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Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
Only for sales in a single location code on or after January 1, 2020.This affidavit will not be accepted unless all areas on all pages are fully completed.This form is your receipt when stamped by cashier. Please type or print.
Check box if the sale occurred in more than one location code. Check box if partial sale, indicate % sold.
List percentage of ownership acquired next to each name.2 Buyer/Grantee
Name
Mailing address
City/state/zip
Phone (including area code)
1 Seller/Grantor
Name
Mailing address
City/state/zip
Phone (including area code)
3 Send all property tax correspondence to: Same as Buyer/Grantee
Name
Mailing address
City/state/zip
List all real and personal property tax
parcel account numbers
Personal
property?
Assessed
value(s)
4 Street address of property
This property is located in (for unincorporated locations please select your county)
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 you need more space, attach a separate sheet to each page of the affidavit).
5
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 org., senior
citizen or disabled person, homeowner with limited income)? Yes No
Is this property predominantly used for timber (as classified under RCW 84.84 and 84.33) or agriculture (as classified under RCW 84.34.020)? See ETA 3215. Yes No If yes, complete the predominate use calculator (see instructions for section 5).
6 Is this pr
operty designated as forest land per RCW 84.33?Yes No
Is this property classified as current use (open space, farm
and agricultural, or timber) land per RCW 84.34? Yes No
Is this property receiving special valuation as historical
property per RCW 84.26? Yes 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 84.33.140 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
8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
Signature of grantor or agent _______________________________ Signature of grantee or agent __________________________
Name (print) Name (print)
Date & city of signing 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 $5000, or by both imprisonment and fine (RCW 9A.20.020(1c)).
REV 84 0001a (01/27/21) THIS SPACE TREASURER’S USE ONLY COUNTY ASSESSOR
7 List all personal property (tangible and intangible) included in selling
price.
If claiming an exemption, list WAC number and reason for exemption.
WAC number (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
Less than $500,000.01 at 1.1%
From $500,000.01 to $1,500,000 at 1.28%
From $1,500,000.01 to $3,000,000 at 2.75%
Above $3,000,000 at 3%
Agricultural and timberland at 1.28%
Total 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
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.
Form 84 0001a
EXHIBIT___
RIGHT-OF-WAY DEDICATION
LEGAL DESCRIPTION
THAT PORTION OF LOT 5, BLOCK 1 OF CEDAR PARK FIVE ACRE TRACTS, AS PER PLAT RECORDED IN
VOLUME 15 OF PLATS, PAGE 91, RECORDS OF KING COUNTY, WASHINGTON, EXCEPT THE WEST 358.51
FEET THEREOF MEASURED ALONG THE NORTH BOUNDARY OF SAID LOT 5, AND EXCEPT THE EAST
118.76 FEET OF THE NORTH 143.71 FEET OF SAID LOT 5, AND EXCEPT THE NORTH 30 FEET THEREOF,
DESCRIBED AS FOLLOWS:
COMMENCING AT THE NORTHEAST CORNER OF SAID LOT 5;
THENCE SOUTH 01°11’50” WEST ALONG THE EAST LINE THEREOF 264.74 FEET TO THE POINT OF
BEGINNING;
THENCE CONTINUING SOUTH 01°11’50” WEST ALONG THE EAST LINE THEREOF 61.42 FEET TO THE
SOUTHEAST CORNER OF SAID LOT 5;
THENCE NORTH 87°39’02” WEST ALONG THE SOUTH LINE OF SAID LOT 5 A DISTANCE OF 8.28 FEET TO A
POINT THAT BEARS SOUTH 06°31’40” WEST FROM THE POINT OF BEGINNING;
THENCE NORTH 06°31’40” EAST 61.47 FEET TO THE POINT OF BEGINNING;
SITUATE IN THE CITY OF RENTON, COUNTY OF KING AND STATE OF WASHINGTON.
(BEING AN AREA OF 254 SQUARE FEET).