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MOBILE HOME REAL ESTATE EXCISE TAX AFFIDAVIT (Thurston County, WA)

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MOBILE HOME
REAL ESTATE EXCISE TAX AFFIDAVIT
Submit to County Treasurer of the
county in which property is located.
Chapter 82.45 RCW
Chapter 458-61A WAC
This form is your receipt when
stamped by cashier.
Used for sales on or after Jan. 1, 2020
FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY
PLEASE TYPE OR PRINT
INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED
REGISTERED
OWNER (Seller)
Name
NEW REGISTERED
OWNER (Buyer)
Name
Street
Street
City State Zip code
City State Zip code
Phone number
Phone number
LOCATION OF
MOBILE HOME
Name
LEGAL OWNER
Name
Street
Street
City State Zip code
City State Zip code
PERSONAL PROPERTY
PARCEL or ACCOUNT NO.
LIST ASSESSED VALUE(S): $
MAKE YEAR MODEL SIZE SERIAL NO. or I.D.
REVENUE TAX
CODE NO.
Is this property predominantly used for timber (as classified under RCW
84.34 and 84.33) or agriculture (as classified under RCW 84.34.020)?
See ETA 3215 Yes No
Date of Sale
Taxable Sale Price ............................................ $
Excise Tax: State ........................................... $
Local.......................................... $
Delinquent Interest: State ............................... $
Local .............................. $
Delinquent Penalty ........................................... $
Subtotal ............................................................ $
State Technology Fee ....................................... $
Affidavit Processing Fee ................................... $
Total Due .......................................................... $
If exemption claimed, WAC number & title:
WAC No. (Sec/Sub)
WAC Title
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX.
AFFIDAVIT
I certify under penalty of perjury under the laws of the State of
Washington that the foregoing is true and correct.
Signature of
Seller/Agent
Name (print)
Date and Place of Signing:
Signature of
Buyer/Agent
Name (print)
Date & Place of Signing:
If, in selling (or otherwise transferring ownership of) a mobile home
which possesses a tax lien, the seller does not inform the buyer (new
owner) of such a lien, the seller is guilty of deliberate deception as it
applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW
9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).
TREASURER’S CERTIFICATE
I hereby certify that property taxes due
County on the mobile home described hereon have been paid to and
including the year .
Date County Treasurer or Deputy
THIS SPACE - TREASURER’S USE ONLY
REV 84 0003e (12/13/19) COUNTY TREASURER
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MOBILE HOME
REAL ESTATE EXCISE TAX AFFIDAVIT
Submit to County Treasurer of the county
in which property is located.
Chapter 82.45 RCW
Chapter 458-61A WAC
This form is your receipt when stamped
by cashier.
Used for sales on or after Jan. 1, 2020.
FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY
PLEASE TYPE OR PRINT
INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED
REGISTERED
OWNER (Seller)
Name
NEW REGISTERED
OWNER (Buyer)
Name
Street
Street
City State Zip code
City State Zip code
Phone number
Phone number
LOCATION OF
MOBILE HOME
Name
LEGAL OWNER
Name
Street
Street
City State Zip code
City State Zip code
PERSONAL PROPERTY
PARCEL or ACCOUNT NO.
LIST ASSESSED VALUE(S): $
MAKE YEAR MODEL SIZE SERIAL NO. or I.D.
REVENUE TAX
CODE NO.
Is this property predominantly used for timber (as classified under RCW
84.34 and 84.33) or agriculture (as classified under RCW 84.34.020)?
See ETA 3215 Yes No
Date of Sale
Taxable Sale Price ............................................ $
Excise Tax: State ........................................... $
Local.......................................... $
Delinquent Interest: State ............................... $
Local .............................. $
Delinquent Penalty ........................................... $
Subtotal ............................................................ $
State Technology Fee ....................................... $
Affidavit Processing Fee ................................... $
Total Due .......................................................... $
If exemption claimed, WAC number & title:
WAC No. (Sec/Sub)
WAC Title
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX.
AFFIDAVIT
I certify under penalty of perjury under the laws of the State of
Washington that the foregoing is true and correct.
Signature of
Seller/Agent
Name (print)
Date and Place of Signing:
Signature of
Buyer/Agent
Name (print)
Date & Place of Signing:
TREASURER’S CERTIFICATE
I hereby certify that property taxes due
County on the mobile home described hereon have been paid to and
including the year .
Date County Treasurer or Deputy
If, in selling (or otherwise transferring ownership of) a mobile home
which possesses a tax lien, the seller does not inform the buyer (new
owner) of such a lien, the seller is guilty of deliberate deception as it
applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW
9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).
THIS SPACE - TREASURER’S USE ONLY
REV 84 0003e (12/13/19) COUNTY ASSESSOR
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MOBILE HOME
REAL ESTATE EXCISE TAX AFFIDAVIT
Submit to County Treasurer of the county
in which property is located.
Chapter 82.45 RCW
Chapter 458-61A WAC
This form is your receipt when stamped
by cashier.
Used for sales on or after Jan. 1, 2020.
FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY
PLEASE TYPE OR PRINT
INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED
REGISTERED
OWNER (Seller)
Name
NEW REGISTERED
OWNER (Buyer)
Name
Street
Street
City State Zip code
City State Zip code
Phone number
Phone number
LOCATION OF
MOBILE HOME
Name
LEGAL OWNER
Name
Street
Street
City State Zip code
City State Zip code
PERSONAL PROPERTY
PARCEL or ACCOUNT NO.
LIST ASSESSED VALUE(S): $
MAKE YEAR MODEL SIZE SERIAL NO. or I.D.
REVENUE TAX
CODE NO.
Is this property predominantly used for timber (as classified under RCW
84.34 and 84.33) or agriculture (as classified under RCW 84.34.020)?
See ETA 3215 Yes No
Date of Sale
Taxable Sale Price ............................................ $
Excise Tax: State ........................................... $
Local.......................................... $
Delinquent Interest: State ............................... $
Local .............................. $
Delinquent Penalty ........................................... $
Subtotal ............................................................ $
State Technology Fee ....................................... $
Affidavit Processing Fee ................................... $
Total Due .......................................................... $
If exemption claimed, WAC number & title:
WAC No. (Sec/Sub)
WAC Title
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX.
AFFIDAVIT
I certify under penalty of perjury under the laws of the State of
Washington that the foregoing is true and correct.
Signature of
Seller/Agent
Name (print)
Date and Place of Signing:
Signature of
Buyer/Agent
Name (print)
Date & Place of Signing:
TREASURER’S CERTIFICATE
I hereby certify that property taxes due
County on the mobile home described hereon have been paid to and
including the year .
Date County Treasurer or Deputy
If, in selling (or otherwise transferring ownership of) a mobile home
which possesses a tax lien, the seller does not inform the buyer (new
owner) of such a lien, the seller is guilty of deliberate deception as it
applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW
9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).
THIS SPACE - TREASURER’S USE ONLY
REV 84 0003e (12/13/19) DEPT. OF REVENUE
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MOBILE HOME
REAL ESTATE EXCISE TAX AFFIDAVIT
Submit to County Treasurer of the county
in which property is located.
Chapter 82.45 RCW
Chapter 458-61A WAC
This form is your receipt when stamped
by cashier.
Used for Sales on or after Jan. 1, 2020.
FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY
PLEASE TYPE OR PRINT
INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED
REGISTERED
OWNER (Seller)
Name
NEW REGISTERED
OWNER (Buyer)
Name
Street
Street
City State Zip code
City State Zip code
Phone number
Phone number
LOCATION OF
MOBILE HOME
Name
LEGAL OWNER
Name
Street
Street
City State Zip code
City State Zip code
PERSONAL PROPERTY
PARCEL or ACCOUNT NO.
LIST ASSESSED VALUE(S): $
MAKE YEAR MODEL SIZE SERIAL NO. or I.D.
REVENUE TAX
CODE NO.
Is this property predominantly used for timber (as classified under RCW
84.34 and 84.33) or agriculture (as classified under RCW 84.34.020)?
See ETA 3215 Yes No
Date of Sale
Taxable Sale Price ............................................ $
Excise Tax: State ........................................... $
Local.......................................... $
Delinquent Interest: State ............................... $
Local .............................. $
Delinquent Penalty ........................................... $
Subtotal ............................................................ $
State Technology Fee ....................................... $
Affidavit Processing Fee ................................... $
Total Due .......................................................... $
If exemption claimed, WAC number & title:
WAC No. (Sec/Sub)
WAC Title
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX.
AFFIDAVIT
I certify under penalty of perjury under the laws of the State of
Washington that the foregoing is true and correct.
Signature of
Seller/Agent
Name (print)
Date and Place of Signing:
Signature of
Buyer/Agent
Name (print)
Date & Place of Signing:
TREASURER’S CERTIFICATE
I hereby certify that property taxes due
County on the mobile home described hereon have been paid to and
including the year .
Date County Treasurer or Deputy
If, in selling (or otherwise transferring ownership of) a mobile home
which possesses a tax lien, the seller does not inform the buyer (new
owner) of such a lien, the seller is guilty of deliberate deception as it
applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW
9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).
THIS SPACE - TREASURER’S USE ONLY
REV 84 0003e (12/13/19) COUNTY AUDITOR/ LICENSING AGENT
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MOBILE HOME
REAL ESTATE EXCISE TAX AFFIDAVIT
Submit to County Treasurer of the county
in which property is located.
Chapter 82.45 RCW
Chapter 458-61A WAC
This form is your receipt when stamped
by cashier.
Used for Sales on or after Jan. 1, 2020.
FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY
PLEASE TYPE OR PRINT
INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED
REGISTERED
OWNER (Seller)
Name
NEW REGISTERED
OWNER (Buyer)
Name
Street
Street
City State Zip code
City State Zip code
Phone number
Phone number
LOCATION OF
MOBILE HOME
Name
LEGAL OWNER
Name
Street
Street
City State Zip code
City State Zip code
PERSONAL PROPERTY
PARCEL or ACCOUNT NO.
LIST ASSESSED VALUE(S): $
MAKE YEAR MODEL SIZE SERIAL NO. or I.D.
REVENUE TAX
CODE NO.
Is this property predominantly used for timber (as classified under RCW
84.34 and 84.33) or agriculture (as classified under RCW 84.34.020)?
See ETA 3215 Yes No
Date of Sale
Taxable Sale Price ............................................ $
Excise Tax: State ........................................... $
Local.......................................... $
Delinquent Interest: State ............................... $
Local .............................. $
Delinquent Penalty ........................................... $
Subtotal ............................................................ $
State Technology Fee ....................................... $
Affidavit Processing Fee ................................... $
Total Due .......................................................... $
If exemption claimed, WAC number & title:
WAC No. (Sec/Sub)
WAC Title
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX.
AFFIDAVIT
I certify under penalty of perjury under the laws of the State of
Washington that the foregoing is true and correct.
Signature of
Seller/Agent
Name (print)
Date and Place of Signing:
Signature of
Buyer/Agent
Name (print)
Date & Place of Signing:
TREASURER’S CERTIFICATE
I hereby certify that property taxes due
County on the mobile home described hereon have been paid to and
including the year .
Date County Treasurer or Deputy
If, in selling (or otherwise transferring ownership of) a mobile home
which possesses a tax lien, the seller does not inform the buyer (new
owner) of such a lien, the seller is guilty of deliberate deception as it
applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW
9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).
THIS SPACE - TREASURER’S USE ONLY
REV 84 0003e (12/13/19) TAXPAYER
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TAX LIABILITY
RCW 82.45.080 subjects the seller of real estate to the payment of the excise tax, and RCW 82.08.050 and 82.12.020 subjects the
buyer or user of personal property to the retail sales or use tax. Therefore, if the transfer is subject to the excise tax, it is the liability of
the seller and if the transfer is subject to the retail sales or use tax, it is the liability of the purchaser or user.
DEFINITION OF REAL ESTATE
A used mobile home is defined as real estate for purposes of this tax when the following conditions are met:
1. The mobile home was previously taxed by: (a) having been sold at retail and the retail sales tax has been paid (Chapter 82.08
RCW), or (b) having been used, and the use tax has been paid (Chapter 82.12.RCW).
2. The mobile home has substantially lost its identity as a mobile unit by virtue of : (a) being fixed in location upon land owed
or leased by the owner of the mobile home, (b) being placed on a foundation (posts & blocks), and (c) having fixed pipe
connections with sewer, water, and other utilities.
TRANSFER SUBJECT TO EXCISE TAX
The transfer of a used mobile home will be subject to the real estate excise tax (Chapter 82.45 RCW) on the following transactions:
1. Transfers between individuals, and there is no requirement that the unit be moved.
2. Transfer from individual to dealer (trade-in), and there is no requirement that the unit be moved.
3. Transfer from a dealer to individual, and there is no requirement that the unit is to be moved. Dealer may be allowed credit on
the excise tax if unit was taken in trade, was not moved, and resale occurred within nine months.
TRANSFER SUBJECT TO THE RETAIL SALES OR USE TAX
The transfer of a new or used mobile home will be subject to the retail sales tax (Chapter 82.08 RCW) or use tax (Chapter 82.12
RCW) on the following transactions:
1. Transfers between individuals when as part of the written agreement the unit is required to be moved.
2. Transfers of a mobile home upon which neither the retail sales tax, use tax, nor the real estate excise tax has been paid,
whether the unit is to be moved or not.
3. All transfers from a dealer’s sales lot.
CERTIFICATION OF TAXES PAID
The law requires that a copy of the excise tax affidavit and a copy of a treasurer’s certificate, stating that the property taxes have
been paid, be used as evidence of payment of the taxes. The Department of Licensing is prohibited from transferring or issuing a
certificate of ownership until it has verified that:
1. The excise tax on the sale, if due, has been paid, or the sales or use tax, if due, has been paid, and
2. Any property taxes, whether real or personal, which are due on the mobile home have been paid.
LOCAL REAL ESTATE EXCISE TAX
Cities and/or counties are authorized to adopt by ordinance additional real estate excise tax to be collected and distributed by the
county treasurer (Chapter 82.46 RCW).
DUE DATE, INTEREST AND PENALTIES
Tax is due at the time of sale/transfer. If tax is not paid within one month of the date of sale/transfer, interest and penalties will
apply. The interest rate is variable and determined per RCW 82.32.050. Delinquent penalties are 5% one month after the due date;
10% two months after the due date; and 20% three months after the due date. (RCW 82.45.100)
• State Technology Fee: A $5.00 Electronic Technology Fee is due on all transactions. (RCW 82.45.180)
• Affidavit Processing Fee: A minimum of $5.00 shall be collected in the form of tax and processing fee. A processing fee is due
on all transactions where no tax is due and on all taxable transactions where the tax due is less than $5.00. (RCW 82.45.180)
AUDIT
Information you provide on this form is subject to audit by the Department of Revenue. Underpayments of tax will result in
the issuance of a tax assessment with interest and penalties. Note: in the event of an audit, it is the taxpayers’
responsibility to provide documentation to support the selling price or any exemption claimed. This documentation must
be maintained for a minimum of four years from date of sale. (RCW 82.45.100)
RULING REQUESTS
You may request a ruling on the taxability of the property transfer. Go to our website at dor.wa.gov/rulings or fax your request to
360-705-6655.
WHERE TO SEND COMPLETED FORMS:
Completed forms must be submitted to the County Treasurer’s or Record’s Office where the property is located.
For tax assistance, contact your local County Treasurer/Recorder or visit https://dor.wa.gov or call 360-534-1503. To request this document in an alternate format, visit
https://dor.wa.gov or call 360-705-6705. Teletype (TTY) users may use the Washington Relay Service by calling 711.
REV 84 0003e (12/13/19)
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MOBILE HOME REAL ESTATE EXCISE TAX AFFIDAVIT (Thurston County, WA)

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Completed 18 July 2020

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