HomeMy WebLinkAboutD 20171011001318Electronically Recorded Instrument Number: 20171011001318 Document:D Rec: S77.00 Page-1 of 4
Excise Docs: 2894454 Selling Price: S0.00 Tax Amount: S10.00 Record Date:10/11/2017 2:44 PM
King County, WA
Return Address:
City Clerk's Office
City of Renton
1055 South Grady Way
Renton, WA 98057
Instrument Number: 20171011001318 Document:D Rec: $77.00 Page-2 of 4
Record Date:10/11/2017 2:44 PM King County, WA
REPRESENTATIVE FORM OF ACKNOWLEDGMENT
/DEE &DEDI 'TION (2)1 D Page 2 of 4 FORM 04 0001/b
Instrument Number: 20171011001318 Document:D Rec: $77.00 Page-3 of 4
Record Date:10/11/2017 2:44 PM King County, WA
Exhibit A
Legal Description
The South 6 feet of Lot A, City of Renton Lot Line Adjustment Number LUA-11-008LLA, recorded under
recording number 20120126900002, in King County, Washington.
/ EED&DEOiCATI (2)\ i3 Page 3 of 4 FORM 04 0001/bh
Instrument Number: 20171011001318 Document:D Rec: $77.00 Page-4 of 4
Record Date:10/11/2017 2:44 PM King County, WA
Map Exhibit
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Instrument Number: E2894454 Document:EXTX
Conveyance: 20171011001318 Selling Price:S0.00 Tax Amount:S10.00
Record Date: 10/11/2017 2:44 PM King County, WA
Select Land Use Code(s):
enter any additional codes; —
(See back of last page for instructions)
YES NO
Is this property exempt from property tax per chapter El El
84.36 RCW (nonprofit organization)?
YES NO
Is fts property designated as threst land per chapter 94.33 RCW? 0 ED
This land El does [3 does not qualify for continuance.
FUNMINEURRM
(2) NOTICE OFCOMPLIANCE (HI&MRIC.PROPERTY)
NEW OWNER(S): To continue special valuation as historic property,
sign (3) below. If the new owner(s) does not wish to continue, all
additional tax calculated pursuant to chapter 84.26 RCW, shall be due
and payable by the seller or transferor at the time of sale.
(3) OWNER(S)SIGNATURE
List all personal property (tangible and intangible) included in selling
price.
None
If claiming an exemption, list "SAC number and reason for exemption-,
WAC No. (Section/Subsection) 4158-61A-205(4)
Reason for exemption
Dedication of Street Right of Way
Type of Document Deed of Dedication
Date of Document : I =()q
Gross Selling Price
*Personal Property (deduct)
Exemption Claimed (deduct)
Taxable Selling Price
0-00
Excise Tax : State S
OM
7—
Local
OM
*Delinquent Interest: State
Local
*Delinquent Penalty
Subtotal
OM
*State Technology Fee S
5M
*Affidavit Processing Fee
Total Due
M00
*SEE INSTRUCTIONS
II CERTIFY U ER ENA OF PERJURY THATTHE FOREGOING IS TM
Signature of All— Signature of
Grantor or Grant .. is Agent Grantee or GrAntee's Agent
L
Name (print) 6py11 Nae (print) Denis Law, Mw
m
Date & city of signing; Date & city of signing: -iie-r
MOMM
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Perjury: Perkury is a class C felony which is punishkle by imprisonment in the sVft correctional institution for a maximum term of not more than five years, or by
a fi-ne in an amount fixed lay We thousand dollars ($5,000,00, or Math sonment and fine (RC w LA. 0-92.q�
_the court of not more than f L
REV 84 0001ae (a) (05108/07) THIS SPACE - TREASURER'S USE ONLY COLNTY TREASURE