6829 BEVERLY BLVD 2022-04-04 - Laserfiche WebLink

Mail Completed Form To: • Washington State C Washington State Departm nt of Revenue irenea Department of Revenue Real Estate Excise Tax Affidavit Special Programs Division Controlling Interest Transfer Return PO Box 47464 Chapter 82.45 RCW-CHAPTER 458-61A WAC Olympia,WA 98504-7464 This form must be used for reporting transfers of controlling interest and for buyer disclosure to the Department of Revenue.(Use Form No.84-0001 A for reporting transfers by deed or real estate contract to the county treasurer/recorder of the county in which the real property is located.) 0 TRANSFEROR © TRANSFEREE (Attach a list for multiple transferors including percentage sold) (Attach a list for multiple transferees including percentage bought) Name Tax Deferred Exchange Services.Inc. NameOwen Owens and Jacqueline Owens Street 3906 S 74th St Street P.O.Box 12922 City Tacoma State WA Zip 98409 City Mill Creek State WA Zip 98082 Tax Registration Number 601223761 Tax Registration Number - Federal Identifier Number 91-146848 Federal Identifier Number 531-44-4784 Percent of Entity Ownership Sold 100 % Percent of Entity Ownership Purchased 1 nn% AFFIDAVIT AFFIDAVIT I certify under penalty of perjury under the laws of the state of I certify under penalty of perjury under the laws of the state of Washington that the information on is return is true and correct. Washington that the information on this return is true and correct STgnsfro/ Tgnsfreof J Transferor/Agent Transferee/Agent f'/_/d7 „, , Name(print) Susy Heathetl_ ice President ' Name(print) /1/ Date&Place of Signing fj JI qj1 Date&Place of Signing Telephone Number 253-383-1200 Telephone Number ElName and address of entity whose ownership was transferred: Type of entity(check one): Name TDES33011,LLC 0 Corporation Street 3906 S 74th St ❑ Partnership City Tacoma State WA Zip 98409 ❑ Trust Tax Registration Number 604 392 623 2 Limited Liability Company Federal Identifier Number - © Attach a list of names,addresses,and relationships of all entities affected by this transfer. ill REAL PROPERTY VALUES:for on-line tax computation,fields A,B,and C are required. A. Select location. For assistance finding a location,use the link below. http://dor.wa.gov/content/findtaxesandrates/sal esandusetaxrates/lookupataxrate/ B. Enter County Tax Parcel number. C. Enter the True&Fair Value of real property. (RCW 82.45.030(2)) D. True&Fair Value x State Rate E. True&Fair Value x Local Rate F. Add D&E to get Subtotal A. Local B. C. D. E. F. Location City/County County Tax Parcel True&Fair Value State Excise Tax Local Subtotal Tax Rate No. Rate(.0128) City/County Tax 3105-Everett 280507-001-022-00 291,600 0.00 0.00 $0.00 Select Location 0.00 0.00 $0.00 Select Location 0.00 0.00 $0.00 Select Location 0.00 0.00 $0.00 Select Location 0.00 0.00 $0.00 Select Location 0.0025 0.00 0.00 $0.00 Select Location 0.0025 0.00 0.00 $0.00 Select Location 0.0025 0.00 0.00 $0.00 Select Location 0.0025 0.00 0.00 $0.00 Select Location 0.0025 0.00 0.00 $0.00 Select Location 0.0025 0.00 0.00 $0.00 © TAX COMPUTATION: 1. Enter total tax due on line 1.If you owe interest or penalties enter the respective amounts in line 2 and 3.(RCW 82.45.100) 2. Sum the total of lines 1-3 to Total Due. 3. If you need assistance in completing this form,please contact the Special Programs Division, Department of Revenue at 360-534-1503. 4. Make check or money order payable to Washington State Department of Revenue. Date of Transfer 7/24/2019 *If tax exemption is claimed,provide reference to WAC Title and Number below* Click here for a complete list of acceptable exemptions.(please click on additional links provided for fimlher details on each WAC) If you conclude that one of these exemptions applies to you please reference the Title and WAC number here. 458-61 A-213(3) If you are claiming a gift exemption under WAC 458-61A-201 you must include a completed Real Estate Excise Tax Supplemental Statement. Department of Revenue Use Only 1.Tax $0.00 2.Delinquent Interest 3.Delinquent Penalty TOTAL DUE $0.00 cnanm 6I t2 Norma.CPPlnfnrmatinnUnReverse