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Re"ffiti[@ Real Estate Excise Tax Affidsyif lncw <br />Orrly for sales in a single lot.ation code an ot aftet )uly 1,2022. <br />This affidavit will not be accepted unless all areas on all pages are fully and <br />This form is your receipt when stamped by cashier. P/eose type or print. <br />82.45 WAC 458€1A) <br />accurately completed.Woshington 5tote <br />Form 84 0601 a <br />E Check box ifpartial sale, indicate %- sold <br />1 seller/Grantor <br />Name Kittitas Cnilntu <br />Attn Bnard of Cnrntu <br />Mailing address ,n5 W 4lh Avonr ra Rrrila <br />City/state/zip Fllanchrrrd tArA OnOtA <br />Phone (including area coae) 509-962-7508 <br />3 Send all property tax correspondence to: Z Same as Buyer/Grantee <br />Name <br />Mailing address <br />City/state/zip <br />List percentage of ownership acquired next to each name. <br />2 Buyer/Grantee <br />Name lAlachinnlnn qlala nanrrlmani ^f Fcoloov <br />Slala Trrrct lAhlor Pi^hfe pr^^rem <br />Mailing address 1 9(0 \nr Aldar alraat <br />City/state/zip Union Gap. WA 98903 <br />Phone (including area code)509-575-2490 <br />List all real and personal property tax <br />parcel account numbers <br />865536-$84.000 <br />855536-$259,1 80 <br />875536-$42,000 <br />Personal <br />property? <br />n!! <br />Assessed <br />value(s) <br />$ 0.00 <br />$ 0.00 <br />$ 0.00 <br />4 Street address of <br />This property is located in {fnr unincorporated l*tdtififts pte$s;e seleft yout t6udty} <br />Check box if any of the listed parcels are being segregated from another parcel, are pan of a boundary line adjustment or parcels being merged. <br />of need more <br />5 30 - Water or Mineral rights 7 List all personal property (tangible and intangible) included in selling <br />price. <br />Enter any additional codes <br />- <br />(see back of last paBe 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)? <br />ls this property predominately used for timber (as classified <br />under RCW 84.34 and 84.33) or agriculture (as classified under <br />5 ls this property designared as forest land per RCW 84.337 Eves Et'lo <br />ls this property classified as current use (open space, farm <br />and agricultural, or timber) land per RCW 84.34? E yes E t'to <br />ls this property receiving special valuation as historical <br />property per RCW 84.26? E yes El trto <br />lf any answers are yes, complete as instructed below. <br />(x) NoilcE oF coNTTNUANCE (FOREST lAND OR CURRENT USEI <br />NEW OWNER(S): To continue the current designa6on as forest land <br />or classification as current use (open space, farm and agriculture, or <br />timber) land, you must 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 lf the land no longer qualifies 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.L08). Prior to <br />signing (3) below, you may contact your local county assessor for more <br />information. <br />This land: E does E does not qualify for <br />continuance. <br />Deputy assessor signature Date <br />(2) NOICE OF COMPLTANCE (HtSTORtC pROpERW) <br />NEW OWNER(S): To continue special valuation as historic property, sign <br />(3) below. lf the new owner(s) 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(SI STGNATURE <br />Signature Signature <br />Print name Print name <br />lf claiming an exemption, list WAC number and reason for exemption. <br />EIves E ttio wAc number (section/subsection) 458:01&205 <br />Reason for exemption <br />Per Article Xl of the Washington State Constitution, the grantor is a <br />Eves Et'to governmental entity. <br />Type of document QU!! 01!i[t Deed <br />Date of document <br />Gross selling price <br />* Personal property (deduct) <br />Exemption claimed (deduct) <br />Taxable selling price <br />Excise tax: state <br />Less than S500,000.0! at t.7% <br />0.00 <br />0.00 <br />000 <br />0.00 <br />0.00 <br />From S50O,OOO.O1 to 51,500,000 at 1.2eX 0.00 <br />From S1,5OO,O0O.01 to 53,000,000 at 2 nX 0 00 <br />Above 53,000,000 a1 37" 0.00 <br />Agricultural and tim6s4366 31 1.2g"/" 0 00 <br />Total excise tax: state <br />0.0025 Local <br />0.00 <br />0.00 <br />*Delinquent interest: state ------0-00- <br />Local 0.00 <br />*Delinquent penalt <br />5g91s131 0,00 <br />*State technology fee <br />Affidavit processing fee <br />Total due <br />5.00 <br />5.00 <br />10.00 <br />A MTNTMUM OF s10.00 rS DUE rN FEE(S) AND/OR TAX <br />*SEE INSTRUCTIONS <br />QReset form <br />Aftached "Exhibit A" <br />I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING I5 TRUE AND CORRECT <br />Signature of grantor or agent _ <br />Name (print) <br />Date & city of signing <br />- <br />Signature of grantee or agent <br />Name lo'intl <br />- <br />Date & city of signing <br />- <br />Perjury in the second degree is a class C felonv which is punishable bv confinement in a state correctional institution for a maximum term of five vears. or bv <br />a fine in an amount fixed by the court of fiot more than $10,000; or by both such confinement and fine (RCW 94.72.030 and RCW 9A.20.021(1Xc)i. <br />To ask about the availability of this publjcation in an alternate format fqr the visually.impaired, please call 36S705{705. Teletype <br />fiTY) users may use the WA Relay Service by ciillind 71 1. ' ' <br />REV8a0001a (s/31/22) THISSPACETREASURER'SUSEONLY COUNTYTREASURER <br />Print an legal size paper. <br />Page 1 of 6