNER(S) SIGNATU RE <br />7 List all personal property (tangible and intangible) included in selling <br />price. <br />If claiming an exemption, lin WAC number and reason for exemption. <br />WAC number (section/subsection) 458-61A-205 <br />Reason for exemption <br />Per Article XI of the Washington State Constitution, the grantor is a <br />governmental entity. <br />Type of document Quit Claim Deed <br />Date of document <br />Gross selling price <br />0.00 <br />'Personal property (deduct) <br />0.00 <br />Exemption claimed (deduct) <br />000 <br />Taxable selling price <br />000 <br />Excise tax: state <br />0.00 <br />Less than $500,000.01 at 1.1% <br />0.00 <br />From $500,000.01 to $1,500,000 at 1.28% <br />0.00 <br />From $1,500,000.01 to$3,000,0D0 at 2.75% <br />0.00 <br />Above $3,DDO,000 at 3% <br />0.00 <br />Agricultural and timberland at 1.28% <br />0.00 <br />Total excise tax: state <br />0.00 <br />0.0025 Local <br />0.00 <br />'Delinquent interest: nate <br />000 <br />Local U.UU <br />'Delinquent penalty 0.00 <br />Subtotal 0.00 <br />'State technology fee 5.00 <br />Affidavit processing fee 500 <br />Signature Signature Total due 10.00 <br />A MINIMUM OF $10.0015 DUE IN FEE(S) AND/OR TAX <br />Printname Printname 'SEE INSTRUCTIONS <br />I CERTIFY UNDER PENALTY OF PERIURV THAT THE FOREGOING IS TRUE AND CORKER <br />Signature of grantor or agent <br />Name (print) <br />Signature of grantee <br />Name (print) <br />Date & city of signing Date & city of signing <br />Perjuryin the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maximum term of five ears or by <br />a fine in an amount fixed by the court of not more than $10,000, or by both such confinement and fine (PCW 9A.72.030 and RCW 9A.20.021�1)(C)(. <br />To ask about the availability of this publication in an alternate format for the visuallyf impaired please call 360-705-6705. Teletype <br />TTY <br />() users may use the WA Relay service by ca ling 711. <br />REVMOOg1a (5/31/22) THIS SPACE TREASURER'S USE ONLY COUNTYTREASURER <br />Print on legal size paper. <br />Page 1 of 6 <br />