HomeMy WebLinkAboutReeta signed aR�;;;;��(@ Real Estate Excise Tax Affidavit (Rew s2.4s wAc 4sa-s1A>
Washington State Only for sales in a single location code on or after March l, 2023.
Fonw �. ooo-aa 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.
liikheck box if partial sale, indicate% 0.0138
1 Seller/Grantor Name NW Seattle Builders. LLC
Mailing address 9675 SE 36th Slnlel Suite 105
City/state/zip Mercer Island WA 98040
sold.
Phone (including area code) -=2�53-40 ..... �5-... 5�58=7 _________ _
3 Send all property tax correspondence to: li2I Same as Buyer/Grantee Name City of Renton
Mailing address 1055 South Grady Way
City/state/zip renton WA 98057
Ust percentage of ownership acquired next to each name.
2 Buyer/Grantee
Name City of Renton. a Washington Municipal Corporation
Mailing address 1055 South Grady Way
City/state/zip Renton WA 98057
Phone (Including area codel--------------Ust all real and personal property tax parcel account numbers Portion of 334210-2460
Personal property? □ □ □
AssHsed value(s) S 4,347.00 SO.OD SO.OD
4 Street address of propel 1014 N. 33rd Place Renton WA 98056 This property is located In Renton 8Ctor unlntmporotell' fccat/on$ p/e,mi sele�i. ,..,1.1, mmizy}D 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. if ou need more s ace attach a se a rate sheetto each a e of the affidavit. he South 1.5' of Lot 41 , Block 18, C.D. Hillman"s Garden of Eden Addition to Seattle, No. 1, According to the Plat Thereof Recorded in Volume 11 f Plats, Page 63, in King County, Washington.
5 &s -Highway and street right of way t3 Ente� 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)? D Yes li2I No Is this property predominately used for timber (as classified under RCW 84.34 and 8433) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? lfyesanclthe tr.ansfer Involves multlple para!ls with different dassfflc:atlons, complelethepredomlnateusecalculator(seel�) Dves ii21No
6 Is this property designated as forest land per RCW 84.33? Dves ii21No
7 List all personal property (tangible and intangible) included in selling price. None
If claiming an exemption, list WAC number and reason for exemption. WAC number (section/subsection) WAC 458-61A-205{4l Reason for exemption Dedication of street or right-of-way.
Type of document Deed of Dedication is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? D Yes li2I No Date of document -=S=e_pt""em-be-r-=2-5,-2=0=23 _________ _ Is this property receiving special valuation as historical property per RCW 84.26? If any answers are yes, C!)mplete as instructed below. 0Yesii21No
(1) NOTICE OF CONTINUANCE (FOREST IAND 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 classificatlon, 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 84.34.108). Prior to signing (3) below, you may contact your local county assessor for more Information. This land: continuance. □does
Deputy assessor signature
D does not qualify for
Date (2) NOTICE OF COMPLIANCE (HISlORIC 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 tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE
Signature Signature
Print name Print name 8 I aRTIFY UNDER PENALTY OF PE Signature of granter or agent -W�4,;l!..!����===-Name (print) Michael Gladstein -Mana r
Date & city of signing -=Se ... p.,te,..m,..be==r-=25"'1-=2 .. 02,,,3,__--"M"'e"'rce=-r .,,ls..,la .. nd"',_.W.,'A_,__
Gross selling price _______ ... D.:::0:::..0
*Personal property (deduct) _______ .,.0.,.,0=-0
Exemption claimed (deductl-------=0=.0=-0
Taxable selling price _______ ... 0,.,,.00=-Excise tax: state Less than $525,000.01 at 1.1% ______ ___,,0=.0=-0 From $525,000.01 to $1,525,000 at 1.28% ______ ___,,0=.0=-0
From $1,525,000.01 to $3,025,000 at 2.75% ______ ___,,0=.0=-0 Above $3,025,000 at 3%------�0=.0=-0 11.gricultural and timberland at 1.28% _______ ,.0 . .,.0:..D Total excise tax: state -------=0-=0=-0
.___0_._00 __ 5 __ 0_....,! Local -----�0=.0=-0
*Delinquent Interest: state -------=0-=0=-0
Local ______ _,0..,.0=-0 *Delinquent penalty _______ ..,0 . .,.0:..0
Subtotal ______ _,0..,.0=-0
•state technology fee -------=5-=0=-0
Affidavit processing fee _______ .,.5.,.0"'-0
Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS
Signature of grantee or agent _________ _ Name (prlntl----------------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 years1 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(l)(cl,. To ask about the availability of this publication In an alternate format for the visuallx im�lred, please cali 360-705-6705. Teletype . ; , (TTY) users may use the WA Relay Service by calling 711. REV 84 0001a (02/28/23) THIS SPACE TREASURER'S USE ONLY COUNTY ASSESSOR
Print on legal size paper. Page 2 of 6
Mayor Armondo PavoneRenton, Wa