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Ra"fifiila(@ <br />Woshingron Stdte <br />Form 84 0001a <br />E check box if partial sale, indicate %- sold. <br />1 seller/Grantor <br />Name Kittitas Countv <br />Real EState ExCiSe TaX AffidSyi[ 1ncwo245wAc45s-61A) <br />Only for sales in a srngle location code on or after March 1, 2023. <br />Thls affidavit will not be accepted unless all areas on all pages are futlv and accurately completed. <br />This form is your receipt when stamped by cashier. Pleose tYpe or print, <br />List percentage of ownership acquired next to each name. <br />2 Buyer/Grantee <br />Washinoion Stale Deoarlment ofName <br />alln: Board of Countv State Trrrsl Waler Ri6hts Prodrem <br />Mailing address 205 W slh Ave.. Suite 108 <br />City/state/zlp Fllenshrrro WA 98926-2887 <br />Phone {including area code)509-8S26-7508 <br />3 send all property tax correspondence to: E Same as Buyer/Grantee <br />Name Solar Dolar. LLC <br />Mailing address 1410 W Dolarwav Suite <br />Phone {including area code)509-575-2490 <br />List all real and personal property tax <br />parcel account numbers <br />q461 33 <br />295736 <br />nq5736 <br />Mailing address 1?50 W Aldnr Slreel <br />City/state/zip llninn Gan WA q8903 <br />Personal <br />property? <br />n <br />tr <br />tr <br />Assessed <br />value(s) <br />$ 519,610.00 <br />$ 349,830.00 <br />$ 217.800.00 <br />citylstate/zip FllAnshrrro WA 98926 <br />4 street address of <br />This property is located in (lor unincorporated locatlons pleose select your county) <br />E Check box if any of the listed parcels are being segregated fronr another parcel, are part of a boundary line adjustment or parcels being merged. <br />of need a sheet to each of the <br />5 - Water or Mineral 7 List all personal property {tangibte and intangible} included in selling <br />price. <br />lf claiming an exemption, list WAC number and reason for exemption <br />E yes O t'to wAc number {section/subsection)485-61A205 <br />Reason for exemption <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 predominatelV used for timber {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? lf yes and <br />the transfer involves multiple parcels with different classifications, <br />complete the predominate use calculator (see instrudionsl Eves Etlo <br />See attached Exhibit A <br />5 ts this property clesignated as forest land per Rcw 84.33r fhes Ettto <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 receiving special valuation as histolical <br />property per RCW 84.26? <br />lf any answers are yes, complete as instructed below. <br />(11 NOTICE OF CONTINUANCE (FOREST l-AND OR CURRENT USEI <br />NEW OWNER(s): To continue tlre current desiSnation as forest land <br />or classification as current use (open space, farm and agriculture, or <br />timber) land, Vou must sign on (31 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 addirional taxe: will be due and payable bV the seller <br />or transferor at the hme of sale {RCW 84-33.140 or 84.34.108). Prior to <br />signing (3) below, you may contact your local county assessor for more <br />information. <br />This land: <br />conti n ua nce <br />O doet I does not qualify for <br />Deputy assessor signature Date <br />(21 NOTrC€ OF COMPLIANCE (HISTORIC PROPERTY) <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(S} sIGNATURE <br />Signature Signatu re <br />Print name Print name <br />I CERTIFY UNOER PENATTY OF THAT <br />Signature of grantor or <br />Name (print) <br />Date & citv of signing <br />second <br />Type of document Ouit Claim <br />EIvesEt.to Date of document <br />G.oss selling price <br />tPersonal property (deduct) <br />o'od <br />I ves O tto <br />Exemption claimed (deduct) 0 00 <br />Taxable selling Pric <br />Excise tax: state <br />Less tha n 5 s2s,000.0 1 at 1.. 1% -------------'g!9. <br />From 5525,000.01 to 51,525,000 at 1.297" 0'00 <br />From 51,525,000.01 to 53,025,000 at 2.754 0 00 <br />Above 53,025,000 at 3% 0 00 <br />Agricultural and timberland at 1.28% <br />Total excise tax: state <br />---------!!0 <br />0.0050 Local <br />'Delinquent interest: state <br />Local <br />*Delinquent penalty <br />Subtotal <br />'State technology fee <br />Affidavit processing fee <br />Total due <br />0n0 <br />A MTNTMUM OF s10.00 ls DUE lN FEE{SI AND/OR TAX <br />*SEE INSTRUCTIONS <br />IS TRUE AND CORRECT <br />Signature of grantee or agent <br />Name {print}Healher <br />Date & clty of signing lzlr{lt t t,tnior &^r. wA <br />by confinement in a state fo( a te rm of five vears, or bV <br />eA.20.02 1( 1Xc)).or by both such confinement 94.72.030 and RCW <br />please call 360-705-6705. Teletype <br />COI.JNTY TREASURER <br />Print on legal size paqet <br />Page I of I <br />000 <br />0.00 <br />nnn <br />nnn <br />ono <br />0,00 <br />5,00 <br />500 <br />1n nn <br />a rn an amou <br />degree ls a <br />nt fixed by <br />class C felony ts <br />the court of not more <br />ro ask about the avairabrrity of thi' o(iE{,i.l',"JJ[,..!,.,jiE {tti,l;,#t$"s:iii.I'Si1l1tiff9ff, <br />REV840001. 102/28123) THISSPACETREASURER'SUsEONLY