HomeMy WebLinkAboutC_REETA_Voyager1002_230601_V4.pdfDepartment of Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
Revenue c Only for sales in a single location code on or after March 1, 2023.
Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed.
Form 84 0001 a This form is your receipt when stamped by cashier. Please type or print.
0 Check box if partial sale, indicate % 1 A7 sold. List percentage of ownership acquired next to each name
1 Seller/Grantor 2 Buyer/Grantee
Name Samshar Management LLC and Shiras ventures LLC
Mailing address 1302 N 301h St.
City/state/zip Renton WA 98056
Phone (including area code)
3 Send all property tax correspondence to:0 Same as Buyer/Grantee
Mailing address
City/state/zip
4 Street address of properqj992ALL
This property is located in[Renton
❑ Check box if any of the listed parcels are
Name City of Renton. A Municipal Corporation
Mailing address 1055 South Grady BY
City/state/zip Renton. wa 98057
Phone (including area code) 425-430-6400
List all real and personal property tax
parcel account numbers
Portion of 3342101725
Personal
Assessed
property?
value(s)
®
$10,143.00
❑
$ 0.00
❑
$ 0.00
(for unincorporated locations please select your county)
segregated from another parcel, are part of a boundary line adjustment or parcels being merged.
Legal description of property (if you need mores ace, attach a separate sheet to each page of the affidavit).
the south 1.5 feet of lot 44, block 15, C.D. Hillmans lake washington garden of eden addition to seatde no. 1, Vol 1.1 page 53, king county,
washington.
5 5 - Highway and street fight of way 17-1
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, 94.37, or 84.38 (nonprofit org., senior
citizen or disabled person, homeowner with limited income)? [I Yes 0 No
Is this property predominately used fortimber (as classified
under RCW 84.34 and 94.33) or agriculture (as classified under
RCW 94.34.020) and will continue in it's current use? ff yes and
the transfer involves multiple parcels with different classifications,
complete the predominate use calculator (see instructions) []Yes ONo
6 Is this property designated as forest land per RCW 84.33? ❑Yes 0No
Is this property classified as current use (open space, farm
and agricultural, or timber) land per RCW 84.34? ❑ Yes 0 No
Is this property receiving special valuation as historical
property per RCW 84.26? ❑ Yes 0 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 94.33.140 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
I CERTIFY UNDER PENALTY OF PER1U `! THAT THE FO ING IS TRI
Signature of grantor or agent
Name (print)
Date & city of signing W 2 A c E I, j e
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) 458-61A-205(4)
Reason for exemption
Dedication of street right of way
Type of document deed of dedication
Date of document 06/01/23
Gross selling price 0.00
*Personal property (deduct) 0.00
Exemption claimed (deduct) 0.00
Taxable selling price 0.00
Excise tax: state
Less than $525,000.01 at 1.1% 0.00
From $525,DDo.01 to $1,525,000 at 1.28% 0.00
From $1,525,000.01 to $3,025,000 at 2.75% 0.00
Above $3,025,000 at 3% 0.00
Agricultural and timberland at 1.28% 0.00
Total excise tax: state 0.00
0.0050 Local 0.00
*Delinquent interest: state 0.00
Local 0.00
*Delinquent penalty 0.00
Subtotal 0.00
*State technology fee 5.00
Affidavit processing fee 5.00
Total due 10.00
A MINIMUM OF $10.00IS DUE IN FEE(S) AND/OR TAX
*SEE INSTRUCTIONS
CORRECT
grantee or agent
city of signing
Perjury in the second degree is a class C felony which is punishable by confihement in a state correctional institution for a maximum term of five yyears, or
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)(0).
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.
REV 840001a (02/28/23)
THIS SPACE TREASURER'S USE ONLY COUNTYTREASURER
Print on legal size paper.
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