HomeMy WebLinkAboutREETA20160716Department of
Revenue
Washington State
REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt
PLEASE TYPE OR PRINT CHAPTER $2.45 RCW -CHAPTER 458-6 IA WAC when stamped by cashier.
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FtTLLY COMPLETED
(See back of last page for instructions)ElCheck box if prh.I indicate %sold.List percentage ofownership acf d next to each name.A Name Renton School District No.403,a Municipal U Name City of Renton,a Municipal corporation
corporation
Mailing Address 300 SW 7th Street Mailing Address 1055 S.Grady Way
City/State/Zip Renton WA 98057 City/State/Zip Renton WA 98057
Phone No.(including area code)(425)204-2300 Phone No.(including area code)(425)430-6400
A ,List all real and personal property tax parcel account -Send all property tax correspondence to:Same as Buyer/Grantee .List assessed value(s)numbers —check box ifpersonal property
Name Ptn 722780-01 35 p Not Applicable
Mailing Address
City/State/Zip 17
Phone No.(including area code)________________________________________El
Street address of property:1800 Index Avenue.Renton WA 98046
This property is located in Renton
ri Check box ifany ofthe 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)
The southerly and westerly 4 feet of the following described parcel:
Tract A and C,Block 5,Renton Highlands No.2,Corrected Plat recorded in Volume 57 of Plats,Pages 92 to 93,inclusive,records ofKingCounty,Washington,LESS that portion lying Easterly of a line beginning at the Northwest corner of Tract B of said plat;thenceNorth04°41 ‘00”East to the Northerly line of Tract C.
Was the sellerreceiving a property tax exemption or deferral under Elchapters$4.36,$4.37.or 84.38 RCW (nonprofit organization,senior
citizen,or disabled person,homeowner with limited income)?
NO
El
0
Is this property designated as forest land per chapter $4.33 RCW?
Is this property classifiedas cunnt use (open space.farm and Pagricultural,or timber)land per chapter $4.34?
Is this property receiving special valuation as historical property P 0perchapter$4.26 RCW?
Il’any answers are yes,complete as instructed below.
(1)NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT tTF)
NEW OWNER(S):To continue the current designation as forest land orclassificationascurrentuse(open space,farm and agriculture,or timber)land,you must sign on (3)below.The county assessor must then determine if thelandtransferredcontinuestoqualifyandwillindicatebysigningbelow.Ifthelandnolongerqualifiesoryoudonotwishtocontinuethedesignationor
classification,it will be removed and the compensating or additional taxes will
be due and payable by the seller ortransferor at the time ofsale.(RCW
84.33.140 or RCW 84.34.108).Prior to signing (3)below,you may contactyourlocalcountyassessorformoreinformation.
This land Qioes El 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,alladditionaltaxcalculatedpursuanttochapter84.26 RCW,shall be due andpayablebythesellerortransferoratthetimeofsale.
(3)OVNER(S)SIGNATURE
List all personal property (tangible and intangible)included in selling
price.
Right ofWay improvements on Harrington Ave NE,Index Ave NE,and NE16thStreet.Including new curb,gutter,and sidewalk.As well as streetlights,and storm water infrastructure.Also included are new public water
mains,hydrants,and appurtenances.
*Delinquent Penalty $________________________________
Subtotal S 0.00
*State Technology Fee 5,
*Affidavit Processing fee S.
Total Due S_________________________10.00
Signature of
Grantee or Grantee’s Agent.
Name (print)
_______________
Date &city of sinnine:
Select Land Use Code(s):
]45-Highway and street right ofway
enter any additional codes:____________
(See back of last page for instructions)
U
YES NO
P
YES If claiming an exemption,list WAC number and reason for exemption:
WAC No.(Section/Subsection)458-61 A-205
Reason for exemption
______________________________________________
Transfer from governmental entity to another governmental entity
Type of Document Deed of Dedication
Date of Document
__________________
Gross Selling Price $_
Personal Property (deduct)S_
Exemption Claimed (deduct)$.._.,,
Taxable Selling Price S_
Excise Tax :State $_
0.0050 1 Local S_
*Delinqtlent Interest:State $_
Local S
0.00
0.00
0.00
PRINT NAME
U
Signature of
Grantor or Grantor’s Agent
Name (print)
5.00
5.00
Date &city of signing:I 2
A MINIMUM OF 510.00 IS DUE IN FEE(S)AND/OR TAX*SEE INSTRUCTIONS
PENALTY OF PER.I(IRY THAT THE FOREGOING IS TRUE AND CORRECT.
Perjury:Perjuty is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than live years.or byafineinanamountfixedbythecourtofnotmorethanfivethousanddollars($5,000.00).or by both imprisonment and fine (RCW 9A.20.020 (IC)).
REV $4 000Ia(09/l4/l6)THIS SPACE -TREASURER’S USE ONLY DEPT.OF REVENUE