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Ra:tffi"il[(@ <br />WoshinS'ton Stote <br />Foram E4 S&0ta <br />Real EState ExCiSe Tax Affidsyif 6cw82.4swAc4ss_61A) <br />9nly for sales in.a single location code on or after March L, 2023. <br />Ili::I!..yi! yi! not be. accepted unress.ail areas on ail pages are tuily and accurately compreted. <br />r nrs rorm ts your feceipt when stamped by cashier. pleose type or print <br />Elcheck box if partial sale, indicate %_ sold. <br />on Swauk Creek LLC <br />Mailing address 737 Bishoo St. Ste 2600 <br />City/state/zip Hmnhrfir lll <br />Phone (including area code) <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 />List percentage of ownership acquired next to each name, <br />2 Buyer/Grantee <br />Name Kittitas <br />clo Board of Commissioners <br />Mailing address 205 W sth Ave Suite #108 <br />City/state/zip Ellensburs WA 98926 <br />Phone (including area code)509-962-7508 <br />List all real and perconal property tax <br />parcel account numbets <br />Portion 961866 <br />Portion 961865 <br />- <br />Perconal <br />property? <br />tr <br />trn <br />Assessed <br />value(s) <br />$ 250.290.00 <br />$ 4.780.00 <br />5 <br />(for unincorporated locotions please select your county) <br />listed parcels are being segregated from another parcel, are part of a boundary line adjustment or parcels being merged. <br />to <br />Tlist all personal property {tangible and intangible) included in sellingpnce. <br />Enter any additional codes <br />- <br />(see back of last page for instructions) <br />Was the seller receiving a property tax exemption or deferralunder RCW 84.36, 84.3-7, rir 84.38'(nonproni-dig., ;,n;;"-' <br />citizen or disabled person, homeowner with limited income)? E vesE No <br />lf claiming an exemption, list WAC number and reason for exemption. <br />WAC number (section/subsection) <br />Reason for exemption <br />No removal owing per RCW 84.34.108(6)(f) and S4.34.210 <br />Type of document Quitclaim Deed <br />Date of document <br />6 ls this property designated as forest land per RCW 84,33? Elyes Eruo <br />ls this property classified as current use (open space, farm <br />and agricultural, or timber) land per RCW 84.34? E Ves E lto <br />ls this property receiving special valuation as historicalpropertyperRcw84.26? EV"sEtto <br />lf any answers are yes, complete as instructed below. <br />!1llollgE glcoNflNUANCE (FoREsr TANDoR cuRRENr rrsE) <br />NEW OWNER{S): To continue the current designation as forest land <br />or classification as current use (open spacg farm and agriculture, or <br />timber) land, you must sign on (3) below. The county aisessor must then <br />determine ifthe land transferred continues to qualifi/ 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 84.33.1"40 or a434.t6e1. erior to <br />signing (3) beloW you may contact your local county asserrorior roru <br />information. <br />This land: Edoer Edoes not oualitu for <br />continuance. No removal owing per R6 / g4.34.t1qb)ff)'ana A.U.Z^O. <br />flYes Pluo <br />Deputy assessor signature Date <br />0.11 <br />From 51,525,000.01 to 53,025,000 at 2.75% 0.00 <br />Above g3,o25,ooo at 3% 0.00 <br />Agricultural and timberland at 1.28% <br />Total excise tax: state <br />0.0050 Locat <br />*Delinquent interest: state <br />Local <br />000 <br />0.1't <br />005 <br />000 <br />*Delinquent penalty 0.00 <br />Gross selling price <br />*Personal property (deduct) <br />Exemption claimed (deduct) <br />Taxable selling price <br />Excise tax: state <br />Less than 5525,0@ .OI at f.!% <br />From S525,0o0.01 to g1,5Z5,ooo at 1.28% <br />subtotal <br />*State technology fee <br />Affidavit processing fee <br />Total due <br />10 n0 <br />n0n <br />000 <br />10 00 <br />000 <br />00n <br />01A <br />5.00 <br />4R4 <br />10 00 <br />AND/OR TAX <br />orb <br />COUNTY TREASURER <br />Print on legal size popr <br />page 1 o <br />(2) NOflCE oF CoMpuANcE {HtsroRtc pRopERry) <br />Il\ / gWNER(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 puBuant to RCW 84.2q shall be due and payable by the seller <br />or transferor at the time of sale. <br />(3) NEWOWNER(S) StGNAruRE <br />Signature Signature <br />Print name Print name <br />I CEKTIFY UNDER PENALTYOF PERJURYTHATTHE <br />Signature of grdntor or <br />Name (print) <br />Date & city of <br />A MTN|MUM OF 510.00 ts DUE tN FEE(S) <br />*SEE INSTRUCTIONS <br />AND CORRECT <br />Signature of grdntee or <br />amount by <br />Name (print) <br />Date & city of <br />punishable bv <br />than S1O000,or by <br />a ts <br />more <br />To ask about the availability of thtr pfiqli1;rglJ?rB <br />fl l8ttl'tff '#i|il3t#il'B${tlrlillf tl'f :1 <br />please call 360-705$705. Teletype <br />2A that certain oIRecordper filed Booktn of45Survey '16916&underPageSurveys,Auditors No.File Records of202306230005,Kittitas <br />15.70 ormore less.Washington,being acres, <br />re classified under cunent use <br />REVs4ooola 102/28/231 THIS SPACE TREASURER'S USE ONLY