PDF Mobile Home Real Estate Excise Tax Affidavit

MOBILE HOME REAL ESTATE EXCISE TAX AFFIDAVIT

Submit to County Treasurer of the

Chapter 82.45 RCW

county in which property is located.

Chapter 458-61A WAC

FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY

PLEASE TYPE OR PRINT INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED

Name

Name

Reset This Form

This form is your receipt when stamped by cashier.

NEW REGISTERED OWNER (Buyer)

REGISTERED OWNER (Seller)

Street City Phone number Name

State

Zip code

Street City Phone number Name

State

Zip code

LEGAL OWNER

LOCATION OF MOBILE HOME

Street City

PERSONAL PROPERTY PARCEL or ACCOUNT NO.

LIST ASSESSED VALUE(S): $

MAKE

YEAR

State

Zip code

MODEL

Street City

State

Zip code

REAL PROPERTY PARCEL or ACCOUNT NO.

LIST ASSESSED VALUE(S): $

SIZE

SERIAL NO. or I.D.

REVENUE TAX CODE NO.

Date of Sale

Taxable Sale Price ............................................ $

Excise Tax: State...........................................$

0.00

Select Location

Local.......................................... $

0.00

Delinquent Interest: State...............................$

0.00

Local .............................. $ Delinquent Penalty ........................................... $ Subtotal ............................................................ $ State Technology Fee ....................................... $ Affidavit Processing Fee...................................$ Total Due .......................................................... $

0.00 0.00 0.00

5.00 5.00 10.00

If exemption claimed, WAC number & title: WAC No. (Sec/Sub) WAC Title

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

AFFIDAVIT I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signature of Seller/Agent

Name (print) Date and Place of Signing:

Signature of Buyer/Agent Name (print)

Date & Place of Signing:

TREASURER'S CERTIFICATE

I hereby certify that property taxes due

County on the mobile home described hereon have been paid to and

including the year

.

If, in selling (or otherwise transferring ownership of) a mobile home which possesses a tax lien, the seller does not inform the buyer (new owner) of such a lien, the seller is guilty of deliberate deception as it applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW 9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).

Date

County Treasurer or Deputy

THIS SPACE - TREASURER'S USE ONLY

REV 84 0003e (6/25/19) COUNTY TREASURER

Print This Form

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MOBILE HOME REAL ESTATE EXCISE TAX AFFIDAVIT

Submit to County Treasurer of the county

Chapter 82.45 RCW

in which property is located.

Chapter 458-61A WAC

FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY

PLEASE TYPE OR PRINT INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED

Name

Name

This form is your receipt when stamped by cashier.

NEW REGISTERED OWNER (Buyer)

REGISTERED OWNER (Seller)

Street City Phone number Name

State

Zip code

Street City Phone number Name

State

Zip code

LEGAL OWNER

LOCATION OF MOBILE HOME

Street City

PERSONAL PROPERTY PARCEL or ACCOUNT NO.

LIST ASSESSED VALUE(S): $

MAKE

YEAR

State

Zip code

MODEL

Street City

State

Zip code

REAL PROPERTY PARCEL or ACCOUNT NO.

LIST ASSESSED VALUE(S): $

SIZE

SERIAL NO. or I.D.

REVENUE TAX CODE NO.

Date of Sale

Taxable Sale Price ............................................ $ Excise Tax: State...........................................$ Select Location Local..........................................$ Delinquent Interest: State...............................$

Local .............................. $ Delinquent Penalty ........................................... $ Subtotal ............................................................ $ State Technology Fee ....................................... $

0.00 0.00 0.00 0.00 0.00 0.00 5.00

Affidavit Processing Fee...................................$

5.00

Total Due .......................................................... $

10.00

If exemption claimed, WAC number & title: WAC No. (Sec/Sub) WAC Title

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

AFFIDAVIT I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signature of Seller/Agent

Name (print) Date and Place of Signing:

Signature of Buyer/Agent Name (print)

Date & Place of Signing:

TREASURER'S CERTIFICATE

I hereby certify that property taxes due

County on the mobile home described hereon have been paid to and

including the year

.

If, in selling (or otherwise transferring ownership of) a mobile home which possesses a tax lien, the seller does not inform the buyer (new owner) of such a lien, the seller is guilty of deliberate deception as it applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW 9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).

Date

County Treasurer or Deputy

THIS SPACE - TREASURER'S USE ONLY

REV 84 0003e (6/25/19) COUNTY ASSESSOR

MOBILE HOME REAL ESTATE EXCISE TAX AFFIDAVIT

Submit to County Treasurer of the county

Chapter 82.45 RCW

in which property is located.

Chapter 458-61A WAC

FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY

PLEASE TYPE OR PRINT INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED

Name

Name

This form is your receipt when stamped by cashier.

NEW REGISTERED OWNER (Buyer)

REGISTERED OWNER (Seller)

Street City Phone number Name

State

Zip code

Street City Phone number Name

State

Zip code

LEGAL OWNER

LOCATION OF MOBILE HOME

Street City

PERSONAL PROPERTY PARCEL or ACCOUNT NO.

LIST ASSESSED VALUE(S): $

MAKE

YEAR

State

Zip code

MODEL

Street City

State

Zip code

REAL PROPERTY PARCEL or ACCOUNT NO.

LIST ASSESSED VALUE(S): $

SIZE

SERIAL NO. or I.D.

REVENUE TAX CODE NO.

Date of Sale

Taxable Sale Price ............................................ $

Excise Tax: State...........................................$

0.00

Select Location

Local.......................................... $

Delinquent Interest: State...............................$

Local .............................. $

Delinquent Penalty ........................................... $

Subtotal ............................................................ $

State Technology Fee ....................................... $

0.00 0.00 0.00 0.00 0.00 5.00

Affidavit Processing Fee...................................$ Total Due .......................................................... $

5.00 10.00

If exemption claimed, WAC number & title: WAC No. (Sec/Sub) WAC Title

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

AFFIDAVIT I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signature of Seller/Agent

Name (print) Date and Place of Signing:

Signature of Buyer/Agent Name (print)

Date & Place of Signing:

TREASURER'S CERTIFICATE

I hereby certify that property taxes due

County on the mobile home described hereon have been paid to and

including the year

.

If, in selling (or otherwise transferring ownership of) a mobile home which possesses a tax lien, the seller does not inform the buyer (new owner) of such a lien, the seller is guilty of deliberate deception as it applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW 9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).

Date

County Treasurer or Deputy

THIS SPACE - TREASURER'S USE ONLY

REV 84 0003e (6/25/19) DEPT. OF REVENUE

MOBILE HOME REAL ESTATE EXCISE TAX AFFIDAVIT

Submit to County Treasurer of the county

Chapter 82.45 RCW

in which property is located.

Chapter 458-61A WAC

FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY

PLEASE TYPE OR PRINT INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED

Name

Name

This form is your receipt when stamped by cashier.

NEW REGISTERED OWNER (Buyer)

REGISTERED OWNER (Seller)

Street City Phone number Name

State

Zip code

Street City Phone number Name

State

Zip code

LEGAL OWNER

LOCATION OF MOBILE HOME

Street City

PERSONAL PROPERTY PARCEL or ACCOUNT NO.

LIST ASSESSED VALUE(S): $

MAKE

YEAR

State

Zip code

MODEL

Street City

State

Zip code

REAL PROPERTY PARCEL or ACCOUNT NO.

LIST ASSESSED VALUE(S): $

SIZE

SERIAL NO. or I.D.

REVENUE TAX CODE NO.

Date of Sale

Taxable Sale Price ............................................ $

Excise Tax: State...........................................$

Select Location

Local.......................................... $

Delinquent Interest: State...............................$

Local .............................. $

Delinquent Penalty ........................................... $

Subtotal ............................................................ $

State Technology Fee ....................................... $

Affidavit Processing Fee...................................$

Total Due .......................................................... $

0.00 0.00 0.00 0.00 0.00 0.00 5.00 5.00 10.00

If exemption claimed, WAC number & title: WAC No. (Sec/Sub) WAC Title

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

AFFIDAVIT I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signature of Seller/Agent

Name (print) Date and Place of Signing:

Signature of Buyer/Agent Name (print)

Date & Place of Signing:

TREASURER'S CERTIFICATE

I hereby certify that property taxes due

County on the mobile home described hereon have been paid to and

including the year

.

If, in selling (or otherwise transferring ownership of) a mobile home which possesses a tax lien, the seller does not inform the buyer (new owner) of such a lien, the seller is guilty of deliberate deception as it applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW 9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).

Date

County Treasurer or Deputy

THIS SPACE - TREASURER'S USE ONLY

REV 84 0003e (6/25/19) COUNTY AUDITOR/ LICENSING AGENT

MOBILE HOME REAL ESTATE EXCISE TAX AFFIDAVIT

Submit to County Treasurer of the county

Chapter 82.45 RCW

in which property is located.

Chapter 458-61A WAC

FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY

PLEASE TYPE OR PRINT INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED

Name

Name

This form is your receipt when stamped by cashier.

NEW REGISTERED OWNER (Buyer)

REGISTERED OWNER (Seller)

Street City Phone number Name

State

Zip code

Street City Phone number Name

State

Zip code

LEGAL OWNER

LOCATION OF MOBILE HOME

Street City

PERSONAL PROPERTY PARCEL or ACCOUNT NO.

LIST ASSESSED VALUE(S): $

MAKE

YEAR

State

Zip code

MODEL

Street City

State

Zip code

REAL PROPERTY PARCEL or ACCOUNT NO.

LIST ASSESSED VALUE(S): $

SIZE

SERIAL NO. or I.D.

REVENUE TAX CODE NO.

Date of Sale

Taxable Sale Price ............................................ $

Excise Tax: State...........................................$

0.00

Select Location Local..........................................$

0.00

Delinquent Interest: State...............................$

0.00

Local .............................. $

0.00

Delinquent Penalty ........................................... $ Subtotal ............................................................ $ State Technology Fee ....................................... $ Affidavit Processing Fee...................................$ Total Due .......................................................... $

0.00 0.00 5.00 5.00 10.00

If exemption claimed, WAC number & title: WAC No. (Sec/Sub) WAC Title

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

AFFIDAVIT I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signature of Seller/Agent

Name (print) Date and Place of Signing:

Signature of Buyer/Agent Name (print)

Date & Place of Signing:

TREASURER'S CERTIFICATE

I hereby certify that property taxes due

County on the mobile home described hereon have been paid to and

including the year

.

If, in selling (or otherwise transferring ownership of) a mobile home which possesses a tax lien, the seller does not inform the buyer (new owner) of such a lien, the seller is guilty of deliberate deception as it applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW 9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).

Date

County Treasurer or Deputy

THIS SPACE - TREASURER'S USE ONLY

REV 84 0003e (6/25/19) TAXPAYER

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