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RA"i,tHffi(E
<br />Wdshington Stdte
<br />Form 84 0001 a
<br />Real Estate ExCise Tax AffidSvil 1ncw8245wAc458-61A)
<br />Only for sales in a single location code on or after April L' 2025'
<br />ihiiaffidavit will not-be accepted unless all areas on all pages are fully and accurately completed
<br />riiii io,r it you, receipt when stamped by cashier' Please type or print'
<br />E Check box if partial sale, indlcate %- sold.
<br />1 seller/Grantor
<br />Name
<br />Mailing address 205 W sth Sriie 108
<br />city/state/zip
<br />Phone (including area code)
<br />List percentage of ownership acquired next to each name.
<br />2 Buyer/crantee
<br />Name State Deoartment of
<br />State Trust Riohts Prooram
<br />Mailing address 1250 W Alder SlrAct
<br />city/state/zip
<br />Phone (including area code)
<br />List all real and personal property tax Personal
<br />parcel account numbers Property?
<br />Name qAlA8s
<br />Assessed
<br />value(sl
<br />$ 100.00
<br />$ 0.00
<br />Mailing address
<br />city/state/zip
<br />$ 0.00
<br />4 street address of
<br />(for unincorporated locations pleose select yout county)This property is located in
<br />E Check box if any of the listed parcels are segregated another parcel, are part of a boundary line adjustment or parcels being merged
<br />descri need attach a to each of
<br />5 7 List all personal property {tangible and intangible) included in selling
<br />price.
<br />Enter any additional codes
<br />3 Send all property tax correspondence toE Same as Buyer/Grantee
<br />(see back of last page for instructions)
<br />Was the seller receiving a property tax exemption or deferral
<br />under RCW 84.36,84.3/, or 84 38 (nonpront org, senlor
<br />citizen or disabled person, homeowner with Iimited income)?
<br />I!
<br />tr
<br />lf claiming an exemption, enter exemption code and reason for
<br />Ll Yes E No exemption. *5ee dor.wa.gov/REET to{ae1qr;gtAq? cqdes*
<br />ExemPtion No. (sec/sub)
<br />Reason for exemPtion
<br />Per Article Xl of ihe Washington State Constitution, the grantor is a
<br />EYes Elto governmenlal entity.
<br />attached "Exhibit A"
<br />Water or Mineral
<br />6 ts this property designated as forest land per RcW 84 33? EYes Eruo
<br />ls this property classified as current use (open space, farm
<br />"na "jiJirr"r, ot timber) land per ncw ila.rar E ves E t'to
<br />ls this propertY receiving special valuation as historical
<br />prop"itv pur icw a+.zol E Yes 9l t'to
<br />lf any answers are yes, complete as instructed below'
<br />{1} NOTICE OF CONTINUANCE {FOREST tAND OR CURRENT USE}
<br />iliw owugn(s)' ro 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 tire land transferred continues to qualify and will indicate
<br />bv sisnins below. lf the land no longer qualifies or you do not wish to
<br />conti-nue-the designation or classification, it will be removed and the
<br />compensating or additional taxes will be due and payable by the seller
<br />ortransferoritthe time of sale (RcW 84.33.140 or 84 34 108) Priorto
<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 />Gross selling Price
<br />*Personal property (deduct)
<br />Exemption claimed (deduct)
<br />Taxable selling Price
<br />Excise tax: state
<br />Less than S525,ooo.o1 at 1.1%
<br />-------q!q
<br />From 5525,000,01 to 51,525,000 at 1.28% 0 00
<br />From s1,525,000.01 to s3,025,000 at 2'75%
<br />Above S3,025,000 at 3%
<br />nn0
<br />Agricultural and timberland at 1.zs% 0'00
<br />Type of document
<br />Date of document
<br />0nn
<br />nnn
<br />0n0
<br />000
<br />0,00Total excise tax: state
<br />0.0050 Local
<br />* Delinquent interest: state
<br />Local
<br />*Delinquent penalty
<br />subtotal 0 00
<br />*State technologY fee
<br />Affidavit processing fee
<br />Total due
<br />A MINIMUM OF S1O.OO lS DUE lN FEE{SI AND/OR TAX
<br />+5EE INSTRUCTIONS
<br />000
<br />nn0
<br />Deputy assessor signature Date nnn
<br />(2) NOTICE oF COMPLIANcE (HISTORIC PROPERTY)
<br />itiw owugn(s), fo continue special valuation as historic property, sitn
<br />iiJ;"i"*. lftire new owner(s) doesn't wish to continue, all additional tax
<br />iii.riut.O 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 />000
<br />q00
<br />50n
<br />10 00
<br />Signature Signature
<br />Print namePrint name
<br />E r cgnttrY uNoeR PENALTY oF
<br />Signature of ntor or agent
<br />Name (print)
<br />Date & city of signing
<br />a an amount
<br />isa
<br />by ihe court
<br />class C
<br />not more
<br />which is
<br />To ask about the availability of this
<br />REV s4 0001a (3/1712s)
<br />AND coRREcT I O
<br />Signature ofgrante" o, ug"@
<br />trtame (print) [\r atra,z Sirnmons v-
<br />o","n.',r.tr,*'ng 6/rzlzS Uaior GIP
<br />FOREGOING IS TRUE
<br />o(i4v5'$,""1; ?,s,! ijlE il*i'is't?.'J"'tlli.x'i$'lli'iff I i?9'
<br />THIS SPACE TREASURER,S USE ONLY
<br />ne ment
<br />or by both and fine 9A.72.030
<br />o{ five or
<br />please call 360-205-6705.Teletype
<br />COUNTY TREASURER
<br />2025-0998 ,"0,o"
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