1)
NAME(S) NAME(S)
MAILING ADDRESS
MAILING ADDRESS
CITY/ STATE/ ZIP
CITY/ STATE/ ZIP
3)
No. OF STRUCTURES
ON PROPERTY
4b)
ABBREVIATED LEGAL DESCRIPTION
*ATTACH COPIES OF FULL LEGAL DESCRIPTION, DEED, AND EXHIBITS WITH AFFIDAVIT
APPROXIMATE
SIZE OF PROPERTY
SELLER/GRANTOR SHALL PAY $ ____________
OF CURRENT AND/OR PAST DUE LOUT
$
$
$
Signature
Date
Specify:
Address of residence or place of business of person signing:
2)
Return complete and notarized affidavits, payment,
and required and/or supplemental documents to:
TULALIP TAX & LICENSING DIVISION
6406 MARINE DR - TULALIP, WA 98271
REAL ESTATE EXCISE TAX AFFIDAVIT
Additional information on reverse
SELLER/
GRANTOR
BUYER/
GRANTEE
PROPERTY
INFORMATION
PROPERTY
LOCATION
SNO CO TAX PARCEL No., IF ANY
PROPERTY ADDRESS
CITY/STATE/ZIP
4a)
PROPERTY TAX &
USE INFORMATION
$
CURRENT No.
OF RESIDENTS
PROPOSED No.
OF RESIDENTS
_____________________
_____________________
_____________________
_____________________
Reserved
for
Official Tax
Stamp
Initial Date
Grantor Other:
/
Affix
Notary
Seal
AFFIDAVIT
THE STATEMENTS MADE HEREIN ARE MADE UNDER OATH WITH THE INTENT THAT
THEY BE RELIED ON AS SWORN STATEMENTS. A FALSE STATEMENT IS PUNISHABLE.
/ /
Sale or Conveyance Date
Type of instrument
Gross Sale Price
1% of Gross Sale Price
Interest Due for Late Payment
TOTAL REET DUE
SEE REVERSE SIDE FOR ASSISTANCE
5)
Uses
Current property use:
b.
6b)
Request for Tax Credit - Determination
A "tax credit" is being claimed pursuant to TTC 12.20.100 wherein a
single family residence (SFR), for which the REET was paid, is now
being transferred in consideration for the purchase of another SFR,
and such transfer shall occur nine (9) months or less after the first
transfer. A credit for the amount of the tax paid at the time of the
first transfer to the other party is requested to be herein credited toward
the amount of tax due on the subsequent transfer. The first transfer
occurred on _____/_____/_____, in the amount of $ ____________, and
is recorded via Tulalip REET affidavit no. 2019-_______.
*If the tax now due is greater than the tax paid previously, the
difference must be remitted to the Tulalip Tax & Licensing Division.
6a)
Indicate reason for claiming this transaction is exempt from tribal and/
or federal law and submit proof of exemption claim and tax payment
with affidavit.
Request for Exemption Determination
1. _____ The land is being sold by or to the Tulalip Tribes of
Washington.
2. _____ The land is being sold by or to the United States in
trust for the Tulalip Tribes of Washington or an Indian Person(s).
3. _____ The property is subject to a restriction on alienation,
imposed bythe UnitedStates.
4. The property is being sold by the State of Washington.
5. _____ The property is being transferred via gift, devise, or
inheritance.
6. _____ The real property being transferred is otherwise excluded
from taxation by Tulalip Real Estate Excise Tax Code, Title
12.20, Section __________ for the following reason(s):
LAND OCCUPATION USE TAX - ANNUAL RATE: $ __________
Water Sewer
Grantor's Agent
/
2019 Taxes Due: $ ____________ Past Due Taxes: $ ____________
Acct:
Total Due: $ ____________
N/A
7) Transfer Document Enclosed
c. Current water and sewer source:
Tulalip
Sewer Both
d. Current power sources:
Marysville
REET IS DUE AT THE THE TIME OF SALE.
SUBMIT TWO ORIGINAL NOTARIZED AFFIDAVITS.
The foregoing affidavit was acknowledged and
subscribed before me on this _____ day of
_____________ 20___ in the State of _____, County
of _____________ by _________________________.
Printed Name
CurrentDeliquent
BUYER/GRANTEE SHALL PAY $ ____________
OF CURRENT AND/OR PAST DUE LOUT
INCOMPLETE FILINGS WILL BE RETURNED &
SUBJECT TO PENALTY FEES.
Individual
(private)
Source
Well Septic
Community
Water Assoc./
Shared Source
Well Septic
Water Both
Natural Gas PUD
Renewable: __________
CHECK ALL THAT APPLY
Vacant land - no connection/ source
Natural Gas
Yes- Lessor number and name(s)
Wood/Pellet StoveElectricity
of Postmark Delivery
/ /
Proposed uses including any division of the property for future sale or use:
Notary Public Signature
Telephone No.
e. Current heat source:
f.
Land lease:
No
a.
TDS-28432 02-19
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