Resolution Authorize Transfer Water Right

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Department of Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458 61A; Revenue Only for sales in a single location code on or aft Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. Form 84 0001 a I This form is your receipt when stamped by cashier. Please type or print. ❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name 1 Seller/Grantor Name Kittitas County Attn: Board of County Commissioners Mailing address 205 W 5th Avenue, Suite 108 City/state/zip Ellensburo, WA 98926 Phone (including area code) 3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Mailing address City/state/zip _ 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) List all real and personal property tax parcel account numbers 961885 Personal Assessed property? value(s) ❑ $100.00 ❑ $ 0.00 ❑ $ 0.00 4 Street address of propert Water Rights Onlv/2603 W GREEN AVE ELLENSBURG 98926 This property is located in Klttltas County (for unincorporated locations 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. pal description of property (if you need more space attach a separate sheet to each page of the affidavit) see attached "Exhibit A" 5 180 - Water or Mineral rights 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)? ❑ Yes 0 No Is this property predominately used for 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 and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) ❑Yes 0No 6 Is this property designated as forest land per RCW 84.33? []Yes ONO Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes 0 No Is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes 0 No If any answers are yes, complete as instructed below. (1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE) NEW OWNER(5): 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(S): 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 OWNER(S) SIGNATURE Signature Print name Signature Print name 7 List all personal property (tangible and intangible) included in selling price. If claiming an exemption, enter exemption code and reason for exemption. *See dor.wa.gov/REET fo a pY n codes* Exemption No. (sec/sub) 4�8-K6e1ii-2b� Reason for exemption Per Article XI of the Washington State Constitution, the grantor is a governmental entity. Type of document Quit Claim Deed Date of document Gross selling price *Personal property (deduct) 0.00 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% 0A0 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% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Signature of grantor or agent Name (print) Signature of grantee or agent Name (print) Date & city of signing Date & city of signing 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 yyears, 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.20.021(1)(c)). To ask about the availability ofthis publication in an alternate format for the visually impaired, please call 360-705-6705.Teletype (TTY) users may use the WA Relay Service by calling 711. REV 840001a (3/17/25) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1 of 6