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Re"i'6ffi[@ Real Estate Excise Tax Affidqyi[ lncw <br />Only for sales in a single location code on or afier July 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/eoie iype or print. <br />Woshington 5tdte <br />Form 84 0001 a <br />El Check box if partial sale, indicate %- sold <br />1 seller/Grantor <br />Name Kittitas Coilntu <br />Aftn: Board of Corrntu <br />Mailing address 205W5lhAvenue Srrite <br />City/state/zip Fllensbrrro WA q8q?6 <br />Phone (including area code)50q-q62-750R <br />3 Send all property tax correspondence to: E Same as Buyer/Grantee <br />Name <br />Mailing address <br />City/state/zip <br />4 Street address of <br />This property is located in <br />E Check box if any of the <br />82.45 WAC 458-61A) <br />accurately completed. <br />List percentage of ownership acquired next to each name. <br />2 Buyer/Grantee <br />Name Washinoton Slate Denertmenl of Ecoloov <br />State Trust Waler Riohls Proaram <br />Mailing address 1 250 W Alder Strapt <br />City/state/zip Union Gan WA 98q03 <br />Phone (including area code)509-575-2490 <br />List all real and personal property tax <br />parcel account numbers <br />960277-$1 00 <br />Pe6onal Assessedproperty? value(s)n $o.oo <br />! $o.oon $o.oo <br />{f*r unincarparated lfitutiotts ple#se sele& yaw #uilty} <br />listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged. <br />need more each of the <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 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)? <br />ls this property predomlnately used fortimber (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? tfyes and <br />the transfer involws multiple parcels with different classifications, <br />omplete the pedominate u* calculator (se instructions) <br />6 ls this property designated as forest land per RcW 84.337 Eves Elttto <br />ls this propeny classified as current use (open space, farm <br />and agricultural, or timber) land per RCW 84.34? E yes E ttto <br />ls this property receiving special valuation as historical <br />property per RCW 84.26? E yes Et r,,to <br />lf any answers are yes, complete as instructed below. <br />(1) NOTTCE OF CONTTNUANCE (FOREST tAND OR CURRENT USE) <br />NEW OWNER(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 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 8 4.33.!40 ot 84.34.!08). 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 />Type of document <br />0.00 <br />lf claiming an exemption, list WAC <br />ElYesE ttto wAc number (section/subsection) <br />number and reason for exemption. <br />458-61A-205 <br />Reason for exemption <br />Per Article Xl of the Washingion State Constitution, the grantor is a <br />Eves ZNo governmental entity. <br />Cllrit Claim DcFd <br />Date of document <br />Deputy assessor signature Date <br />(2) NOTTCE OF COMPLTANCE (HtSrORtC pROpERWI <br />NEW OWNER(S): To continue special valuation as historic property, sitn <br />(31 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(51 StcNATURE <br />Gross selling price <br />*Personal property (deduct) <br />Exemption claimed (deduct) <br />Taxable selling price <br />Excise tax: state <br />Less than S500,000.0J, at !.!% <br />0.00 <br />0.00 <br />000 <br />0.00 <br />From S5OO,OOO.O1 to 51,500,000 at 1.28% - 0.00 <br />From 51,500,000.0L to 53,000,000 ar 2 .75y 0.00 <br />Above $3,000,000 at g"/" 0 00 <br />Agricultural and timberland at 1.28% <br />Total excise tax: state <br />0.0025 Local <br />* Delinquent interest: state <br />Local <br />*Delinquent penalty <br />Subtotal <br />*State technology fee <br />Affidavit processing fee <br />Total due <br />0.00 <br />000 <br />000 <br />000 <br />000 <br />000 <br />000 <br />500 <br />5.00 <br />10.00 <br />A MTNTMUM OF s10.00 tS DUE tN FEE(SI AND/OR TAX*SEE INSTRUCTIONS <br />Signature Signature <br />Print name Print name <br />{}Reset form <br />Attached "Exhibit A" <br />6 I CERTIFY UNDER PENATTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT <br />Signature of Brantor or agent _ <br />Name (print) <br />Date & city of signing <br />- <br />Signature of grantee or agent _ <br />Name (print) <br />- <br />Date & city of signing <br />- <br />Perjury-in the second degree is a <br />a tine in an amount fixed by <br />punishable by confinement in a state correctional institution for a maximum term of five vears. or bvthan S10,000, or by both such confinement and fine (RCW 9A.72.030 and RCW 94.20.021(1Xc)i. <br />which is <br />rt of more <br />To ask about the availability of this publication in an alternate.fornat fqr the visually impaired, please call 36G705-6705. Teletype' (TTY) users may use the WA Relay Seivke by -riilin{7n:' - ---- <br />REVS4OOO1a (5/31/22) THIS SPACE TREASURER,S USE oNLY coUNTY TREASURER <br />Frint on legal sire paper. <br />Page 1 of 6