Real Estate Excise Tax Affidavit {REV 84 0001a}

PLEASE TYPE OR PRINT REAL ESTATE EXCISE TAX AFFIDAVIT CHAPTER 82.45 RCW 226 CHAPTER 458-61A WAC This form is your receipt when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED (See back of last page for instructions) Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name. 1 Name Mailing Address City/State/Zip Phone No. (including area code) 2 Name Mailing Address City/State/Zip Phone No. (including area code) SELLER GRANTOR BUYER GRANTEE 3 Send all property tax correspondence to: Same as Buyer/Grantee List all real and personal property tax parcel account numbers 226 check box if personal property List assessed value(s) Name Mailing Address City/State/Zip Phone No. (including area code) 4 Street address of property: This property is located in 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. Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit) 5 Select Land Use Code(s): 7 List all personal property (tangible and intangible) included in selling enter any additional codes: (See back of last page for instructions) price. If claiming an exemption, list WAC number and reason for exemption: WAC No. (Section/Subsection) Reason for exemption Type of Document Date of Document Gross Selling Price $ *Personal Property (deduct) $ Exemption Claimed (deduct) $ Taxable Selling Price $ Excise Tax : State $ Local $ *Delinquent Interest: State $ Local $ *Delinquent Penalty $ Subtotal $ *State Technology Fee $ *Affidavit Processing Fee $ Total Due $ A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS YES NO Was the seller receiving a property tax exemption or deferral under chapters 84.36, 84.37, or 84.38 RCW (nonprofit organization, senior citizen, or disabled person, homeowner with limited income)? 6 YES NO Is this property designated as forest land per chapter 84.33 RCW? Is this property classified as current use (open space, farm and agricultural, or timber) land per chapter 84.34 RCW? Is this property receiving special valuation as historical property per chapter 84.26 RCW? If any answers are yes, complete as instructed below. (1) 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 RCW 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 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) does not wish to continue, all additional tax calculated pursuant to chapter 84.26 RCW, shall be due and payable by the seller or transferor at the time of sale. (3) OWNER(S) SIGNATURE PRINT NAME 8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Grantor or Grantor222s Agent Name (print) Date & city of signing: Signature of Grantee or Grantee222s Agent Name (print) Date & city of signing: Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years, or by a fine in an amount fixed by the court of not more than five thousand dollars ($5,000.00), or by both imprisonment and fine (RCW 9A.20.020 (1C)). REV 84 0001a (09/06/17) THIS SPACE - TREASURER222S USE ONLY COUNTY TREASURER American LegalNet, Inc. www.FormsWorkFlow.com PLEASE TYPE OR PRINT REAL ESTATE EXCISE TAX AFFIDAVIT CHAPTER 82.45 RCW 226 CHAPTER 458-61A WAC This form is your receipt when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED (See back of last page for instructions) Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name. 1 Name Mailing Address City/State/Zip Phone No. (including area code) 2 Name Mailing Address City/State/Zip Phone No. (including area code) SELLER GRANTOR BUYER GRANTEE 3 Send all property tax correspondence to: Same as Buyer/Grantee List all real and personal property tax parcel account numbers 226 check box if personal property List assessed value(s) Name Mailing Address City/State/Zip Phone No. (including area code) 4 Street address of property: This property is located in 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. Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit) 5 Select Land Use Code(s): 7 List all personal property (tangible and intangible) included in selling enter any additional codes: (See back of last page for instructions) price. If claiming an exemption, list WAC number and reason for exemption: WAC No. (Section/Subsection) Reason for exemption Type of Document Date of Document Gross Selling Price $ *Personal Property (deduct) $ Exemption Claimed (deduct) $ Taxable Selling Price $ Excise Tax : State $ Local $ *Delinquent Interest: State $ Local $ *Delinquent Penalty $ Subtotal $ *State Technology Fee $ *Affidavit Processing Fee $ Total Due $ A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS YES NO Was the seller receiving a property tax exemption or deferral under chapters 84.36, 84.37, or 84.38 RCW (nonprofit organization, senior citizen, or disabled person, homeowner with limited income)? 6 YES NO Is this property designated as forest land per chapter 84.33 RCW? Is this property classified as current use (open space, farm and agricultural, or timber) land per chapter 84.34? Is this property receiving special valuation as historical property per chapter 84.26 RCW? If any answers are yes, complete as instructed below. (1) 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 RCW 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 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) does not wish to continue, all additional tax calculated pursuant to chapter 84.26 RCW, shall be due and payable by the seller or transferor at the time of sale. (3) OWNER(S) SIGNATURE PRINT NAME 8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Grantor or Grantor222s Agent Name (print) Date & city of signing: Signature of Grantee or Grantee222s Agent Name (print) Date & city of signing: Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years, or by a fine in an amount fixed by the court of not more than five thousand dollars ($5,000.00), or by both imprisonment and fine (RCW 9A.20.020 (1C)). REV 84 0001a (09/06/17) THIS SPACE - TREASURER222S USE ONLY COUNTY ASSESSOR A