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Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
Only for sales in a single location code on or after Marchϭ͕ϮϬϮϯ.
This affidavit will not be accepted unless all areas on all pages are fully aŶĚaccƵraƚĞůLJcompleted.
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.
2 Buyer/Grantee
Name
Mailing address
City/state/zip
Phone (including area code)
1 Seller/Grantor
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
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
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Ztϴϰ͘ϯϰ͘ϬϮϬͿaŶĚǁŝůůcŽŶƚŝŶƵĞŝŶŝƚΖƐcƵrrĞŶƚƵƐĞ͍If yes and
the transfer involves multiple parcels with different classifications,
complete the predominate use calculator (see instructions) Yes No
6 Is this pr
operty designated as forest land per RCW 84.33?Yes No
Is this property classified as current use (open space, farm
and 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 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 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 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 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 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
Perũury 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 ;ϬϮͬϮϴͬϮϯͿ THIS SPACE TREASURER’S USE ONLY COUNTY TREASURER
7 List all personal property (tangible and intangible) included in selling
price.
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 $5Ϯϱ,000.01 at 1.1%
From $5Ϯϱ,000.01 to $1,5Ϯϱ,000 at 1.28%
From $1,5Ϯϱ,000.01 to $3,0Ϯϱ,000 at 2.75%
Above $3,0Ϯϱ,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
✔23
JUSTIN GASPAIRE
5601 N 37th St #NN3
Tacoma, WA 98407
(253) 209-7155
City of Renton, a Municipal Corporation
1055 South Grady Way
Renton, WA 98057
(425) 430-6400
✔
Portion of 0923059101 $ 62,538.46
$ 0.00
$ 0.00
Portion of 39XX NE 6th Street, Renton, WA
✔
✔
✔
✔
✔
None
458-61A-205(4)
Dedication of Street Right of Way
Deed of Dedication
3-28-24
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5.00
5.00
10.00
45 - Highway and street right of way
Renton
0.0050
THAT PORTION OF THE NORTH 130 FEET OF THE NORTH HALF OF THE NORTHEAST QUARTER OF THE SOUTHEAST QUARTER IN
SECTION 9, TOWNSHIP 23 NORTH, RANGE 5 EAST OF THE WILLAMETTE MERIDIAN, LYING WESTERLY OF A LINE DESCRIBED AS
FOLLOWS: BEGINNING AT A POINT ON THE NORTH LINE OF SAID NORTH HALF WHICH BEARS NORTH 88° 57’11” WEST 540.45 FEET
FROM THE NORTHEAST CORNER THEROF; THENCE SOUTH 0°22’15” WEST TO THE SOUTH LINE OF SAID NORTH 130 FEET AND THE
TERMINUS OF SAID LINE. EXCEPT THE WEST 60 FEET THEREOF. SITUATE IN THE COUNTY OF KING, STATE OF WASHINGTON
DocuSign Envelope ID: EE64B836-2523-49D9-A292-8E77D9E896A1
Justin Gaspaire
Justin Gaspaire