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. REAL ESTATE EXCISE TAX .
CHAPTER 82.45 RCW
CHAPTER 458-61 WAC
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ITEMS 0) THROUGH 0 ARE FULLY COMPLETED
e. Does conveyance involve a trade, partial
interest corporate affiliates, re.lated parties,
trust, receivership or an estate?
f. Is the grantee acting as a nominee for a third
party?
g. Principal use:
1 0 agricultural 2 0 condominium
4 0 apt (4+ units) 5 0 industrial
FOR TREASURER'S u~ ~ moo'''h,m.
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Submit to County Treasurer of the
county in which property is located.
PLEASE TYPE OR PRINT
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Name
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Cit
State
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NEW OWNER'S Name
PERMANENT ADDRESS
FOR ALL PROPERTY Street
TAX RELATED
CORRESPONDENCE City I State
o
LEGAL DESCRIPTION OF PROPERTY SITUATED IN UNINCORPORATED
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o Is this property currently:
Classified or designated as forest land?
Chapter 84.33 RCW
YES NO
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Classified as current use land (open space,
farm and agricultural, or timber)? Chapter 84.34 RCW
Exempt from property tax under nonprofit
organizations Chapter 84.36 RCW?
Receiving special valuation as historic
property under Chapter 84.26 RCW?
Type Property: "@-rand only
o
o
land with new building.
o land with previously
used building
SEE TAX OBLIGATIONS ON REVERSE SIDE
land with mobile home
@
(1) NOTICE OF CONTINUANCE (RCW) 84.33 orRCW 84.34)
If the new owner(s) of land that is classified or designated as current use or
forest land wish(es) to continue the classification or designation of such land,
the new owner(s) must sign below. If the new owner(s) do(es) not desire to
continue such classification or designation, all compensating or additional tax
calculated pursuant to RCW 84.33.120 and 140 or RCW 84.34.108 shall be due
and payable by the seller or transferor at the time of sale. To determine if the
land transferred qualifies to continue classification or designation, the county
assessor must be consulted. All new owners must sign.
This land 0 does
o does not qualify
for continuance.
DEPUTY ASSESSOR
DATE
(3) NOTICE OF COMPLIANCE (Chapter 84.26 RCW)
If the new owner(s) of property with special valuation as historic property
wish(s) to continue this special valuation the new owner(s) must sign below. If
the new owner(s) do(es) not desire to continue such special valuation, all addi-
tional 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
0
The following optional questions are requested by RCW 82.45.120
Is property at the time of sale:
YES NO
a. Subject to elderly, disability, or physical improvement 10 20
exemption?
b. Does building, if any, have a heat pump or solar 10 20
heating or cooling system?
c. Does this conveyance divide a current parcel of land? 10 20
d. Does sale include current crop or merchantable 10 20
timber?
This form is your receipt when stamped
by cashier. Pay by cash or certified
check to County Treasurer.
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Name
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Zip
ALL TAX PARCE~ NUMBERS
9&-1 yCiJ ?tJ9
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COUNTY 'JiI OR IN CITY
d- F(/1I/~~ (}d"vf~
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o Description of personal property if included in sale (furniture, ap-
pliances, etc.)
If eXec"Pt...i" c1"m.d, ..pi", ;[~Ii 6'
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Type of Document
Date of Sale or Conveyance Instrument
Gross Sale Price 1 I $
Personal Property (deduct) 2 I $
Taxable Sale Price $
Excise Tax State 31 $
Local 41 $
Delinquent Penalty 51 $
Total Tax Due $
(SEE 1-5 ON REVERSE SIDE)
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AFFIDAVIT
I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF
THE STATE OF WASHINGTON THAT TH OREGOING IS TRUE
AND CORRE T (see #6 on reverse or p nal i
SIGNA TUR
NAME (print)
DATE & PLACE OF SIGNING:
SPECIFY (circle): grantor I grantee I grantor's agent I grantee's agent
Address of residence or place of business of person signing (speCify):
Telephone Number'
YES NO
10
10
20
20
3 0 recreational
6 0 residential
9 0 timber
FORM REV 64 0030 3m (5/66) '1155-
COUNTY
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