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RaTtfiil[@ Real EState ExCiSe Tax Affidayil lncwoz.rswAc4ss-61A) <br />Only for sales in a single location code on or after July 1.2022. <br />This affidavit will not be accepted unles.(.all areas on ill pages are fully and accurately completed. <br />r nrs torm rs your receipt when stamped by cashier pleose type or Drint. <br />Woshingfon Stote <br />Form 84 0001a <br />EI check box if pantal sale, indlcate %_ sotd. <br />1 seller/Grantor <br />Name Kitlilas Countv <br />Aftn: Board of Countv Commissioners Name <br />Mailing .rr.-"" 205 W 5th Avenrre '108 <br />city/state/zip Ellensburo. WA 98926 <br />phone (incruding area .oa"1 509-962-7s0I-- <br />3 Send all property tax correspondence to:Et Same as Buyer/Grantee <br />Name <br />Mailing <br />Ljst percentage ofownership acquired next to each name. <br />2 EuyerlGrantee <br />Dabarlmpnl df Fml^^v <br />State Trust Water Riohts Prooram <br />Majling address 1250 W Aldcr Skpel <br />city,/state/zip Union Gao. WA 98903 <br />Phone {including area code)509-575-r4qn <br />city/state/zi p <br />List all real and peEonal propertytax <br />parcel aqcount numbers <br />See attached "Exhibit A" <br />Personal Assessedprope.ty? value(s)tr $o.ootr $ o.oon $o.oo <br />4 street address of <br />This property i! located (for unincorponted locdtions pledse selectyour couitty)E check box lf any ofthe llsted are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged. <br />5 30 - Water or rights <br />Was the seller receiving a properW tax exemDtion or deferralunder RCW 84.36, 84.37, or 84.38 (nonprofit org., senior <br />citizen or disabled person, homeowner with limited income)? fl yes Z No <br />ls this property predominately used for tlmber {asclassifiedunder RCW 84.34and 84.33) oragriculture (as;lassified under <br />RCW 84.34.020)nnd wlll continue ln tt's current use? tfyesand <br />the t.ansfer involves muldple parcels wlth dlfferent cla$illEtions. _ _ <br />complete the predomlnate us @l@lator (see instructions) LrYes 14 No <br />6 ls this propeny designated as forest land per RcW 84.33? Eves Etio <br />Enter any additional codes <br />(see back of last page for instructions) <br />ls this property classified as current use (open space, farm <br />and agricultural, or timber) land per RCW 84.34? <br />ls this property recelving special valuation as historical <br />property per RCW 84.26?EvesEt'to <br />E does <br />7 list all personal property (tanglble and intangtble) included in selling <br />price. <br />lf claiming an exemption, list WAC number and reason for exemption. <br />WAc number (section/subsection) 458-6lA-205 <br />Reason for exemption <br />Per Arlicle Xl of the Washington State Constitution, lhe grantor is a <br />govemmental entity. <br />Type of document Quit Claim Deed <br />Eves Z ttto Date of document <br />- <br />lf any answers are yes, complete as instructed below. <br />(1) NOIICE OF CONnNUANC€ (FOREST IAND OR CURRENT USE) <br />NEW OWNER(S): lo continue the current designation as forest land <br />or classification as current use {open space, hrm and agriculture, or <br />timber) land, you must slgn on (3) below, The county assessor must then <br />determlne ifthe land transferred continues to qualify and wil' lndicate <br />by signlng below. Ifthe land no longer qualifies or you do not wish to <br />continue the designation or classlfication, it will be removed and the <br />compensating or additional taxes will be due and payable by the seller <br />ortransferor at the time of sale (RCW 84.33.140 or 84.34.108). prior to <br />signlng (3) below, you may contact your local county assessor for more <br />information. <br />(21 NOnCE OF COMpt-tANCE (H|STORIC pROpERW) <br />NEW OWNER(S): To continue special valuation as historic property, sign <br />{3} below. lfthe new owner(s) doesn't wish to continue, all additional tax <br />calculated pursuant to RCW 84.25, shall be due and payable by the seller <br />or transferor at the time of sale, <br />(31 NEW OWNER(S) STGNATURE <br />Gross selling prjce <br />*Personal property (deduct) <br />000 <br />000 <br />Exemption claim€d (deduct) 0.00 <br />Taxable selling price <br />- <br />0.00 <br />Excise tax: state <br />Less than 550q000.01 at 1.1%0.00 <br />From S50o,0oo.o1 to 51,500,000 at 1.28% 0.00 <br />From s1,500,000.01 to s3,000,000 at 2.75% <br />Above 53,000,000 at 3% <br />Agricultural and timbetland at L2Bo/. <br />Total excise tax: state <br />0.0025 Locat <br />000 <br />000 <br />0.00 <br />0n0 <br />0.00 <br />*Delinquent interest: state 0,00 <br />Local 000 <br />*Delinquent penalty- 0.00 <br />subtotal <br />*State technology fee <br />Affidavit processlng fee <br />Total due <br />000 <br />500 <br />500 <br />10.00 <br />A MTNTMUM OF 510.00 tS DUE tN FEE(sl AND/ORTAX*SEE INSTRUCTIONS <br />Thls land: <br />continuance. <br />El does not qualify for <br />Deputy assessor signature Date <br />Signature Signature <br />Print name <br />I CERTIFY UNOER PENATTY <br />Signature of <br />Name (print) <br />or agent <br />Date & city of signing <br />which is <br />an amount by the court of <br />To ask about the availability of this, <br />AND CORRECT r <br />signatureof grantee orur"n, dA.. ".=M* S,* <br />Name(pring Han{1^,' Sir*^n <br />FOREGOING IS TRUE <br />or <br />Date& cityof signine J l?.flzo?-Z <br />^rro^ <br />6afll r^.iA <br />Teletype <br />COUNTY TREASURER <br />Print on legdl size papt <br />Attached "Exhibit B" <br />REV 84 Gmla (5/31/22) <br />more <br />THIS SPACE TREASURER'S USE ONLY