Real Estate Excise Tax Affidavit - Wa

1 Print on legal size paper. Page 1 of 6 Real Estate Excise Tax Affidavit (RCW WAC 458-61A)Only for sales in a single location code on or after January 1, Affidavit will not be accepted unless all areas on all pages are fully and accurately completed. This form is your receipt when stamped by cashier. Please type or print. Check box if partial sale, indicate % percentage of ownership acquired next to each Buyer/GranteeName Mailing address City/state/zip Phone (including area code) 1 seller /GrantorName Mailing address City/state/zip Phone (including area code) 3 Send all property tax correspondence to: Same as Buyer/GranteeName Mailing address City/state/zip List all real and personal property tax parcel account numbersPersonal 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 description of property (if you need more space, attach a separate sheet to each page of the Affidavit ).

2 5 Enter any additional codes (see back of last page for instructions)Was the seller receiving a property tax exemption or deferral under RCW , , or (nonprofit org., senior citizen or disabled person, homeowner with limited income)? Yes No Is this property predominately used for timber (as classified under RCW and ) or agriculture (as classified under RCW ) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) Yes No 6 Is this pr operty designated as forest land per RCW NoIs this property classified as current use (open space, farmand agricultural, or timber) land per RCW Yes NoIs this property receiving special valuation as historical property per RCW Yes NoIf 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 landor classification as current use (open space, farm and agriculture, ortimber) land, you must sign on (3) below.

3 The county assessor must thendetermine if the land transferred continues to qualify and will indicateby signing below. If the land no longer qualifies or you do not wish tocontinue the designation or classification, it will be removed and thecompensating or additional taxes will be due and payable by the selleror transferor at the time of sale (RCW or ). Prior tosigning (3) below, you may contact your local county assessor for land: does does not qualify for _____ 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 taxcalculated pursuant to RCW , shall be due and payable by the selleror transferor at the time of sale.(3) NEW OWNER(S) SIGNATURE_____ _____Signature Signature_____ _____Print name Print name8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECTS ignature of grantor or agent _____ Signature of grantee or agent _____ Name (print) Name (print) Date & city of signing Date & city of signing Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maximum term of five years, 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 and RCW (1)(c)).

4 REV 84 0001a (9/17/21)THIS SPACE TREASURER S USE ONLY COUNTY TREASURER7 List all personal property (tangible and intangible) included in claiming an exemption, list WAC number and reason for C 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, at From $500, to $1,500,000 at From $1,500, to $3,000,000 at Above $3,000,000 at 3% Agricultural and timberland at Total Excise tax: state Local *Delinquent interest: stateLocal *Delinquent penaltySubtotal *State technology feeAffidavit processing fee Total due A MINIMUM OF $ IS DUE IN FEE(S) AND/OR TAX*SEE INSTRUCTIONSTo 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 84 0001aPrint on legal size paper. Page 2 of 6 Real Estate Excise Tax Affidavit (RCW WAC 458-61A)Only for sales in a single location code on or after January 1, Affidavit will not be accepted unless all areas on all pages are fully and accurately form is your receipt when stamped by cashier.

5 Please type or print. Check box if partial sale, indicate % percentage of ownership acquired next to each Buyer/GranteeName Mailing address City/state/zip Phone (including area code) 1 seller /GrantorName Mailing address City/state/zip Phone (including area code) 3 Send all property tax correspondence to: Same as Buyer/GranteeName Mailing address City/state/zip List all real and personal property tax parcel account numbersPersonal 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 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 , , or (nonprofit org.)

6 , senior citizen or disabled person, homeowner with limited income)? Yes No Is this property predominately used for timber (as classified under RCW and ) or agriculture (as classified under RCW ) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) Yes No 6 Is this pr operty designated as forest land per RCW NoIs this property classified as current use (open space, farmand agricultural, or timber) land per RCW Yes NoIs this property receiving special valuation as historical property per RCW Yes NoIf 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 landor classification as current use (open space, farm and agriculture, ortimber) land, you must sign on (3) below. The county assessor must thendetermine if the land transferred continues to qualify and will indicateby signing below.

7 If the land no longer qualifies or you do not wish tocontinue the designation or classification, it will be removed and thecompensating or additional taxes will be due and payable by the selleror transferor at the time of sale (RCW or ). Prior tosigning (3) below, you may contact your local county assessor for land: does does not qualify for _____ 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 taxcalculated pursuant to RCW , shall be due and payable by the selleror transferor at the time of sale.(3) NEW OWNER(S) SIGNATURE_____ _____Signature Signature_____ _____Print name Print name8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECTS ignature of grantor or agent _____ Signature of grantee or agent _____ Name (print) Name (print) Date & city of signing Date & city of signing REV 84 0001a (9/17/21)THIS SPACE TREASURER S USE ONLY COUNTY ASSESSOR7 List all personal property (tangible and intangible) included in claiming an exemption, list WAC number and reason for C 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, at From $500, to $1,500,000 at From $1,500, to $3,000,000 at Above $3,000,000 at 3% Agricultural and timberland at Total Excise tax: state Local *Delinquent interest.

8 StateLocal *Delinquent penaltySubtotal *State technology feeAffidavit processing fee Total due A MINIMUM OF $ IS DUE IN FEE(S) AND/OR TAX*SEE INSTRUCTIONSTo 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 84 0001aPerjury in the second degreeis a class C felony which is punishable by confinement in a state correctional institution for a maximum term of five years, 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 and RCW (1)(c)).Print on legal size paper. Page 3 of 6 Real Estate Excise Tax Affidavit (RCW WAC 458-61A)Only for sales in a single location code on or after January 1, Affidavit will not be accepted unless all areas on all pages are fully and accurately form is your receipt when stamped by cashier. Please type or print. Check box if partial sale, indicate % percentage of ownership acquired next to each Buyer/GranteeName Mailing address City/state/zip Phone (including area code) 1 seller /GrantorName Mailing address City/state/zip Phone (including area code) 3 Send all property tax correspondence to: Same as Buyer/GranteeName Mailing address City/state/zip List all real and personal property tax parcel account numbersPersonal property ?

9 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 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 , , or (nonprofit org., senior citizen or disabled person, homeowner with limited income)? Yes No Is this property predominately used for timber (as classified under RCW and ) or agriculture (as classified under RCW ) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) Yes No 6 Is this pr operty designated as forest land per RCW NoIs this property classified as current use (open space, farmand agricultural, or timber) land per RCW Yes NoIs this property receiving special valuation as historical property per RCW Yes NoIf any answers are yes, complete as instructed below.

10 (1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)NEW OWNER(S): To continue the current designation as forest landor classification as current use (open space, farm and agriculture, ortimber) land, you must sign on (3) below. The county assessor must thendetermine if the land transferred continues to qualify and will indicateby signing below. If the land no longer qualifies or you do not wish tocontinue the designation or classification, it will be removed and thecompensating or additional taxes will be due and payable by the selleror transferor at the time of sale (RCW or ). Prior tosigning (3) below, you may contact your local county assessor for land: does does not qualify for _____ 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 taxcalculated pursuant to RCW , shall be due and payable by the selleror transferor at the time of sale.