Resolution_QCD Water Rights_DOE - Laserfiche WebLink

Home Browse Search

Departmentof Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61 A) Revenue C Only for sales Ina single 10cation code 11 11 after July 1, 2022. Woshington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. Form 84f1001a This form is your receipt when stamped by cashier. Please type or print. O Check box if partial sale, indicate% sold. Ust percentage of ownership acquired next to each name. A Seller/Grantor Name Kidjtas Coun Aftw Board of County Commissioners Mailing address 205 W 5th Avenue Suite 108 City/state/zip Ellensbum, WA 98926 Phone (including area code) 509-962-7508 3 Send all property tax correspondence to:0 Same as Buyer/Grantee Mailing 4 Street address o This property is loc ❑ Check box if any 2 Buyer/Grantee Name Washington State Department of Ecology 0.00 State Trust Water Riahts Program 0.00 Exemption claimed )deduct) Mailing address 1250 W Alder Street Taxable selling price 0.00 City/state/zip Union Gap, WA 98903 0.00 Agricultural and timberland at 1.28% Phone (including area code) 509.575-2490 Total exdse tax: state 0.00 List all real and personal property tax Personal Assessed parcel account numbers property? value(s) 951892-$745.130 ❑ $ 0,00 845034-$196.150 ❑ $ 0.00 951893-$73.000 ❑ $ 0.00 J (for unincorporated locations Please select your county) another parcel, are part of a boundary line adjustment or cartels brine merepd Lefial deucri citron of moperty (if you need mares ace attach a separate sheet to each page of the affidavit), See Attached "Exhibit A" )80 - Water or Mineral rights Enter any additional codes (see back of las[ page for instructions) Was the seller receiving a property tax exam pdon or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)?0Yes 0 No Is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? Byes and the transfer Imrohes multiple parcels with different classifications, complete the ped0lorate use calwlator(we Instructions) ❑Yes ONo 6 Is this property designated as forest land per RCW 84.337 Oyes 0No Is this property classified as current use (open space, farm and agricultural, ortimber) land per RCW 84.347 0Yes0 No Is this property receiving special valuation as historical property per RCW 84267 0 Yes O No If any answers are yes, complete as instructed below. (1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE) NEW OWNER(S): To continue the current designation as forest land or classification as current use (open space, farm and agriculture, or timber) land, you must sign on (3) below. The county assessor must then determine if the land transferred continues to qualify and will indicate by signing below. If the land no longer qualifies or you do not wish to continue the designation or classification, it will be removed and the compensating or additional taxes will be due and payable by the seller or transferor at the time of sale (RCW 84.33.140 or 84.34.108). Prior to signing 13) below, you may contact your local county assessor for more information. This land: 11 does ❑ does not qualify for continuance. Deputy assessorsignature Date (2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY) NEW OW NER(S): To continue special valuation as historic property, sign (3) below. If the new owner(s) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Signature Print name Print name CERTIFY UNDER PENALTY OF Signature of grantor or agent Name (mint) 7 List all personal property (tangible and intangible) included in selling price. If claiming an exemption, list WAC number and reason for exemption. WAC number lsearon/subsection) 4.58-61A-205 Reason for exemption Per Addle XI of the Washington State Constitu5on, the grantor is a governmental entity. Type of document Quit Claim Deed Date of document _ Gross selling price 0.00 "Personal property (deduct) 0.00 Exemption claimed )deduct) 0.00 Taxable selling price 0.00 Excise tax: state Less than $500,000.01 at 1.1% 0.00 From $500,000.01 to $1,500,000 at 1.28% 0.00 From $1,500,000.01 to $3,000,000 at 2.75% 0.00 Above $3,000,000 at 3% 0.00 Agricultural and timberland at 1.28% 0.00 Total exdse tax: state 0.00 0.0025 Local 0.00 "Delinquent interest state 0.00 Local 0.00 "Delinquent penalty 0.00 Subtotal 0.00 "State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10.001$ DUE IN FEE(S) AND/OR TAX "SEE INSTRUCTIONS FOREGOING IS TRUE AND CORRECT Signature of gramme or agent Date & city of signing Date & city of signing Perjury in the second deggree is a class C felony which is punishable by confinement in a state correctional institution for a maximum term of five yyears or by a fine in an amount fixed by the court of not more than $10,000, or by both such confinement and fine (RCW 9A.72.030 and RCW 9A.20.021(1)(c)). To ask about the availability of this publication in an alternate formatfor the visually impaired, please call 360-705-6705.Teletype (TTY) users may use the WA Relay Service by calling 711. REy940003a (5/31/22) THIS SPACE TREASURER'S USE ONLY COUNTYTREASURER Print on legal size paper. Page 1 of 6