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Home My WebLink AboutREETADepartment of Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A) Revenue ` Only for sales in a single location code on or after January 1, 2020. Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. Form 84 0001 a This form is your receipt when stamped by cashier. Please type or print. 0 Check box if partial sale, indicate % 4 sold. 1 Seller/Grantor Name Yvonne Bui Mailing address 6210 12M PL SE City/state/zip Bellevue WA 98006 Phone (Including area code) (206) 2W2272 3 Send all property tax correspondence to:0 Same as Buyer/Grantee Name Mailing address City/state/zip _ List percentage of ownership acquired next to each name. 2 Buyer/Grantee Name City of Renton a Municipal Comora6on Mailing address 1055 Grady Way City/state/zip Renton WA 98057 Phone (including area code) (425) 430-6400 Ust all real and personal property tax parcel account numbers portion of 7841300400 Personal Assessed property? value(s) ❑ $ 7,680.00 ❑ $ 0.00 ❑ $ 0.00 4 Street address of property portion of 530 Shattuck Ave S. Renton WA 98057 This property is located in Penton (for unincorporated locations please select your county) 0 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). OTS 5 AND6, BLOCK 5, SMITHERS FIFTH ADDITION TO THE TOWN OF RENTON, CCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 16 OF PLATS, PAGE 33, ECORDS OF KING COUNTY, WASHINGTON 5 5 - Highway and street right of way Enter any additional codes (see back of last page for instructions) Was the seller receivingg 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 0 No Is this property predominately used for timber (as classified under RCW 8434 and 84.33) or agriculture (as classified under RCW 8434.020) and will continue In les current use? If yes and the transfer involves multiple parcels with different dassficatbns, complete the predominate use calculator (see instructions) )]Yes 0 No IS Is this property designated as forest land per RCW 84.33? byes 0No Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes 0 No Is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes 0 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 determined 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 (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 OWNERS) SIGNATURE Signature Signature Print name Print name 7 List all personal property (tangible and intangible) included in selling price. NONE If claiming an exemption, list WAC number and reason for exemption. WAC number (section/subsection) 458-61A-205(4) Reason for exemption DEDICATION OF STREET RIGHT OF WAY Type of document DEED OF DEDICATION Date of document 1 CERTIFY UNDER PENALTY OF PER) Y HAT THE FOREGOING IS TRUE AND CORRECT Signature of grantor or agent � f (I Name (print) ONNE I — Signature of grantee or agent Date & city of signing $i10/2022 BELLEVUE WA Name (print) --_ Date &city of signing yury n the second degree Is a class C felony which Is punishable by confinement in a state correctional institution for a maximum term of five ears, or by a fine in an amount fixed by the court of not more than $10,000, or by both such confinement and fine (RCW 9A.72.030 and RCW 9A.Of five 1)(rs, To ask about the availability of this P4blicatlon In an alternate format for the visually impaired, please call 360-705-6705. Teletype (77Y) users may use theft Relay Service by calling 711. REV 84 pooh (9/1?/21) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Gross selling price 0.00 'Personal property (deduct) 0.00 Exemption claimed (deduct) 0.00 Taxable selling price 0.00 Excise tax: state Less than $500,000.01 at 1.1% 0.00 From $500,000.01 to $1,500,000 at 1.28% 0.00 From $1,SD0,000.01 to $3,000,000 at 2.7S% 0.00 Above $3,000,000 at 3% 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0 00 'Delinquent penalty 0.00 Subtotal 0.00 'State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10,00 IS DUE IN FX EES) AND/OR TA *SEE INSTRUCTIONS It "W-14 r v*+w_ Print on legal size paper. Page 1 of 6