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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 _A_
RIGHT-OF-WAY DEDICATION
LEGAL DESCRIPTION
THAT PORTION OF THE WEST 200 FEET OF THE NORTH HALF OF THE NORTH HALF OF THE SOUTHWEST
QUARTER OF THE NORTHWEST QUARTER OF SECTION 13, TOWNSHIP 23 NORTH, RANGE 5 EAST, W.M.,
IN KING COUNTY, WASHINGTON, EXCEPT THE WEST 30 FEET FOR ROAD, DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHWEST CORNER OF THE ABOVE DESCRIBED PARCEL;
THENCE SOUTH 86°31’48” EAST ALONG THE NORTH LINE THEREOF 170.57 FEET;
THENCE SOUTH 01°11’50” EAST ALONG THE EAST LINE OF SAID PARCEL 30.10 FEET;
THENCE NORTH 86°31’48” WEST ON A LINE PARALLEL WITH AND 30.00 FEET SOUTH OF, WHEN
MEASURED AT RIGHT ANGLES TO, THE NORTH LINE OF SAID PARCEL, A DISTANCE OF 161.89 FEET TO A
POINT ON A CURVE TO THE LEFT HAVING A RADIUS OF 8.00 FEET;
THENCE SOUTHERLY ALONG SAID CURVE AN ARC DISTANCE OF 13.22 FEET THROUGH A CENTRAL ANGLE
OF 94°40’02” TO A POINT ON THE WEST LINE OF THE ABOVE DESCRIBED PARCEL 38.78 FEET SOUTHERLY
OF THE POINT OF BEGINNING;
THENCE NORTH 01°11’50” WEST ALONG THE WEST LINE OF SAID PARCEL 38.78 FEET TO THE POINT OF
BEGINNING;
SITUATE IN THE CITY OF RENTON, COUNTY OF KING AND STATE OF WASHINGTON.
(BEING AN AREA OF 5134 SQUARE FEET).