REAL ESTATE EXCISE TAX AFFIDAVIT
CHAPTER 82.45 RCW - CHAPTER 458-61A WAC
THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED
O
nly for sales in a single location code on or after January 1, 2020.
is form is your receipt
when stamped by cashier.
PLEASE TYPE OR PRINT
1
Name
2
Name
SELLER
GRANTOR
BUYER
GRANTEE
Mailing Address Mailing Address
City/State/Zip City/State/Zip
Phone No. (including area code) Phone No. (including area code)
3
Send all property tax correspondence to: o Same as Buyer/Grantee
List all real and personal property tax parcel
account numbers - check box if personal property
List assessed value(s)
Name
o
Mailing Address
o
City/State/Zip
o
Phone No. (including area code)
o
4
Street address of property:
This property is located in
o 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 more space is needed, you may attach a separate sheet to each page of the afdavit)
5
Select Land Use Code(s):
7
List all personal property (tangible and intangible) included in selling price.
enter any additional codes:
(See back of last page for instructions) YES NO
Was the seller receiving a property tax exemption or deferral
under chapters 84.36, 84.37, or 84.38 RCW (nonprot
organization, senior citizen, or disabled person, homeowner
with limited income)?
o o
o o
If claiming an exemption, list WAC number and reason for exemption:
WAC No. (Section/Subsection)
Reason for exemption
Is this property predominantly used for timber (as classied under
RCW 84.34 and 84.33) or agriculture (as classied under RCW
84.34.020)? See ETA 3215
6
YES NO
Is this property designated as forest land per chapter 84.33 RCW? o o Type of Document
Is this property classied as current use (open space, farm and
agricultural, or timber) land per chapter 84.34 RCW?
o o
o o
Date of Document
Gross Selling Price $
Is this property receiving special valuation as historical property
per chapter 84.26 RCW?
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
classication 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 qualies or you do not wish to continue the designation or classi-
cation, 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
RCW 84.34.108). Prior to signing (3) below, you may contact your local county
assessor for more information.
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% $
This land o does o does not qualify for continuance.
Above $3,000,000 at 3.0% $
Agricultural and timberland at 1.28% $
Total Excise Tax: State $
DEPUTY ASSESSOR DATE
Local $
(2) NOTICE OF COMPLIANCE (HISTORIC 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 calcu-
lated pursuant to chapter 84.26 RCW, shall be due and payable by the seller or
transferor at the time of sale.
*Delinquent Interest: State $
Local $
*Delinquent Penalty $
Subtotal $
*State Technology Fee $
(3) NEW OWNER(S) SIGNATURE
*Afdavit Processing Fee $
Total Due $
PRINT NAME
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
*SEE INSTRUCTIONS
8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
Signature of
Grantor or Grantor’s Agent
Signature of
Grantee or Grantee’s 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 ve years, or by a
ne in an amount xed by the court of not more than ve thousand dollars ($5,000.00), or by both imprisonment and ne (RCW 9A.20.020(1C)).
REV 84 0001a (12/6/19)
THIS SPACE - TREASURER’S USE ONLY COUNTY TREASURER
List percentage of ownership acquired next to each name.
o Check box if partial sale, indicate % ________ sold.
o Check box if the sale occurred
in more than one location code.
Required (For Unincorporated locations please select your county)
Print This Form (all copies)
Please print on legal size paper.