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Department of Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
<br /> Revenue`V- Only for sales in a single location code on or after January 1,2020.
<br /> Washington State This affidavit will not be accepted unless all areas on all pages are fully completed.
<br /> Form 84 000la This form is your receipt when stamped by cashier.Please type or print.
<br /> 0 Check box if the sale occurred in more than one location code. ❑Check box if partial sale,indicate% sold.
<br /> List percentage of ownership acquired next to each name.
<br /> 1 Seller/Grantor 2 Buyer/Grantee
<br /> Name City of Everett, Name Everett Museum of History,
<br /> Mailing address Real Property Manager,3200 Cedar Street Mailing address Barbara George,Everett Museum of History PO BOX 5556
<br /> City/state/zip Everett,WA 98201 City/state/zip Everett,WA 98206
<br /> Phone(including area code) Phone(including area code)
<br /> 3 List all real and personal property tax Personal Assessed
<br /> Send all property tax correspondence to: Same as Buyer/Grantee parcel account numbers property? value(s)
<br /> Name 00-4391-434-017-00
<br /> ❑ $666,500.00
<br /> Mailing address ❑❑
<br /> City/state/zip
<br /> 4 Street address of property 2130 Colby Avenue,Everett,WA 98201
<br /> This property is located in I City of Everett I (for unincorporated locations please select your county)
<br /> 0 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.
<br /> Legal description of property(if you need more space,attach a separate sheet to each page of the affidavit).
<br /> SEE ATTACHED EXHIBIT A
<br /> 5 111 7 List all personal property(tangible and intangible)included in selling price.
<br /> Enter any additional codes
<br /> (see back of last page for instructions)
<br /> Was the seller receiving a property tax exemption or deferral
<br /> under RCW 84.36,84.37,or 84.38(nonprofit org.,senior If claiming an exemption,list WAC number and reason for exemption.
<br /> citizen or disabled person,homeowner with limited
<br /> income)? [ ]Yes [x]No WAC number(section/subsection) 458-61A-205(2)
<br /> Is this property predominantly used for timber(as classified Reason for exemption
<br /> under RCW 84.84 and 84.33)or agriculture(as classified
<br /> under RCW 84.34.020)?See ETA 3215. [ ]Yes [x]No Government Seller
<br /> If yes,complete the predominate use calculator(see instructions for Donation
<br /> section 5).
<br /> 6 Is this property designated as forest land per RCW
<br /> 84.33? [ ]Yes [x]No
<br /> Is this property classified as current use(open space,farm Type of document Quit Claim Deed
<br /> and agricultural,or timber)land per RCW 84.347 [ ]Yes [x]No Date of document December 22nd 2021
<br /> Is this property receiving special valuation as historical Gross selling price $0.00
<br /> property per RCW 84.26? [ ]Yes [x]No *Personal property(deduct)
<br /> if any answers are yes,complete as instructed below. Exemption claimed(deduct)
<br /> (1) NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Taxable selling price $0.00
<br /> NEW OWNER(S):To continue the current designation as forest land
<br /> or classification as current use(open space,farm and agriculture,or Excise tax:state $0.00
<br /> timber)land,you must sign on(3)below.The county assessor must then determine if the Less than$500,000.01 at 1.1% $0.00
<br /> land transferred continues to qualify and will indicate From$500,000.01 to$1,500,000 at 1.28% $0.00
<br /> by signing below.If the land no longer qualifies or you do not wish to From$1,500,000.01 to$3,000,000 at 2.75% $0.00
<br /> continue the designation or classification,it will be removed and the compensating or Above$3,000,000 at 3% $0.00
<br /> additional taxes will be due and payable by the seller
<br /> or transferor at the time of sale(RCW 84.33.140 or 84.34.108).Prior to
<br /> signing(3)below,you may contact your local county assessor for more information. Agricultural and timberland at 1.28% $0.00
<br /> This land: ❑ does ❑ does not qualify for
<br /> continuance. Total excise tax:state $0.00
<br /> Local $0.00
<br /> Deputy assessor signature Date *Delinquent interest:state $0.00
<br /> Local $0.00
<br /> (2) NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent penalty $0.00
<br /> NEW OWNER(S):To continue special valuation as historic property,sign Subtotal $0.00
<br /> )below.If the new owner(s)doesn't wish to continue,all additional tax calculated pursuant
<br /> to RCW 84.26,shall be due and payable by the seller or transferor at the time of sale. *State technology fee $5.00
<br /> (3)NEW OWNER(S)SIGNATURE Affidavit processing fee $5.00
<br /> Total due $10.00
<br /> Signature Signature A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX
<br /> Office of the City Attorney *SEE INSTRUCTIONS
<br /> Print APPROVED AS TO FORM Print name
<br /> David C.Hall,CityAttorney
<br /> 8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
<br /> Signature of grantor or agent Signature of grantor or agent
<br /> Name(print) City of Everett by Cassie Franklin,Mayor Name(print) Barbara George,Everett Museum of History
<br /> Date&city of signing Date&city of signing
<br /> 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
<br /> amount fixed by the court of not more than$10,000,or by both such confinement and fine(RCW 9A.72.030 and RCW 9A.20.021(1)(c)).
<br /> To ask about the availability of this publication in an alternate format for the visually impaired,please call 360-705-6705.Teletype(TTY)
<br /> users may use the WA Relay Service by calling 711.
<br /> REV 84 0001a(11/06/2020) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER
<br /> Print on legal size paper.
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