Real Estate Excise Tax Affidavit

PLEASE TYPE OR PRINT

REAL ESTATE EXCISE TAX AFFIDAVIT

CHAPTER 82.45 RCW – CHAPTER 458-61A WAC

This form is your receipt

when stamped by cashier.

THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED

(See back of last page for instructions)

□ Check box if partial sale, indicate % _____sold. List percentage of ownership acquired next to each name.

Name

Mailing Address

City/State/Zip

Phone No. (including area code)

Name

Mailing Address

City/State/Zip

Phone No. (including area code)

SELLER

GRANTOR

BUYER

GRANTEE

Send all property tax correspondence to:

Same as Buyer/Grantee

List all real and personal property tax parcel account

numbers – check box if personal property

List assessed value(s)

Name

Mailing Address

City/State/Zip

Phone No. (including area code)

Street address of property:

This property is located in

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.

Legal description of property (if more space is needed, you may attach a separate sheet to each page of the affidavit)

Select Land Use Code(s):

List all personal property (tangible and intangible) included in selling

enter any additional codes:

(See back of last page for instructions)

price.

If claiming an exemption, list WAC number and reason for exemption:

WAC No. (Section/Subsection)

Reason for exemption

Type of Document

Date of Document

Gross Selling Price $

*Personal Property (deduct) $

Exemption Claimed (deduct) $

Taxable Selling Price $

Excise Tax : State $

Local $

*Delinquent Interest: State $

Local $

*Delinquent Penalty $

Subtotal $

*State Technology Fee $

*Affidavit Processing Fee $

Total Due $

A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX

*SEE INSTRUCTIONS

YES NO

Was the seller receiving a property tax exemption or deferral under

chapters 84.36, 84.37, or 84.38 RCW (nonprofit organization, senior

citizen, or disabled person, homeowner with limited income)?

YES NO

Is this property designated as forest land per chapter 84.33 RCW?

Is this property classified as current use (open space, farm and

agricultural, or timber) land per chapter 84.34 RCW?

Is this property receiving special valuation as historical property

per chapter 84.26 RCW?

If any answers are yes, complete as instructed below.

(1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE)

NEW OWNER(S): To continue the current designation as forest land or

classification as current use (open space, farm and agriculture, or timber) land,

you must sign on (3) below. The county assessor must then determine if the

land transferred continues to qualify and will indicate by signing below. If the

land no longer qualifies or you do not wish to continue the designation or

classification, it will be removed and the compensating or additional taxes will

be due and payable by the seller or transferor at the time of sale. (RCW

84.33.140 or RCW 84.34.108). Prior to signing (3) below, you may contact

your local county assessor for more information.

This land does does not qualify for continuance.

DEPUTY ASSESSOR DATE

(2) NOTICE OF COMPLIANCE (HISTORIC PROPERTY)

NEW OWNER(S): To continue special valuation as historic property,

sign (3) below. If the new owner(s) does not wish to continue, all

additional tax calculated pursuant to chapter 84.26 RCW, shall be due and

payable by the seller or transferor at the time of sale.

(3) OWNER(S) SIGNATURE

PRINT NAME

I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.

Signature of

Grantor or Grantor’s Agent

Name (print)

Date & city of signing:

Signature of

Grantee or Grantee’s Agent

Name (print)

Date & city of signing:

Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years, or by

a fine in an amount fixed by the court of not more than five thousand dollars ($5,000.00), or by both imprisonment and fine (RCW 9A.20.020 (1C)).

REV 84 0001a (09/06/17) THIS SPACE - TREASURER’S USE ONLY COUNTY TREASURER

Select Location

Required (For Unincorporated locations please select your county)

If more space is

needed, attach

additional

sheets.

Select Land Use Codes

0.00

0.0000

0.00

5.00

10.00

Print This Form (all copies)

Please print on legal size paper.

Reset This Form

PLEASE NOTE: This completed document cannot be saved to your hard drive

without the full version of Adobe Acrobat. If you are not using the full version

of Adobe Acrobat, you must complete this form, then print.

INSTRUCTIONS

Note: To report a transfer of a controlling interest in real property, please use the Real Estate Excise Tax Affidavit Controlling Interest Transfer Return,

Revenue Form No. 84-0001B. This form is available online at http://dor.wa.gov.

Section 1:

Enter the name(s) of seller/grantor. This is the person(s) conveying interest in the property. If sale is less than 100%, check the box “Check if

partial sale” and fill in the percentage sold.

Section 2:

Enter the name(s) of buyer/grantee. This is the person(s) receiving interest in the property. List the percentage acquired after each name.

Section 3:

• E

nter the name and address where you would like all future property tax information sent.

• Enter the tax parcel number and current assessed value for real and personal property being conveyed. Check the box to indicate personal

property

Section 4:

• Enter the street address of the property

• Enter the county

if in unincorporated area. Enter city name if located within a municipality.

• Enter the legal description of the property

Section 5:

• Enter the appropriate land use

code for the property. Please list all codes that apply on the line

s provided in section 5.

See W

AC 458-53-030 (5) for a complete list.

 09 - Land with mobile home

 10 - Land with new building

 11 - Household, single family units

 12 - Multiple family residence (2-4 Units)

 13 - Multiple family residence (5 + Units)

 14 - Residential condominiums

 15 - Mobile home parks or cour

 16 -

Hotels/motels

 17 - Institutional Lodging

(convalescent

mes, nursing homes, etc.)

 18 - All other residential not coded

 19 - Vacation and cabin

 21 - Food and kindred products

 22 - Textile

mill products

 23 - Apparel and other finished

products made from fabrics,

leather, and similar materials

 24 - Lumber and wood prod

ucts

(ex

cept furniture)

 25 - Furniture and fixtures

 26 - Paper and allied products

 27 - Printing and publishing

 28 - Chemicals

 29 - Petroleum refining and related

industries

 30 - Rubber and mi

scellaneous

plastic pr

oducts

 31 - Leather and leather pr

oducts

 32 -

Stone, clay and glass products

 33 - Primary metal industries

 34 - Fabricated metal products

 35 - Professional scientific and controlling

instruments; photographic and optical

goods; watches/clocks manufacturing

 39 - Miscellaneous manufactur

ing

 50 -

Condominiums-other than residential

 53 - Retail Trade - general merc

handise

 54 - Retail Trade - food

 58 -

Retail trade - eating & dr

inking

(restau

rants, bars)

 59 -

Tenant occupied, commercial proper

ties

 64 -

Repair serv

ices

 6

5 - Professional services (medical, dental, etc.)

 71 - Cultural activities/nature exhibitions

 74 - Recreational activities (golf

courses, etc.)

 75 - Resorts and group camp

 80 -

Water or mineral ri

ght

 8

1 - Agriculture (not in current use)

 83 - Agriculture current use RCW 84.34

 86 - Marijuana grow operations

 87 - Sale of Standing Timber

 88 - Forest land designated RCW 84.33

 91 - Undeveloped Land (land only)

 94 - Open space land RCW 84.34

 95 - Timberland classified RCW 84.34

 96 - Improvements

on leased land

Section 6:

Indicate whether the property is designated as forest land per chapter 84.33 RCW, classified as current use (open space, farm, agricultural, or

timber) per chapter 84.34 RCW, or receiving special valuation as historic property per chapter 84.26 RCW.

Section 7:

 List personal property included in the selling price of the real property. For example, include tangible (furniture, equipm

ent, etc) and

intangible (goo

dwill, agreement not to compet

e, etc).

 Use Tax is due

on personal property purchased without payment of the sales tax. Use Tax may be reported on your Combin

ed Excise Tax

Return or a Consumer Use Tax Return, both available at http://dor.wa.gov.

 If you are claiming a tax exemption, cite the specific Washington Administrative Code (WAC) number, section and subsection and

provide a brief explanatio

n. Most tax exemptions require specific documentation. Refer to the appropriate WAC to determin

docu

mentation requirements. Chapter 458-61A WAC is available online at http://dor.wa.gov

 Enter the type of

document (quit claim deed, statutory warranty deed, etc.), and date of document (MM/DD/YYY

 Enter the selling price of the property

 Selling price: For tax purposes, the selling price is the true and fair value of the property conveyed. When property is conveyed in an arm’s

length transaction between unrelated persons for valuable consideration, there is a presumption that the selling price is equal to the total

consideration paid or contracted to be paid, including any indebtedness. Refer to RCW 82.45.030 for more information about selling pric

 Deduct the a

mount of personal property included in the sell

ing price.

 Deduct the a

mount of tax exemption claimed per chapter 458-61A WAC

 Due Date, I

nterest and Penalties: Tax is due at the time of sale/transfer. If tax is not paid within one mo

nth of the date of sale/transfer,

interest and penalties will apply. The interest rate is variable and determined per RCW 82.32.050. Delinquent penalties are 5% one month

after the due date; 10% two

months after the due date; and 20% three months after the due date. (RCW 82.45.100

)

 Stat

e Technology Fee: A $5.00 Electronic Technology Fee that is due on all transactions. (82.45.180

)

 Affidavit Process

ing Fee: A minimum of $5.00 shall be collected in the form of tax and processing fee. A processing fee is due on a

tran

sactions where no tax is due and on all taxable transactions where the tax due is less than $5.00. (RCW 82.45.180

)

Section 8:

Both grantor (seller) and grantee (buyer), or the agent of each, must sign this form, certifying that all the information provided is correct. Note:

Original signatures required on the “County Treasurer” copy. Signatures may be required on the “Assessors” copy. Check with your county.

Audit:

Information you provide on this form is subject to audit by the Department of Revenue. Underpayments of tax will result in the issuance of a tax

assessment with interest and penalties. Note: in the event of an audit, it is the taxpayers’ responsibility to provide documentation to support the

selling price or any exemption claimed. This documentation must be maintained for a minimum of four years from date of sale. (RCW

82.45.100)

Ruling requests:

You may request a ruling on the taxability of the property transfer. Go to our website at dor.wa.gov/rulings or fax your request to

(360) 705-6655.

Where to send

completed forms:

Completed forms must be submitted to the County Treasurer's or Recorder’s Office where the property is located.

For tax assistance, contact your local County Treasurer/Recorder or visit dor.wa.gov/reet. To ask about the availability of this publication in an alternate format for the

visually impaired, please call 360-705-6705. Teletype (TTY) users may use the WA Relay Service by calling 711.

REV 84 0001a inst. (09/06/17)