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REETA 9-14-2019
Department of Revenue Washington State REAL ESTATE EXCISE TAX AFFIDAVIT WAITING is your receipt PLEASE TYPE OR PRINT , CHAPTER 82.45 RCW-CHAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY QH1y IID (See back of last page for instructions) ['Check box if partial sale,indicate% sold. List percentage of ownership acquired next to each name. Name City of Renton. a Washington municipal corporation Name State of Was j ZlREh its tz Department of Tra porrtaa_tiionn�i �I z Mailing Address 1055 S Grady Way z Mailing Address PO Box 330310 MS118 City/State/Zip Renton. WA 98057-3232 m c City/State/Zip Seattle, WA 98133-9710 Phone No.(including area code) Phone No.(including area code) Send all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers—check box if personal property Name WSDOT- Real Estate Services Parcel 1-24345 Ptn 3224059010 ❑ Mailing Address PO Box 330310 MS 118 n City/State/Zip Seattle. WA 98133-9710 rl Phone No.(including area code) rl • Street address of property: This property is located in Renton ❑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) A portion of Government Lot 1 in Section 32 Township 24 North,Range 5 East,W.M. See attached for full legal • Select Land Use Code(s): U List all personal property(tangible and intangible)included in selling 145-Highway and street right of way price. enter any additional codes: (See back of last page for instructions) YES NO Was the seller receiving a property tax exemption or deferral under 0 ❑ \ chapters 84.36,84.37,or 84.38 RCW(nonprofit organization,senior citizen,or disabled person,homeowner with limited income)? • If claiming an exemption, list WAC number and reason for exemption: YES NO Is this property designated as forest land per chapter 84.33 RCW? ❑ ❑ WAC No. (Section/Subsection) 458-61A-206 Is this property classified as current use(open space,farm and El ❑ agricultural,or timber)land per chapter 84.34 RCW? Condemnation proceedings-eminent domain Is this property receiving special valuation as historical property ❑ per chapter 84.26 RCW? , If any answers are yes,complete as instructed below. - Type of Document Quit Claim Deed (1)NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE) NEW OWNER(S):To continue the current designation as forest land or Date of Document classification as current use(open space,farm and agriculture,or timber)land, Gross Selling Price $ 20,000.00 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 *Personal Property (deduct) $ land no longer qualifies or you do not wish to continue the designation or 20,000.00 classification,it will be removed and the compensating or additional taxes will Exemption Claimed(deduct) $ be due and payable by the seller or transferor at the time of sale.(RCW Taxable Selling Price $ 0.00 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact Excise Tax : State $ 0.00 your local county assessor for more information. 0.0050 Local $ 0.00 This land ❑does El does not qualify for continuance. *Delinquent Interest: State $ Local $ DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) NEW OWNER(S):To continue special valuation as historic property, Subtotal $ 0.00 sign(3)below. If the new owner(s)does not wish to continue,all *State Technology Fee $ _ 5.00 additional tax calculated pursuant to chapter 84.26 RCW,shall be due and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ 0.00 (3) OWNER(S)SIGNATURE ,Total Due $ 10.00 PRINT NAME A MINIMUM OF S10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS © I CER 1 NDER PEN OF PERJURY TIIAT THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) Denis Law, Mayor Name(print) Patti L. Matson Date&city of signing: September` , 2019 Renton Date&city of signing: Shoreline 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(IC)). REV 84 0001a(09/06/17) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER Department of r/? Revenue ` • Washington State REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC when stamped by cashier. 'fills AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL.PAGES ARE FULLY COMPLETED (See hack of last page for instmctions) ['Check box if partial sale,indicate% sold. List percentage of ownership acquired next to each name. .0 Name City of Renton. a Washington municipal corporation U Name State of Washington, acting by and through its • a Department of Transportation Mailing Address 1055 S Grady Way r t Mailing Address PO Box 330310 MS118 City/state/zip Renton. WA 98057-3232 mr4, city/state/zip Seattle, WA 98133-9710 Phone No.(including area code) Phone No.(including area code) Send all property tax correspondence to:ElSame as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers-•check box it'personal property Name WSDOT- Real Estate Services Parcel 1-24345 Ptn 3224059010 • 1l Mailing Address PO BOX 330,'.1_ M_S 118 fl City/State/Zip Seattle. WA 98133-9710 fl Phone No.(including area code) 1l ---- _ Street address of property: This property is located in Renton ❑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(it'more space is needed,you rimy attach a separate sheet to each page of the affidavit) A portion of Government Lot 1 in Section 32 Township 24 North,Range 5 East,W.M. See attached for full legal - Select Land Use Code(s): III List all personal property(tangible and intangible)included in selling 145-Highway and street right of way • I price. enter any additional codes: - (See back of last page for 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,home owner with limited income)? • If claiming an exemption, list WAC number and reason for exemption: YES NO Is this property designated astitnst land per chapter 84.33RCW? ❑ ❑ WAC No. (Section/Subsection) 458-61A-206 Is this property classified as current use(open space,than and ❑� ❑ Reaon agricultural,or timber)land per chapter 84.34 RCW? onden for exproceedi Condemnation proceedings-eminent domain • Is this property receiving special valuation as historical property ❑ Q per chapter 84.2l RCW? ' • • Ifany answers are yes,complete asinshvctedbelow. Type of Document Quit Claim Deed • (I) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE) NEW OWNER(S):To continue the current designation as tbrest land or Date of Document classification as current use(open space,faun and agriculture,or timber)land, • 20,000.00 you must sign on(3)below.The county assessor must then determine if the Gross Selling Price $ land transferred continues to qualify and will indicate by signing below.If the *Personal Property (deduct) $ land no longer qualifies or you do not wish to continue the designation or 20,000.00 $ classification,it will he removed and the compensating or additional taxes will Exemption Claimed (deduct) he due and payable by the seller or transferor at the time of sale.(RCW Taxable Selling Price $ 0.00 84.33.14(1 or RCW 84.34.108).Prior to signing(3)below,you may contact • Excise Tax : State $ 0.00 your local county assessor for more information. 0.0050 Local $ 0.00 This land ❑does does not quality for continuance. *Delinquent Interest: State $ Local $ • DEPUTY ASSESSOR DATE *Delinquent Penalty $ (2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Subtotal $ • 0.00 NEW OWNER(S):To continue special valuation as historic property, sign(3)below. If the new owner(s)does not wish to continue,all *State Technology Fee $ 5.00 additional tax calculated pursuant to chapter 84.26 RCW,shall he due and • payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ 0.00 (3) OWNER(S)SIGNATURE Total Due $ 10.00 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS © (ER' IFY NDER PEN Y OF PERJURY'l'IIA'l'THE FOREGOING IS TRUE AND CORRECT. Signature of Signature of Grantor or Grantor's Agent Grantee or Grantee's Agent Name(print) Denis Law, Mayor Name(print) Patti L. Matson Date&city of signing: September` 2019 Renton Date&city of signing: Shoreline 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 tine in an amount fixed by the court of not more than five thousand dollars($5,000.00),Or by both imprisonment and tine(RCW 9A.20.020(IC)). REV 84 0001a(09/06/17) THIS SPACE-TREASURER'S USE ONLY COUNTY TREASURER EXCISE TAX AFFIDAVIT ATTACHMENT City of Renton/WSDOT All that portion of the hereinafter described TRACT "X" lying westerly of a line beginning at a point opposite Highway Engineer's Station (hereinafter referred to as HES) 583+30.55 on the SR 405 line survey of SR 405, N.E. 3rd St. Vic. to S.E. 64th St. Vic. and 125 feet easterly therefrom; thence northerly parallel with said line survey to a point opposite HES 583+86 thereon; thence northerly to a point opposite HES 587+41 on said line survey and 164 feet easterly therefrom; thence northeasterly to a point opposite HES 589+31.65 on said line survey and 193.95 feet easterly therefrom; thence northeasterly along a curve to the right having a radius of 1,168 feet, for an arc distance of 487.28 feet to a point opposite HES 594+37 on said line survey and 352.82 feet easterly therefrom;thence northeasterly to a point opposite HES 596+63.97 on said line survey and the end of this line description. TRACT "X" Parcel A: That portion of the following described property lying east and southeast of State Highway No. 1 (SR 405): That portion of Government Lot 1 in Section 32, Township 24 North, Range 5 East, W.M., in King County, Washington, described as follows: Beginning on the east line of said Government Lot 1, South 01°42'13" West 30 feet from the northeast corner thereof; Thence South 01°42'13" West 963.80 feet; • Thence North 88°48'55" West 644.44 feet; Thence South 01°11'02" West 329.55 feet to a point 11 feet north of the south line of said Government Lot 1; Thence North 88°48'58" West 20 feet; Thence North 01°11'02" East 151.58 feet; Thence North 53°55'45" West 416.57 feet; Thence North 77°10'30" West 408.2 feet to the easterly margin of Lake Washington Boulevard; Thence North 30°56'13" East along said easterly margin 907.39 feet; Thence on a curve to the right having a radius of 65.49 feet, distant 68.84 feet to a point 30 feet south of the north line of said Government Lot 1; Thence South 88°50'10" East 907.54 feet to the Point of Beginning. EXCEPT that portion conveyed to King County for 108th Avenue Southeast by deed recorded under King County Recording No. 5700801. Tax Account No.: Ptn 3224059010 WSDOT's Parcel No.: 1-24345 • Parcel B: That portion of the following described property lying east of State Highway No. 1 (SR 405) as conveyed to the State of Washington by deed recorded under King County Recording No. 4673375: That portion of Government Lot 1 in Section 32, Township 24 North, Range 5 East, W.M., in King County, Washington, described as follows: Beginning at a point on the east line of said lot from which the northeast corner thereof bears North 01°42'13" East a distance of 993.80 feet; Thence South 01°42'13" West along the east line of said lot, 340.55 feet to the southeast corner thereof; Thence along the south line of said lot North 88°48'58" West 641.35 feet; Thence North 1°11'02" East 340.55 feet; Thence South 88°48'58" East 641.35 feet to the Point of Beginning. EXCEPTING THEREFROM that portion of the above described tract lying South of the following described lines: Beginning at a point 11 feet north of the southeast corner of the above described tract; thence westerly 559 feet,more or less, to a point which is 13 feet north of the south line of the tract hereinabove described; Thence continuing westerly 82 feet, more or less, to a point on the westerly line of said tract distant 11 feet north of the south line of said Government Lot 1. ALSO EXCEPT that portion conveyed to King County for 108th Avenue Southeast by deed recorded under King County Recording No. 5700802. Also,.the Grantor herein conveys and grants to the State of Washington all rights of ingress and egress (including all existing, future or potential easements of access, light, view and air) to, from and between State Route 405, N.E. 3rd St. Vic. to S.E. 64th St. Vic. and the remainder of said TRACT "X". It is expressly intended that these easements, covenants; burdens and restrictions shall run with the land and shall forever bind the Grantor, its successors and assigns. The lands herein described contain an area of 45,225 square feet, more or less, the specific details. concerning all of which are to be found on sheets 21, 22, and 24 of that certain plan entitled SR 405,N.E. 3rd St. Vic. to S.E. 64th St. Vic.,now of record and on file in the office of the Secretary of Transportation at Olympia, and bearing date of approval April 21, 2006, sheets 21 and 22 revised March 23, 2018 and sheet 24 revised January 12, 2018. Tax Account No.: Ptn 3224059010 WSDOT's Parcel No.: 1-24345 • INSTRUCTIONS Note:To report a transfer of a controlling interest in real property,please use the Real Estate Excise Tax Affidavit Controlling Interest Transfer Return, Revenue Form No.84-0001B. This form is available online at http://dor.wa.gov. Section 1: Enter the name(s)of seller/grantor.This is the person(s)conveying interest in the property.If sale is less than 100%,check the box"Check if partial sale"and fill in the percentage sold. Section 2: Enter the name(s)of buyer/grantee.This is the person(s)receiving interest in the property. List the percentage acquired after each name. Section 3: •Enter the name and address where you would like all future property tax information sent. •Enter the tax parcel number and current assessed value for real and personal property being conveyed.Check the box to indicate personal property. • Section 4: •Enter the street address of the property. •Enter the county if in unincorporated area.Enter city name if located within a municipality. •Enter the legal description of the property. • Section 5: • •Enter the appropriate land use code for the property.Please list all codes that apply on the lines provided in section 5. • See WAC 458-53-030(5)for a complete list. • 09-Land with mobile home • 23-Apparel and other finished • 33-Primary metal industries • 74-Recreational activities(golf • 10-Land with new building products made from fabrics, 34-Fabricated metal products courses,etc.) • 11-Household,single family units leather,and similar materials • 35-Professional scientific and controlling • 75-Resorts and group camps • 12-Multiple family residence(2-4 Units)•• 24-Lumber and wood products instruments;photographic and optical • 80-Water or mineral right (except furniture) goods;watches/clocks manufacturing • g 1-Agriculture • 13-Multiple family residence(5+Units) g (not in current use) • 25-Furniture and fixtures • 39-Miscellaneous manufacturing • 83-Agriculture current use RCW 84.34 • 14-Residential condominiums • 26-Paper and alliedproducts g • 15-Mobile home parks or courts p 50-Condominiums-other than residential . 86-Marijuana grow operations • 27-Printing and publishing • 53-Retail Trade-general merchandise • 87-Sale of StandingTimber • 16-Hotels/motels • 28-Chemicals • 54-Retail Trade-food • 88-Forest land designated RCW 84.33 • 17-Institutional Lodging(convalescent • 29-Petroleum refiningand relatedg homes,nursing homes,etc.) 58-Retail trade-eating&drinking • 91-Undeveloped Land(land only) industries (restaurants,bars) • 18-All other residential not coded • 94-Open space land RCW 84.34 • 30-Rubber and miscellaneous • 59-Tenant occupied,commercial properties • 19-Vacation and cabin 95-Timberland classified RCW 84.34 plastic products • 64-Repair services • 21-Food and kindred products • 31 -Leather and leather products • 96-Improvements on leased land • 22-Textile mill products • 65-Professional services(medical,dental,etc.) • 32-Stone,clay and glass products • 71-Cultural activities/nature exhibitions Section 6: Indicate whether the property is designated as forest land per chapter 84.33 RCW,classified as current use(open space,farm,agricultural,or timber)per chapter 84.34 RCW,or receiving special valuation as historic property per chapter 84.26 RCW. Section 7: • List personal property included in the selling price of the real property.For example,include tangible(furniture,equipment,etc)and intangible(goodwill,agreement not to compete,etc). • Use Tax is due on personal property purchased without payment of the sales tax.Use Tax may be reported on your Combined Excise Tax Return or a Consumer Use Tax Return,both available at http://dor.wa.gov. • If you are claiming a tax exemption,cite the specific Washington Administrative Code(WAC)number,section and subsection and provide a brief explanation.Most tax exemptions require specific documentation.Refer to the appropriate WAC to determine documentation requirements.Chapter 458-61A WAC is available online at http://dor.wa.gov. • Enter the type of document(quit claim deed,statutory warranty deed,etc.),and date of document(MM/DD/YYYY) • Enter the selling price of the property. • Selling price:For tax purposes,the selling price is the true and fair value of the property conveyed.When property is conveyed in an arm's length transaction between unrelated•persons for valuable consideration,there is a presumption that the selling price is equal to the total consideration paid or contracted to be paid,including any indebtedness.Refer to RCW 82.45.030 for more information about selling price. • Deduct the amount of personal property included in the selling price. • Deduct the amount of tax exemption claimed per chapter 458-61A WAC. • Due Date,Interest and Penalties:Tax is due at the time of sale/transfer.If tax is not paid within one month of the date of sale/transfer, interest and penalties will apply.The interest rate is variable and determined per RCW 82.32.050.Delinquent penalties are 5%one month • after the due date; 10%two months after the due date;and 20%three months after the due date.(RCW 82.45.100) • • State Technology Fee:A$5.00 Electronic Technology Fee that is due on all transactions.(82.45.180) • Affidavit Processing Fee:A minimum of$5.00 shall be collected in the form of tax and processing fee.A processing fee is due on all transactions where no tax is due and on all taxable transactions where the tax due is less than$5.00.(RCW 82.45.180). Section 8: Both grantor(seller)and grantee(buyer),or the agent of each,must sign this form,certifying that all the information provided is correct.Note: Original signatures required on the"County Treasurer"copy.Signatures may be required on the"Assessors"copy.Check with your county. Audit: Information you provide on this form is subject to audit by the Department of Revenue.Underpayments of tax will result in the issuance of a tax assessment with interest and penalties.Note: in the event of an audit,it is the taxpayers' responsibility to provide documentation to support the selling price or any exemption claimed.This documentation must be maintained for a minimum of four years from date of sale.(RCW 82.45.100) Ruling requests: You may request a ruling on the taxability of the property transfer.Go to our website at dor.wa.gov/rulings or fax your request to (360)705-6655. Where to send completed forms: Completed forms must be submitted to the County Treasurer's or Recorder's Office where the property is located. For tax assistance,contact your local County Treasurer/Recorder or visit http://dor.wa.gov or call(360)534-1503.To request this document in an alternate format,please call 1-800-647-7706.Teletype(TTY)users may use the Washington Relay Service by calling 711. REV 84 000Ia inst.(09/06/17)