7502 EVERGREEN WAY 1ST INTERSTATE BANK 2018-01-02 MF Import

LTJ Cyyd Iy� gSyy�y. tH�H CA (Hl� x oHt7 MRS �r n ZH r, 01 / � DO a0Ca ROTA I Submit 10County Tre.memofthe �"•'' REAL ESTATE EXCISE TAX county In which property is located. CHAPTER 82.45 RCW PLEASE TYPE OR PRINT CHAPTER 458-61 WAC THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ITEMS Q THROUGH Q ARE Name NEW OWNEWS Nam. _ PERMANENT ADDRESS j FOR ALL PROPERTY Street 1 TAX RELATED CORRESPONDENCE Cityl Stale I Street Zip This form Is your receipt when slompnd by cashier. Pay by cash .r cunilled check to County Treasurer. ALL TAX PARCEL NUMBERS LEGAL CESCRIPTION OF PROPERTY SITUATED IN UNINCORPORATED COUNTY ❑ OR IN CITY OF Is the property currently: YES NO Classified or designated as forest land? ❑ ❑ Chapter 84.33 RCW Classified as current use land (open space, farm and agricultural. Chapter 84.34 RCW or rimber)7❑ ❑ Exempt from property tax unuer Chapter El ❑ 84.36 RCW7 (nonprofit organizations) Receiving special valuation as historic El ❑ property under Chapter 449, Laws of 19857 Type Property: []land only ❑ land with new building ❑ land with previously ❑ land with mobile home used building SEE TAX OBLIGATIONS ON REVERSE SIDE (U NOTICE OF CONTINUANCE (RCW 84.33 or RCW 84.34) If the new owner(s) of land that Is classified or designated as current use or forest land wish(es) to continue the classification or designation of such land, the new owner(s) must sign below. II the new owner(s) doles) not desire to continue such classification or designation, all compensating or additional lax calculated pursuant to RCW 84.33A20 and 140 or RCW 84.34.100 shall be due and payable by the seller or transferor at the time of sale. To determine it the land transferred qualifies to continue classification or tlesignalion, the county assessor must be consulted. All new owners must sign. This land ❑ does ❑ doesnolqualily n rorconlinuance. oerury assssso (2) NOTICE OF COMPLIANCE (Chapter 449, Laws of 1985) II the new owner(s) of properly with special valuation as historic property wish(es) to continue this special valuation the now owner(s) must sign below. If the new owner(s) doles) not desire to continue such special valuation, all addi- tional tax calculated pursuant to Chapter 449, Laws of 1985, shall be due and payable by the seller or transistor at the time of sale. (3) OWNER(S) SIGNATURE g The following optional questions are requested by RCVI 82.45.120 Is property at the time Lf sale: a. Subject to elderly, disability, or physical improvement I ❑ 2 ❑ exemption? Is. Does building, i! any, have a heat pump or solar 1 El 2 ❑ heating or cooling system? c. Does this conveyance divide a current parcel of land? 1 ❑ 2 ❑ d. Does sale include current crop or merchantable 1❑ 2❑ timber? Description of personal property if included in sale (furniture, ap. pliances, etc.) If exemption claimed, explain — Type of Document Dale of Sale or Conveyance — Gross Sale Price I I Personal Property (deduct) 2/ 4 Taxable Sale Price 8 Excise Tax Stale3/ I Local 4/ Delinquent Penalty 5/ 3 Total Tax Due 9 (SEE 1-5 ON REVERSE SIDE) AFFIDAVIT I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT (see #6 on reverse for penalties). NAME (print): DATE A PLACE OF SIGNING: SPECIFY (circle): grantor/grant eo/grantor's agent/grantee's agent Address of residence or place of business of person signing (specily): e. Does conveyance involve a trade,partial interest corporate affiliates, related parties, bust, receivership or an estate? 1. Is the grantee acting as a nominee for a third party? g. Principal use: 1 ❑ agricultural 2 ❑ condominium 4 ❑ apt (4+Units) 5 ❑ industrial 7 ❑ commercial 8 ❑ mobile home FOR TREASURER'S USE ONLY 1❑ 2❑ 1❑ 2❑ 3 ❑ recreational 6 ❑ residential 9 ❑ limber 4' FOPM REV E4 0000 (Rev. Islas) .405- i6323i °titlT FJ2, K CINE TAXPAYER a