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,—Signed ar:
<br />Department of
<br />Revenue
<br />Washington State
<br />Form 84 0001a
<br />Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
<br />Only for sales in a single location code on or after April 1, 2025.
<br />This affidavit will not be accepted unless all areas on all pages are fully and accurately completed.
<br />This form is your receipt when stamped by cashier. Please type or print.
<br />❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name.
<br />1 Seller/Grantor 2 Buyer/Grantee
<br />Name Charlotte E. Walker, a single person, as a separate estate Name City of Everett, a Washington municipal corporation
<br />Mailing address 505 S Green island Way
<br />City/state/zip Stanwood, WA 98292
<br />Phone (including area code) 1425) 319-0165
<br />3 Send all property tax correspondence to: [X] Same as Buyer/Grantee
<br />Name
<br />Mailing address
<br />City/state/zip
<br />4 Street address of property 3310 Paine Avenue, Everett, WA 98201
<br />Mailing address C/O Real Property Manager 802 E. Mukliteo 8lvd.,
<br />City/state/zip Everett, WA 98203
<br />Phone (including area code) (425) 257-8737
<br />List all real and personal property tax Personal
<br />parcel account numbers property?
<br />00-4390-797-026-00
<br />00010
<br />o
<br />Assessed
<br />value(s)
<br />$1,192,000.00
<br />This property Is located in City of Everett I (for unincorporated locations please select your county)
<br />❑ 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 Land use code 637
<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, or84.38 (nonprofit org., senior
<br />citizen or disabled person, homeowner with limited
<br />Income)? [ ] Yes I x ] No
<br />Is this property predominantly used for timber (as classified
<br />under RCW 84.84 and 84.33) or agriculture (as classified
<br />under RCW 84.34.020) and will continue in it's current
<br />use? If yes and the transfer involves multiple parcels with
<br />different classifications, complete the predominated use
<br />calculator (see instructions) [ ] Yes [ x ] No
<br />6 is this property designated as forest land per RCW
<br />84.337 [ ]Yes [x]No
<br />Is this property classified as current use (open space, farm
<br />and agricultural, or timber) land per RCW 84.347 [ ] Yes I x ] No
<br />Is this property receiving special valuation as historical
<br />property per RCW 84.26? [ ]Yes [x]No
<br />If any answers are yes, complete as instructed below.
<br />11) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENrusE)
<br />NEW OWNER(S): To continue the current designation as forest land
<br />or classification as current use (open space, farm and agriculture, or
<br />timber) land, you must sign on (3) below. The county assessor must then determine if the
<br />land transferred continues to qualify and will Indicate
<br />by signing below. d the land no longer qualifies or you do not wish to
<br />continue the designation or classification, h will be removed and the compensating or
<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.
<br />This land: ❑ does ❑ does not qualify for
<br />continuance.
<br />Deputy assessor signature Date
<br />12) NOTICE OF COMPLIANCE IHISTORIC PROPERTYI
<br />NEW OWNERIS): To continue special valuation as historic property, sign
<br />(3)belaw. If the new owneris) 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.
<br />{3) NEW OWNER(5) SIGNATURE
<br />Signature Signature
<br />Pint name Print name
<br />7 List all personal property (tangible and Intangible) Included in selling price.
<br />2t26/(�
<br />If claiming an exemption, enter exemption code and reason for
<br />exemption. `See dor.wa.gov/REET for exemption codes*
<br />Exemption No. (sec/sub)
<br />Reason for exemption
<br />Type of document
<br />Date of document
<br />Statutory Warranty Deed
<br />Gross selling price
<br />`Personal property (deduct)
<br />Exemption claimed (deduct)
<br />Taxable selling price
<br />Excise tax: state
<br />Less than $525,000.01 at 1.1%
<br />From $525,000.01 to $1,525,000 at 1.28%
<br />From $1,525,000.01 to S3,025,000 at 2.7596
<br />Above $3,025,000 at 3%
<br />Agricultural and timberland at 1.28%
<br />Total excise tax: state
<br />Local
<br />'Delinquent interest: State
<br />Local
<br />'Delinquent penalty
<br />Subtotal
<br />' State technology fee
<br />Affidavit processing fee
<br />Total due
<br />$2,550,000.00
<br />$2,550,000.00
<br />$5,775.00
<br />$12,800.00
<br />$28,187.50
<br />$46,762.50
<br />$12,750.00
<br />$59,512.50
<br />$5.00
<br />A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
<br />` SEE INSTRUCTIONS
<br />8 1 CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
<br />Signature of grantor or agent Signature of grantee 2or agent vsx^XI'tC
<br />Name (print) Charlotte E. Walker _ Name (print) f?_ tj °C0"'0"d-
<br />Date & city of signing Date & city of signing 01/08/26 Everett WA
<br />Perjury In the second degree is a class Cfelony 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 510,000, 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 (3/17/25) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER
<br />$59,517.50
<br />Print on legal size paper.
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