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HomeMy WebLinkAbout125245 12- 5 L, ° Department of(rtae x 9 5-.)77 Revenue Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC 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(a�sale of roperpi `IIfgmultipl owners,list p re�enttag_e f ownershhii_ne�xt�to nam`•. ill Name Kms'e i k W cat eu- © Name i 1�.,c_Af A.Q. J J 40 to 1 nu, .l�\1 elk— ,:4 k x �}r txJ z Mailing Address r" Mailing Address 145 4-I I've 1 (,i j(IiIV�. -"*"�e_.....- ._, gi p ` . .1" INA . City/State/Zip t-►'IJ`.1��V t 1jV 7 City/State/Zip*--BC.'i Il t Phone No.(includingarea code q ' )��1�1���"� '7-9 3 5 Phone No.(including area code)..�,/��)L (cS ID © Send all property tax correspondence to:pp Same as Buyer/Grantee List all real and personal property tax parcel account ` Y List assessed values) �(/n(u�mbers-check box if personal property �' `, I Name 1`'FV5000 �)-(0 n I�lr1t�17q` Mailing Address n City/State/Zip n Phone No.(including area code) jun e-r ® Street address of property: ..SO 14 Q,y k i 0 C < 0 p.„ rd(&T t�^)�G QAt1/4....4 q'S 6(0 This property is located in Select Location .J ��•'"`""",,,000 V ❑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) cctv�.i o- . l 3 . C u.o,.-±e.xZ sock- 907\ SW 1/44- <1-0.�n s(n t f-, 'so y\ . -Sele7oc.a VU, Svbd1V i st (Tri 9405. COT CreQYZ5t- VAlek9e. 3 Lot 5-7-- Select ct Land Use Code(s) III: Select Land Use Codes I List all personal property(tangible and intangible)included in selling price. enter any additional codes: (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under 0 chapters 84.3(1,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? aYES NO If claiming an exemption,list WAC number and reasonyfor e�xemptio . -�/!J Is this property designated as forest land per chapter 84.33 RCW? 00 WAC No.(Section/Subsection) 4le I Pr - �.lrmpr V.)' (') Is this property classified as current use(open space,farm and 0 Reason for exemption agricultural,or timber)land per chapter 84.34 RCW? p Is this property receiving special valuation as historical property 0 per chapter 84.26 RCW? If any answers are yes,complete as instructed below. Type of Document q t f ` (}v‘YY\ (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S):To continue the current designation as forest land or Date of Document SJ 2_0 1 1 b .1,sdfi-.atinn as cur e......--<"t'""'•r- c'''''''''''''' _».....,' o+-_.,,,,.e."r titnhrrl Inn, Gross Selling i,.,... . IC* 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 *Personal Property(deduct) $ land no longer qualifies or you do not wish to continue the designation or Exemption Claimed(deduct) $ 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 Taxable Selling Price $ 0.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax:State $ 0.00 your local county assessor for more information. 0.0000 Local $ 0.00 This land ❑does El does not qualify for continuance. *Delinquent Interest:State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) NEW OWNER(S):To continue special valuation as historic property, Subtotal $ 0.00 sign(3)below.If the new owner(s)does not wish to continue,all *State Technology Fee $ 5.00 additional tax calculated pursuant to chapter 84.26 RCW,shall be due and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ (3) OWNER(S)SIGNATURE Total Due $ 10.00 PRINT NAME 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 C a.-.' / v Signature of [���[/// 1 r / /;7� Signature of Grantor or,. . tor's Agent C � L� Grantee or Grantee's Agenti ,/ -yam &rt[, Name(print) _ -' . ► WM'-., Name(print) 1Y\..,('if U-' -1) \ Q'ik Date&city of signing: ,r /6 Pot,)58O(.JA_ Date&city of signing: Perjury:Perjury is a class C felony which is punishable by'imprisonment in the state correctional institution for a mash,urn 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 9. 20.020(IC)). REV 84 0001 a(12/12/14) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER 1,ZSZL-IG . i State of Washington REAL ESTATE EXCISE TAX Department of Revenue C Miscellaneous Fax Section SUPPLEMENTAL STATEMENT rillia PO Box 47477 Olympia WA 95504-7477 (WAC 458-61A-304) This form must be submitted with the Real Estate Excise Tax Affidavit(FORM REV 84 0001A) for claims of tax exemption as provided below. Completion of this form is required for the types of real property transfers listed in numbers 1-3 below. Only the first page of this form needs original signatures. AUDIT: Information you provide on this form is subject to audit by the Department of Revenue. In the event of an audit,it is the taxpayers' responsibility to provide documentation to support the selling price or any exemption claimed. This documentation must be maintained for a minimum of four years from date of sale. (RCW 82.45.100) Failure to provide supporting documentation when requested may result in the assessment of tax, penalties,and interest. Any filing that is determined to be fraudulent will carry a 50%evasion penalty in addition to any other accrued penalties or interest when the tax is assessed. PERJURY: Perjury is a class C felony which is punishable by imprisonment in a 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 ($5,000.00), or by both imprisonment and fine(RCW 9A.20.020 (1C)). The persons signing below do hereby declare under penalty of perjury that the following is true(check appropriate statement): 1. I 1 DATE OF SALE: (WAC 458-61A-306(2)) I, (print name) certify that the_____ _ (type of instrument), dated , was delivered to me in escrow by (seller's name). NOTE: Agent named here must sign below and indicate name of firm. The payment of the tax is considered current if it is not more than 90 days beyond the date shown on the instrument. If it is past 90 days, interest and penalties apply to the date of the instrument. Reasons held in escrow: Signature Firm Name 2. GIFTS: (WAC 458-61A-201) The gift of equity is non-taxable; however, any consideration received is not a gift and is taxable. The value exchanged or paid for equity plus the amount of debt equals the taxable amount. One of the boxes below must be checked. Both Grantor(seller) and Grantee (buyer) must sign below. Grantor(seller) gifts equity valued at$ to grantee (buyer). NOTE: Examples of different transfer types are provided on the back. This is to assist you with correctly completing this form and paying your tax. "Consideration" means money or anything of value, either tangible (boats, motor homes, etc) or intangible, paid or delivered, or contracted to be paid or delivered, including performance of services, in return for the transfer of real property. The term includes the amount of any lien, mortgage, contract indebtedness, or other encumbrance, given to secure the purchase price, or any part thereof, or remaining unpaid on the property at the time of sale. "Consideration" includes the assumption of an underlying debt on the property by the buyer at the time of transfer. A: Gifts with consideration 1. LJ Grantor(seller) has made and will continue to make all payments after this transfer on the total debt of $ and has received from the grantee (buyer) $ (include in this figure the value of any items received in exchange for property). Any consideration received by grantor is taxable. 2. 7 Grantee (buyer) will make payments on % of total debt of$ for which grantor (seller) is liable and pay grantor(seller) $ (include in this figure the value of any items received in exchange for property). Any consideration received by grantor is taxable. B: Gifts without consideration 1. There is no debt on the property; Grantor(seller) has not received any consideration towards equity. No tax is due. 2. I I Grantor(seller) has made and will continue to make 100% of the payments on total debt of$ and has not received any consideration towards equity. No tax is due. 3. I 1 Grantee (buyer) has made and will continue to make 100% of the payments on total debt of$ and has not paid grantor(seller) any consideration towards equity. No tax is due. 4. 7 Grantor(seller) and grantee (buyer)have made and will continue to make payments from joint acciount on total debt before and after the transfer. Grantee (buyer) has not paid grantor(seller) any consideration towards equity. No tax is due. Has there been or will there be a refinance of the debt? Fl YES ) .:NO If grantor(seller) was on title as co-signor only,please see WAC 458-61A-215 for exemption requirements. The undersigned acknowledges this transaction may be subject to audit and h. • r d t:• above information regarding record-keeping requirements and evasion penalties. // 4Z r �i' t, `r7/% 1 �.. /6-6�f�y lJ Grantor's Signature g Grantee's Signature 3. 7 IRS "TAX DEFERRED" EXCHANGE (WAC 458-61A-213) 1, (print name) , certify that I am acting as an Exchange Facilitator in transferring real property to pursuant to IRC Section 1031, and in accordance with WAC 458-61A-213. NOTE: Exchange Facilitator must sign below.