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Home My WebLink About11_L_REETA_20260709_v1Ra"i"6HliE@ Real EState Excise Tax Affidgyif 1ncw82.4swAc458-61A) Only for sales in a single location code on or after January 1, 2026. 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. Pleose type or print. List percentage of ownership acquired next to each name. 2 Buyer/Grantee Woshington Stote Form 84 0001a E Check box if partial sale. indicate %- sold. 1 sefler/Grantor Name .l F INVFSTi,IFNTS a oeneral oartnershio Malling address City/state/zip Mill Valley, CA 94941 Phone (including area code)730 6006 Deputy assessor signature Oate (21 NOflCE OF COMPUANCE (HTSTORTC PROPERTY) NEW OWNER(S): To continue special valua6on as historic property, sign (3) below. lf 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. l3l NEW OWNER(Sl STGNATURE Signature of grantor or Name (print) Date & city of lsa Name [,III TICARF HFAI TH SYSTFI\'a Washinoton nonorofit mmomtion 3 Send all property tax correspondence to:Et Same as Buyer/Grantee I/lI II TICARF HFAI TH SYSTFi'Name ry 0423059095 wailing address Lew Code 2100 109 Willis Dr. Mailing address Post Office Box 5299 lr,rlS' City/state/zip Tacoma WA 9841 5 Phone (including area codel 206.694.9182 List all real and peEonal property tax Personal parcel account numbeE property? tr!tr Assessed value(s) $ 5.7'19.300.00 $ o.oo $ 0.00city/state/zip Tacoma WA 98415 4 Street address of This property is located in (Jot uilincotporated locations please select your county) Check box if any of the listed parcels are beinB segregated from another parcel, are part of a boundary line adiustment or parcels being merged. 5 53 - Retail trade - general merchandise 7 List all personal property (tangible and intangible) included in selling price. Enter any additional codes - (see back of last pag€ for instruc$ons) 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)? ls this property predominately used for timber (as classilied under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will €ontinue in it's current use? lfyes and the transler involves muhiple parceb with different dassification!, complete the predominate u* Gkulats (ffi instructions) Reason for exemption EYes Eruo 5 ls this property designated as forest land per Rcw 84.337 ElYes E No ls this property classified as current use (open space, farm and agricultural, or timber| land per RCW 84.34? E yes E No ls this property receiving special valuation as historical property per Rcw 84.26? E Yes E No lf any answers are yes, complete as instructed below. (1) NOTTCE OF CONTTNUANCE (FOREST r.AND 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. lf 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: E does El does not qualify for continuance, 7.260.000.00 0.00 0.00 7,260,000.00 5,775.00 Above 53,025,000 at 3%127,050.00 Agricultuml and 6mberland at I )R*0.00 Total excise tax: state 0.0050 Local rDelinquent interest: state Local rDelinquent penalty Subtotal 'State technology fee Affi davit processing fee Total due 0.00 0.00 0.00 ?23,175.00 5.00 0.00 Signature Signature 223,1 80.00 A MIN|MUM Ot s10.00 tS DUE rN FEE(S) AND/OR TAX Print name Print name *SEE INSTRUCTIONS I CERTIFY UNDER PENALTY OF CORRECT n.. o -. lf claiming an exemption, enter exemption code and reason foru Yes E No exemption. *See dor.wa.gov/REET for exemption codes. Exemption No. (sec/sub) N/A Type of document Date of document Statutorv Wanantv Deed Gross selling price rPersonal property (deduct) Exemption claimed (deduct) Taxable selling price Excise tax: state Less than S525,000.01 at 1.1% From 5525,000.01 to 51,525,000 at 1.24X- lagq9& From 51,525,000.01 to S3,O25,OOO at 2.75% 41,250'00 186,875.00 36,300.00 a in an amount by the court of irot more ttt''' +rAgury'/(. a state correctional institution for a maximum term of five vears, orconfinement and fine (RCW 9A.72.030 and RCW 94.20.021(1 Xc)). c ls of grantee or agent ,ilame (print) - q Date & city of signing - tnor by both such To ask about the availability of this publication in an alternate format for the visuallv imoaired. olease call 360-705-6705. Teletype' (TTY) users may use the WA Relay Service by cdllin j 71 1. ' REV 84 0001a (1v5l2s) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legol size poper. Exhibit A attached hereto and made a part hereof. PaBe 1 of 6 Ra"ftfiil[@ Real EState EXCiSe TaX Affid3yi[ 1ncw82.45wAc4s8-61A) Only for sales in a single location code on or after January 1, 2026. 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. Woshtngton Stote Form 84 O0Ola E check box if partial sale, indicate %- sold. 1 seller/Grantor Name J.F. INVESTMENTS, A oeneral oartnershio Mailing address 109 Willis Dr City/state/zip [/ill Valley. CA 94941 Phone (including area code)(415) 730 6006 3 Send all property tax correspondence to: E Same as Buyer/Grantee Na me l,/ULTICARE HEALTH SYSTEi/ Mailing address Post Office Box 5299, MS: 8204-LEG City/state/zip Tacoma WA 984'15 4 Street address of prope This property is located in Print name List percentage of ownership acquired next to each name. 2 Buyer/Grantee Name IVULTICARE HEALTH SYSTEM, a Washinqton nonproflt corooration Mailing address Post Office Box 5299, MS: 8204-LEG City/state/zip Tacoma WA 9841 5 Phone (including area code)206.694.9 1 82 List all real and personal property tax parcel account numbers 0423059095 Personal property? Assessed value(sI $ 5.719.300.00 E 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. sheet to each of the 5 53 - Retail trade - qeneral merchandise 7 List all personal property (tangible and intangible) included in selling price. 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 o.g., senror citizen or disabled person, homeowner with limited income)? ls 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? lf yes and the transfer involves muhiple parcels with different classifications, complete the predominate use elculator (se€ instructions) 5 tsthis propertydesignated asforest land per Rcw84.33? Ekes Eruo ls this property classified as current use (open space, farm and agricultural, or timber) land per RCw 84.34? E yes @ t'to ls this property receiving special valuation as historical property per RCW 84,25? E Yes @ tlo lf any answers are yes, complete as instructed below. (1) NOITCE OF CONTTNUANCE (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 sitn on (3) below. The county assessor must then determine if the land transferred continues to qualify and will indicate by signing below. lf the land no longer qualifies or you do not wash 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: E does E does not qualify for continuance. 7,260,000,00 41 250.00 1 27,050.00 0.00 0.0050 Local Deputy assessor signature Date (2) NOTTCE OF COMpLTANCE (HtSTORtC pROpERTyl NEW OWNER(S)i To continue special valuation as historic property, sign (3) below. lf 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) STGNATURE rDelinquent interest: state --J 0.00 223.175.00 5,00 0,00 Signature SiEnature 223,1 80.00 Print name A MINIMUM OF 510.00 '' ^r rc rtr 'te"t ^ ''^ '^6 rAX *SEE IN Date & city of signing Date & city of signing 3t9t2026 Lew Code 2100 $ 0.00 $ 0.00 unincorporoted locotions pleose select yout county) lf claiming an exemption, enter exemption code and reason forU Yes 14 No exemptio-n. 'see dor.wa.gov/REET for exemption codes* Exemption No. (sec/sub) N/A Reason for exemption Eves Etlo Type of document Date of document Statutorv Warrantv Deed lPersonal property (deduct) --------@ Exemption claimed (deduct) J Taxable selling price Excise tax: state Less than 5525,000.01. at 1.1.% From 5525,000.01 to S1,525,000 at 1.28% From S1,525,000.01 to 93,025,000 at 2.75% Above S3,025,000 at 3% Agricultural and timberland at 1.28% Total excise tax: state Subtotal tState technology fee Affidavit processing fee Total due 5,775.00 12,800.00 1 86,875.00 36,300.00 Local rDelinquent penalty 0.00 6 r cgnrrry unogn pENALTv oF prcRUE AND coRREct a signature of granto , o, ,e"nt (A-Afu911V1 signature of grantee or agent Name (print) 11"." 1pr;n11 William G. Robertson, Chief Executive Officer See Exhibit A attached hereto and made a part hereof. Periury in the second degree is a a frne rn an amount fixed by punrshable by than S10.000. r a state correctional institution for a maximum term of five years, or byconfinement and fine (RCW 9A.72.030 and RCW 9A.20.021(1Xc)). confinement in or by both such To ask about the availability of this pu:blication in an alternate format for the visually impe[gd, please call 360-705-6705. Teletype' (TTY) users may use the WA Relay Service b, a;llind 7 i i. ' REV840001a (11/6/2s) THISSPACETREASURER'SUSEONLY COUNTYASSESSOR Ptint on legol size pdpet, PaBe 2 of 5 ! trtr Gross selling price -L@!Q- EXHIBIT A TO REAL ESTATE EXCISE TAX AFFIDAVIT Box 4 - Legal description of propertv That portion of the Southeast quarter of the Southeast quarter of the Southwest quarter of Section 4, Township 23 North, Range 5 East, W.M., in King County, Washington, described as follows: Commencing at the intersection of the West line of said subdivision and the North margin of Northeast l2th Street (County Road No. 431), as shown on Washington State Department of Transportation Right-of-Way Map of SR 900, MP 12.57 to MP 74.46, Sheet 3 of 5, Dated June 19,1969; Thence North 01o03'57" East327.14 feet along said West line; Thence South 88o50'55" East 39.97 feet; Thence South 00o57'58" West 80.47 feet; Thence South 88o46'16" East 149.81 feet; Thence South 58o11'47" East 31.84 feet to the Northwesterly margin of Northeast Sunset Boulevard (SR 900) as shown on said right-of-way Map; Thence South 32o06'19* West 248.39 feet along said Northwesterly margin of Northeast Sunset Boulevard; Thence South 62o48' I l" West 36.01 feet along said Northwesterly margin of Northeast Sunset Boulevard, to a point on said North margin of Northeasl lzth Street; Thence North 88'58'16" West 57.50 feet along said North margin of Northeast lzth Street to the point of beginning; Together with Lots 2,3 and 4, Block I l, Corrected Plat of Renton Highlands No. 2, according to plat recorded in Volume 57 of plats at Page(s) 92 through 98, inclusive, in King County, Washington; Except the South 25.00 feet of said Lot 4 conveyed to City of Renton for street purposes by deed recorded under Recording No. 501 15 l8; (Also known as Lot I of City of Renton Lot Line Adjustment No. LUA-99-007-LLA, recorded April 1, 1999 under Recording No. 990401901 I , in King County, Washington.) REETA Exhibil A - 31 l6 NE Sunset Blvd ND: 2027 3.127 49 I 0-l 6 I 2-48 1 0v I Page I