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Home My WebLink AboutL_REETA_20230419_v2_Dig Sig.pdfPrint on legal size paper. Page 1 of 6 Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A) Only for sales in a single location code on or after March 1, 2023.This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. 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 _____________________________________________________ __________________________________________________________ Mailing address _____________________________________________ City/state/zip _______________________________________________ Phone (including area code) ___________________________________ 2 Buyer/Grantee Name ______________________________________________________ _________________________________________________________ Mailing address _____________________________________________ City/state/zip _______________________________________________ Phone (including area code) ___________________________________ 3 Send all property tax correspondence to: Same as Buyer/Grantee Name _____________________________________________________ __________________________________________________________ Mailing address _____________________________________________ City/state/zip _______________________________________________ List all real and personal property tax parcel account numbers Personal property?Assessed value(s)____________________________________ ____________________________________ ____________________________________ 4 Street address of property ________________________________________________________________________ This property is located in __________________________________________ (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. Legal description of property (if you need more space, attach a separate sheet to each page of the affidavit). ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 5 Land use code ____________________________________________ 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 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 No 6 Is this property designated as forest land per RCW 84.33? Yes No Is this property classified as current use (open space, farmand agricultural, or timber) land per RCW 84.34? Yes No Is this property receiving special valuation as historical property per RCW 84.26? Yes No 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 landor classification as current use (open space, farm and agriculture, ortimber) land, you must sign on (3) below. The county assessor must thendetermine if the land transferred continues to qualify and will indicateby signing below. If the land no longer qualifies or you do not wish tocontinue the designation or classification, it will be removed and thecompensating or additional taxes will be due and payable by the selleror transferor at the time of sale (RCW 84.33.140 or 84.34.108). Prior tosigning (3) below, you may contact your local county assessor for moreinformation. 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 taxcalculated pursuant to RCW 84.26, shall be due and payable by the selleror transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE____________________________ _________________________Signature Signature____________________________ _________________________Print name Print name8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT Signature of grantor or agent ________________________________ Signature of grantee or agent __________________________ Name (print)_____________________________________________ 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 years, 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)). REV 84 0001a ((02/28/23)THIS SPACE TREASURER’S USE ONLY COUNTY TREASURER 7 List all personal property (tangible and intangible) included in sellingprice.___________________________________________________________ ___________________________________________________________ If claiming an exemption, list WAC number and reason for exemption. WAC number (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 Less than $525,000.01 at 1.1% ______________________ From $525,000.01 to $1,525,000 at 1.28% ______________________ From $1,525,000.01 to $3,025,000 at 2.75% ______________________ Above $3,025,000 at 3% ______________________ Agricultural and timberland at 1.28% ______________________ Total 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 To ask about the availability of this 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. Form 84 0001a