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RDepartment of Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A) evenue Only for sales in a single location code on or after March 1, 2023. Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. Form 84 0001 a This form is your receipt when stamped by cashier. Please type orprint. ❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name. 1 Seller/Grantor Name Kitbtas County attn: Board of County Commissioners Mailing address 205 W 5th Ave.. Suite 108 city/state/zip Ellensburg WA 98926-2887 Phone (including area code) 509-8926-7508 2 Buyer/Grantee Name Washington State Department of Ecology State Trust Water Rights Program Mailing address 1250 W Alder Street City/state/zip Union Gap WA 98903 Phone (including area code) 509-575-2490 3 Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal property tax Personal Assessed Name Solar Dolaf LLC parcel account numbers property? value(s) 946133 El $ 519.610.00 Mailing address 1410 W. Dolarwav Suite 301 295736 ❑ $ 349,830.00 City/state/zip Ellensburg WA 98926 095736 ❑ $ 21T800.00 4 Street address of propert water dghts only / 1501 W Dolarway Rd This property is located in JEIIensD (for unincorporated IOLa60n5 please select. your county) ❑ Check box if any of the listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged. Le al description of property (if ou need mores ace, attach a se arate sheet to each page of the affidavit . See attached Exhibit A c Ica - ......ymb I Enter any additional codes (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38(nonprofit org., senior citizen or disabled person, homeowner with limited income)? 0 Yes 0 No Is this property predominately used far 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? If yes am the transfer Involves multiple parcels with different classifications, Complete the predominate use Calculator (sea instructions) ❑Yes ONO 6 Is this property designated as forest land per RCW 84.33? OYes ONO Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑Yes O No Is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes O No If any answers are yes, complete as instructed below. (I) 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 (3) below, you may contact your local county assessor for more information. This land: ❑does ❑ does not qualify for continuance. Deputy assessor signature Date (2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY) NEW OWNER(5): 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 OWNERS) SIGNATURE Signature name Signature Print name / List all personal property (tangible and intangible) included in selling price. It claiming an exemption, list WAC number and reason for exemption. WAC number (section/subsection) 485-61A205 Reason for exemption Type of document Quit Claim Deed Date of document _ Gross selling price b00 *Personal property (deduct) 000 Exemption claimed (deduct) 0.00 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From$525,000.01 to$1,525,000 at 1.28% 000 From $1,525,000.01 to $3,025,000 at 2.75% 0.00 Above $3,025,000 at 3% 0.00 Agricultural and timberland at 1.28% 000 Total excise tax: state 0.00 0.0050 Local 0.00 'Delinquent interest: state 000 Local 0.00 'Delinquent penalty- 000 Subtotal 0.00 'State technology fee 500 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Signature of grantor or agent Signature of grantee or agent �..liri..�-�...�� Name (print) Cory Wright Name (print) Heather Simmons �— Date &city of signi ng Date&city of signing %21P(/23 & WA Perjury in 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 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.20.02111)(c){. To ask about the availability of this publication in an alternate format for the visually impaired, please call 3150-705-6705, Teletype (TTY) users may use the WA Relay Service by Calling 711. REV M 0001a (02/28/23) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper