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REAL ESTATE EXCISE TAX AFFIDAVIT
CHAPTER 82.45 RCW – CHAPTER 458-61A WAC
This form is your receipt
when stamped by cashier.
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
(See back of last page for instructions) □ Check box if partial sale, indicate % _____sold.List percentage of ownership acquired next to each name.
1 Name
Mailing Address
City/State/Zip
Phone No. (including area code)
2 Name
Mailing Address
City/State/Zip
Phone No. (including area code) SELLER GRANTORBUYER GRANTEE3 Send all property tax correspondence to: Same as Buyer/Grantee List all real and personal property tax parcel account
numbers – check box if personal property List assessed value(s)
Name
Mailing Address
City/State/Zip
Phone No. (including area code)
4 Street address of property:
This property is located in
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 more space is needed, you may attach a separate sheet to each page of the affidavit)
5 Select Land Use Code(s): 7 List all personal property (tangible and intangible) included in selling
enter any additional codes:
(See back of last page for instructions)
price.
If claiming an exemption, list WAC number and reason for exemption:
WAC No. (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 $
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
YES NO
Was the seller receiving a property tax exemption or deferral under
chapters 84.36, 84.37, or 84.38 RCW (nonprofit organization, senior
citizen, or disabled person, homeowner with limited income)?
6 YES NO
Is this property designated as forest land per chapter 84.33 RCW?
Is this property classified as current use (open space, farm and
agricultural, or timber) land per chapter 84.34 RCW?
Is this property receiving special valuation as historical property
per chapter 84.26 RCW?
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 RCW 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 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) does not wish to continue, all additional tax calculated pursuant to chapter 84.26 RCW, shall be due and payable by the seller or transferor at the time of sale.
(3) OWNER(S) SIGNATURE
PRINT NAME
8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of
Grantor or Grantor’s Agent
Name (print)
Date & city of signing:
Signature of
Grantee or Grantee’s Agent
Name (print)
Date & city of signing:
Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years, or by
a fine in an amount fixed by the court of not more than five thousand dollars ($5,000.00), or by both imprisonment and fine (RCW 9A.20.020 (1C)).
REV 84 0001a (09/06/17)THIS SPACE - TREASURER’S USE ONLY COUNTY TREASURER