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Home My WebLink About*Other - Public WorksGRANT COUNTY COMMISSIONERS AGENDA MEETING REQUEST FORM (Must be submitted to the Clerk of the Board by 12:00pm on Thursday) REQUESTING DEPARTMENT: PUBLIC WORKS DATE:08/14/24 REQUEST SUBMITTED BY: SHILo NELLIS PHONE:509-754-6082 CONTACT PERSON ATTENDING ROUNDTABLE: SAVE BREN CONFIDENTIAL INFORMATION: DYES BNO ®Agreement / Contract ❑ Bids / RFPs / Quotes Award ❑Computer Related ❑ Facilities Related ❑ Invoices / Purchase Orders Minutes ❑ Policies ❑ Recommendation ❑Tax Levies ❑AP Vouchers ❑ Bid Opening Scheduled ❑County Code CQ Financial ❑ Grants — Fed/State/County ❑ Ordinances ❑Proclamations ❑ Professional Serv/Consultant ❑Thank You's Appointment / Reappointment ❑ Boards / Committees []Emergency Purchase ❑ Funds ❑ Leases ❑ Out of State Travel ❑ Request for Purchase ❑Support Letter ❑Tax Title Property DARPA Related ❑ Budget ❑ Employee Rel. 0-Hearing ❑MOA / MOU ❑ Petty Cash ❑ Resolution ❑Surplus Req. ❑ WSLCB it necessary, was this document reviewed b accounting? y unting . ❑YES ❑ NO Fu-1 N/A �t necessary, was this document reviewed b legal? y g ®YES ❑ NO ❑ N/A DATE OF ACTION: ` APPROVE: DENIED ABSTAIN D1: D2. D3: DEFERRED OR CONTINUED TO: 4/23/24 TRANS1tIITTAL UNIVERSAL FIELD SERVICES, INC. UNIVERSAL FIELD SERVICES 1 MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel:_ (206-550-3221) kbutt'erfield@ufsrw.com DATE: June 14,2024 RECEIVED TO: A�N1� 2024 Bob Bersanti, Grant Co unfiy Design Engi eer G r'?A A111" T C 04 1- ,1 pq T , y p t M. Kristin ButterfieldAc uisition Agent RE: 75 Grant County Maple and Grape Drive Reconstruction Proj Project Parcel # I — Belinda and James T - ect 1) Please find attached Original signed do OY — signed documents transmittal uments: Public Roadway Easement Real Estate Excise Tax Affidavit with Exhibit B Real Property Voucher construction Memorandum of Understanding. IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the County signature(s) on: Public Roadway Easement, on P 3 Real Property Estate Excise Tax Affidavit, in "Signature of Grantee" block Real Voucher, at bottom of page Construction Memorandum of Understanding, at bottom DO NOT forward payment to Property Owner until document 0 page.3) Recording and Release Of Payment: nt has been recorded Take the Public'Roadway Easement and Real Estate Excise Tax Affidavit 0 County Courthouse for recording, along with a check to Grant County Treasurer in the amount of $10. 00 and a check to Grant County Auditor in the amount of $306.5 recording numbers 0. When You have the , You may remit the owner7s check by certified mail to: Belinda and James To P.O. Box 1115 Moses Lake, WA 98837 4) Please email copies of 2oft the fully signed Con hestru ti co , own r-fs check to me to me at kbutte 1- on MOU and recorded rfield' Easement and'a @ufsrw.com. -------- Please zw- do not hesitate to contact me if You have any questions. *NOTE-- Please retain the o - ' al r191n W-9,- it contains private Personal Information and the original Provided for Your Accounting Department records. )=Or securitY PurPoses, we shred ' al is W-9 upon confirmation Of Payment. A COPY of the W- file copies Of the electronic acquisition folder. 9 will not be included in the final Paper or After Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantors: Belinda G. Toy and James V. Toy,, wife and husband Grantee: Grant County; a political subdivision of the State of Washington Abbreviated Legal. PTN NW114 NE114 SW114., STR 10-1 9-28E, W. M., Grant County, Washington Additional Legal Description is on Page I Assessor's Tax Parcel Number, 17-0331-000 Project: Maple and Grape Drive Reconstruction Project Project Parcel Number. I Public Roadway Easement The Grantors, Belinda G. Toy and James V. Toy, wife and husband, for and in consideration of Ten and No/100ths Dollars, ($10.00) and other good and valuable consideration, receipt of which is hereby acknowledged, convey and grant to Grant County, a political subdivision of the State of Washington and its assigns, Grantee, a non-exclusive perpetual easement for public roadway purposes, including but not limited to construction, maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following property situated in Grant County, Washington, to the same extent and purpose as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: The West 8 feet of the Northwest Quarter of the Northeast Quarter of the Southwest Quarter of Section 10, Township 19 North, Range 28 East, W.M., Grant County, Washington; Except the North 250 feet; Also except road right of way for Grape Drive on the West; Situate in the County of Grant, State of Washington As depicted on Exhibit A attached hereto and made a part hereof. 1 of 4 This conveyance shall include all such rights in the above -described land as shall be necessary for Grantee's Easement purposes, including the rights of ingress and egress. Any and all of Grantor's access rights, whether existing or future, shall be established by, governed by and .75.130, or as hereafter may be amended, and applicable County Policy. I subject to RCW 36 This grant of easement is a covenant running with the land and shall be binding upon the heirs, personal representatives, successors and assigns of both parties. It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County, Washington unless and until accepted and approved hereon in writing. A AA Belinda G. Toy Date State of Washington ss. County of Grant On this t day of, 201 , before me personally appeared Belinda G. Toy and James V. Toy, to me known to be the individuals described in and who executed the within and foregoing instrument, and acknowledged that they signed the same as their free and voluntary nl"ntnn/ act and deed, for the uses and purposes ther in men ioned. 13U wee NOTARY • z an mom .9m as* 0 Pusoo C� W # llli"V.Z�OF 1601111111111% N PUBLIC in, ,Stat f Washington df/- a_ndror,6e" Residing at My Commission Expires: 2 of 4 Accepted by Grant County By: Printed Name: ThCiy Ca&k; Title:, Chair Date: Approved as to form: By: Printed Name:' o Title: CountAttorney Date: 3 of 4 .!Ij'u T.�.,,`�r,«^tom,::•a�ava�c��.�:'e+"a�c:> _...... .. iiF.Ly�.. .... _.. - .. 1 o .41 `� xa �,� ' i4 , $'*. �..'l'Vr 4 `'km '�e�.''r �4'-'''. 'eTa.».vE. - 4.'"+s.' 's'.. TES.. *y'"i'"•n'k "fi' `.ix"„3 �7rrs '�c:. OCNTY ROY � r R0W t } f f &OAPE DR I 1: t i f +�+ ...+�k ^•.w'rfw'+c rww .w.s. rr ve..rs .ww� a.�r w.iurr ewr. wr..w. ars �ws wo.r. n..u.� w.�.r ..y,. �wr.y � MAPLE AID D GRAPE D f?.. a 4 of 4 Department of �Affidavit(RAW $2.451NAC 458-61 A) p Excise Tax Real Estate Revenue _location. code on or after March 1. 2023, Only for sales in a single o , Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. Form This form is your receipt when stamped by cashier. Please type or print: ❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name. 1 Seller/Grantor 2 Buyer/Grantee Name Belinda G. Toyand James V. Toy, wife and husband Name Grant County, State of Washinqton Mailing address P.O. Box 1115 city/state/zip Moses Lake, WA 98837 Phone (including area code) 509-765-8404 3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Grantor Mailing address City/state/zip Mailing address P.O. Box 37 City/state/zip Ephrata, WA 98823 Phone (including area code) 509-754-6082 List all real and personal property tax parcel account numbers 17-0331-000 Personal Assessed property? value(s) ❑ $ 50,375.00 ❑ $ 0.00 ❑ $ 0.00 4 Street address of propert 4387 Grape Dr. NE, Moses Lake, WA 98837 This property is located in JGrant County (or unincorporated locations please select your county) ❑ 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. .egal description of property (if you need more space, attach a separate sheet to each page of the affidavit). The west 8 feet of the NW1/4 NE114 SW1/4, Section 10, T19N, R28E, W.M., Grant County WA, EXCEPT the North 250 feet; also EXCEPT road ROW for Grape Drive on the West 5 53 -Retail trade -general merchandise Enter any additional codes (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes ® No Is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) ❑Yes ®No 6 Is this property designated as forest land per RCW 84.33? ❑Yes ®No Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes ®No Is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes ® No 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale— (3) NEW OWNER(S) SIGNATURE Signature Print name Signature Print name 7 List all personal property (tangible and intangible) included in selling price. NONE If claiming an exemption, list WAC number and reason for exemption. WAC number (section/subsection) 458-61A-206(3) Reason for exemption Under threat of eminent domain. Type of document Public Roadway Easement Date of document Gross selling price 2,392.56 *Personal property (deduct) 0.00 Exemption claimed (deduct) 2,392.56 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1°! 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75 % 0.00 Above $3,025,000 at 3% 4•00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE STD CTIONS ---I\ I CERTIFY UNDER PENALTY 0 RYdTAT THE REG 1 IG IS T UE AND CORRECT Signature of g r agr nt Signature of grantee or agent li"A A IT Name (print) Name (print',Cindy Carter, Date & city of signin�* it W .Date & city of signing 7 Chair Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maxim m term of five ears, or by a fine in an 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)). 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 (02/28/23) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page Iof6 AGENCY NAME Grant County P.O. Box 37 Ephrata, WA 98823 GRANTOR OR CLAIMANT (NAME, ADDRESS) ITIN/SSN: REAL PROPERTY VOUCHER I hereby certify under penalty of perjury that the items and amounts listed herein are proper charges against the Agency, that the same or any part thereof has not been paid, and that I am authorized to sign for the claimant. I SIGNATURE (IN INK) FOR EACH CLAIMANT DATED 14- X Belinda G. and James V. Toy P.O. Box 1115 Moses Lake, WA 98937 PROJECT NO. AND TITLE Maple and Grape Drive Reconstruction Project FEDERAL AID NO. PARCEL NO. N/A 1 1 In full, complete and final payment and settlement for the title or interest conveyed or released, as fully set forth in: DATED $ AMOUNT Public Roadway Easement LAND: 3,323 SF in public roadway easement + $25392.56 IMPROVEMENTS: Asphalt and gravel within acquisition area + $49886.28 DAMAGES; Cost to Cure + $0.00 Proximity + $0.00 Other + $0.00 ISPECIAL BENEFITS $0.00 JC (Just Compensation) Amount $79300.00 R REMAINDER: Uneconomic Remnant + $0.00 Excess Acquisition + $0.00 DEDUCTIONS: Amount Previously Paid $0.00 Performance Bond $0.00 Salvage Amount $0.00 Pre Paid Rent $0.00 Other $0.00 ADMINISTRATIVE SETTLEMENT + $0.00 EVALUATION ALLOWANCE + $0.00 -STATUTORY ESCROW -FEE + $0.00 REAL ESTATE EXCISE TAX + $0.00 OTHER: $0.00 0 ACQUISI ION AGENT DATE Voucher No. TOTAL AMOUNT PAID oe $79300.00 R - y �ft & rQED'A'QMT FOR ENC DATE JA I Cindy Carter, Chairs 1 PA-321-IUIZU14 V Grantors: Belinda G. Toy and James V. Toy, wife and husband Grantee: Grant County, a political subdivision of the State of Washington Abbreviated Legal: PTN NW114 NE114 SW114, STR 10-19-28E', WM., Grant County, WA Tax Parcel No.: 17-0331-000 Project: Grant County Maple and Grape Drive Reconstruction Project Project Parcel #1 CONSTRUCTION MEMORANDUM OF UNDERSTANDING between Grant County, apolitical subdivision of the State of Washington and Belinda G. Toy and James V. Toy, wife and husband The purpose of this document is to memorialize the understanding of Grant County (the County) and Belinda and James Toy (the Property Owners) with respect to the details related to the County's acquisition of property acquired in Public Roadway Easement from the undersigned Prop e rty Owners. The County and the undersigned Property Owners hereby agree to the following: As part of the project referenced above, the County has agreed to provide three (3} curb cuts on thew frontage of the Property Owners' parcel located at 4387 Grape Drive NE, Moses Lake, WA, as described below and as depicted on the attached exhibits: 1. Southern driveway to access the self -storage units: Curb cut between and in line with the northwestern corner of Building "A" and the southwestern corner of Building "B", a distance of approximately 37 feet. 2. Center driveway to access the businessoffice: Curb cut between and in line with the second fencepost from the south side of the office building and the tall fencepost on the north side of the building, a distance of approximately 58 feet. 3. Northern driveway: Between the tall gatepost marked on the third exhibit north to a place 9 feet south of the corner fencepost also marked on the exhibit, a distance of approximately 30 feet. 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P z•r LC) , • r Will ,j r,,� 7 !"'. �� 1 . ug I W6 It, , 7z;t� W, M -,w. m MINE, i AI 51;ZIRt Ulu tl,; 1! 1A Ny , oil)�W AIA Al s. tt.4"f 2;3 t;I t. ..... ...... ..... .... . . .4 11 Al s 4�a a I �! �� TRANSMITTAL UNIVERSAL FIELD SERVICES, INC. 111 MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) kbutterfleld@ufsrw.com DATE: July 22, 2024 TO: Bob Bersanti., Grant County Design Eng)-neer FROM: Kristin Butterfield, Acquisition Agent 15 RE: Grant County Ma le and Grape Drive Reconstruction Project Project Parcel # Mark A. Hofstetter — signed documents transmittal 1) Please find attached original signed documents: Public Roadway Easement Real Estate Excise Tax Affidavit with Exhibit B ® Real Property Voucher ® IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the Countyys signature(s) •on: ® Public Roadway Easement, on Page 3 Real Property Estate Excise Tax Affidavit, in "Signature of Grantee" block Real Voucher, at bottom of page DO NOT forward payment to property owner until document has been recorded 3)* Recording and Release of Payment: Take the Public Roadway Easement and Real Estate Excise Tax Affidavit to the County Courthouse for recording, along with a check to Grant County Treasurer in the amount of $10.00 and a check to Grant County Auditor in the amount of $307.50. When you have the recording numbers, you may remit the check by certified mail to: Mark A. Hofstetter 401 W. Broadway Avenue Moses Lake, WA 98837 4) Please email a copy of the recorded Easementand a copy of the check to to minni kbutterfield@utsmcom. 16W 4;1 L Please do not hesitate to contact me if you have any questions. *NOTE: Please retain the original W-9; it contains Private Personal Information and the on final is provided for your Accounting Department records. Fors g ecurity purposes, we shred file copies of the W-9 upon confirmation of payment. A copy of the W- electronic 9 will not bpa e included in the final per or acquisition folder. After Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantor: Mark A. Hofstetter, a single man Grantee: Grant County, a political subdivision of the State of Washington Abbreviated Legal Description: Ptn. NE114 SW114 Section 10 T19N R28Eq Willamette Meridian Additional Legal Description is on Exhibit B Assessor's Tax Parcel Number: 17-0365-000 Project: Maple and Grape Drive Reconstruction Project Project Parcel Number: 8 Public Roadway Easement The Grantor, Mark A. Hofstetter, a single man, for and in consideration of Ten and No/i 00ths Dollars, ($10.00) and other good and valuable consideration, receipt of which is hereby acknowledged, conveys and grants to Grant County, a political subdivision of the State of Washington and its assigns, Grantee, a non-exclusive perpetual easement for public roadway purposes, including but not limited to construction, maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following property situated in Grant County, Washington, to the same extent and purpose as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: As depicted in Exhibit A and described in Exhibit B, both attached hereto and made a part hereof by this reference. This conveyance shall include all such rights in the above -described land as shall be necessary for Grantee's Easement purposes, including the rights of in and egress. Any and all of Grantor's access rights, whether existing or future, shall be established by, governed by and subject to RCW 36.75.130, or as hereafter may be amended, and applicable County Policy. This grant of easement is a covenant running with the land and shall be binding upon the heirs, personal representatives, successors and assigns of both parties. 1 of 5 It is understood and agreed that delivery'of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County, Washington unless and until accepted and approved hereon in writing. DATED THIS DAY OF 20 Tit � , Mark A. HofsteVer State of Washington ss. County of Grant On this day personally appeared before me Mark A. Hofstetter, to me known to be the 'individual described in and who executed the within and foregoing instrument, and acknowledged that he signed the same as his free and voluntary act and deed, or he uses and r)urposes therein mentioned. Given under my hand and official seal this day of 20 BUTI� eq R a 4jj I�Aol A Y z P U Bori • V*# ® OF W NOTA13Y PUB and for the Residing at � My Commission Expires: J 2 of 5 of Washington Accepted by Grant county By: Printed Name: ICtdy Ca1'ter, Title: Chair: Date: ell 3 of 5 Approved as to form C By: Printed Name: � a� Title: Co�}r ty Att ney Date: _ �� LO 4-- 0 Department ofidavit (RCW 82,45 WAG 45$-01A) pRea Tax ff I Revenue(c Only for sales in a single location core on or after March 1, 2023, Woshington Stote This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. For This form is your receipt when stamped by cashier. Please type or print: box if partial safe, indicate % sold-. List percentage of ownership a€quired next to each name Check ❑ p �. Seller/Grantor 2 Buyer/Grantee Name Mark A Hofstetter, a single man Name Grant County, State of Washington Mailing address 401 W Broadway Ave. P.O. Box 37 Mailing address City/state/zip Moses Lake, WA 98837 city/state/zip Ephrata, WA 98823 Phone (including area code) 509-760-4814 Phone (including area code) 509-754-6082 I 3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee List all real and personal property tax .parcel account numbers Name Grantor 17-0365-000 Mailing address City/state/zip _ Personal Assessed property? value(s) ❑ $ 35, 300.00 ❑ $ 0.00 ❑ $ 0.00 4 Street address of property.9391 Maple Dr. NE, Moses Lake, WA 98837 This property is located in lGrant County for unincorporated locations please select your county) ❑ 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. .egal description of property (if you need more space, attach a separate sheet to each page of the affidavit). See attached Exhibit "B" 5118 -All other residential not elsewhere coded Enter.any additional codes -- (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes ® No Is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) []Yes ®No 6 Is this designated as forest land per RCW 84.33? []yes ®No property g Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes ® No is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes ®No 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print name Signature Print name I CERTIFY UNDER PENALTY OF PERJURY a Signature of grantor or agent i (print) VEr6 } Date & city of signing 7 List all personal property (tangible and intangible) included in selling price. NONE If claiming an exemption, list WAC number and reason for exemption. WAC number (section/subsection) 458-61A-206(3) Reason for exemption Under threat of eminent domain. Type of document Public-Roadwav Easement Date of document Gross selling price 7,626.96 *Personal property (deduct) 0.00 Exemption claimed (deduct) 7,626.96 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75% 0.00 Above $3,025,000 at 3% 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Total -due 10.00 A MINIMUM OF $10.00 IS DUE IN. FEE(S) AND/OR TAX *SEE RUCTIONS THE FOREGOING IS TRUE AND CORRECT Signature of grantee or agent LAAMANl ,I Name (print)Cindy C rtE'r(;i r — ,1 r Date & city of signing — Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maxlimum term of five ears, or by a fine in an 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.20.0211)(c)). 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 71:1. REV 84 0001a (02/28/23) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1 of 6 EXHIBIT "B" The North 30 feet of that portion of the Northeast quarter of the Southwest quarter of Section 10, Township 19, Range 28 East W. M., described as follows: Beginning at the Northwest corner of the Northeast quarter of the Northeast quarter of the Southwest quarter of said Section 10., Thence South 00026'50" West, 266.04 feet; Thence South 89'45'30" East, 163.73 feet; Thence North 00'26'50" East, 266.04 feet; Thence North 89045'30" West, 163.73 feet to the point of beginning. EXCEPT that portion of the Northeast quarter of the Southwest quarter of Section 101 Township 19, Range 28 East W.M., described as follows: Beginning at the Northwest corner of the Northeast quarter of the Northeast quarter of the Southwest quarter of said Section 10, thence South 00026'50" West, 217.8 feet to the true point of beginning; Thence South 00026'50" West 48.96 feet; Thence South 89'45'30" East, 163.73 feet; Thence North 00026'50" East, 48.96 feet; Thence North 89045'30" West, 163.73 feet to the point of beginning. Grant County Tax Parcel No. 17-0365-000 5 of 5 EXHIBIT "BY) The North 30 feet of that portion of the Northeast quarter of the Southwest quarter of Section 10, Township 19, Range 28 East W.M., described as follows : Beginning at the Northwest corner of the Northeast quarter of the Northeast quarter of the Southwest quarter of said Section 101 Thence South 00126'50" West, 266.04 feet; Thence South 89145'30" East, 163.73 feet; Thence North 00126'50" East, 266.04 feet; Thence North 89045'30" West, 163.73 feet to the point of beginning. EXCEPT that portion of the Northeast quarter of the Southwest quarter of Section 10, Township 19, Range 28 East W.M., described as follows: Beginning at the Northwest corner of the Northeast quarter of the Northeast quarter of the Southwest quarter of said Section 10, thence South 00026'50" West, 217.8 feet to the true point of beginning; Thence South 00026'50" West 48.96 feet; Thence South 89045'30" East, 163.73 feet; Thence North 00026'50" East, 48-96 feet; Thence North 89045'30" West, 163.73 feet to the point of beginning. Grant County Tax Parcel No. 17-0365-000 REAL PROPERTY VOUCHER TRANSMITTAL IV _ UNIVERSAL FIELD SERVICES, INC. FIELD SERVICEs I I I MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) R"CE1V=n kbutterfield@ufsrw.com E ILI'Lo MAY 2 0 2024 DATE: May 17,2024 G. P,--rai N Ir C 0 lljpq -P(p U Ord 6 TO: Bob Bersanti, Grant County Design E4ngi eer FROM: Kristin Butterfield, Acquisition Agent RE: Grant County Maple and Grape Drive Reconstruction Project Project Parcel # 5 — Chris and Michelle Willis — signed documents transmittal 1) Please find attached original signed documents: ® Public Roadway Easement ® Real Estate Excise Tax Affidavit with Exhibit B ® Real Property Voucher ® IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the Countyys signature(s) on: ® Public Roadway Easement, on Page 3 ® Real Property Estate Excise Tax Affidavit, in "Signature of Grantee" block Z Real Voucher, at bottom of page DO NOT forward payment to property owner until document has been recorded 3) Recording and Release of Payment: Take the Public Roadway Easement and Real Estate Excise Tax Affidavit to the County Courthouse for recording, along with a check to Grant County Treasurer in the amount of $10.00 and a check to Grant County Auditor in the amount of $306.50. When you have the recording numbers, you may remit the check by certified mail -to: Chris and Michelle Willis 9425 Maple Drive NE Moses Lake, WA 98837 4) Please email a copy of the recorded Easement and a cop of the check to me to min ni kbutterfield@ufsrw.com. %W "91 Please do not hesitate to contact me if you have any questions. 'NOTE: Please retain the original W-9; it contains Private Personal Information and the original is provided for your Accounting Department records. For security purposes, we shred file copies of the fir'1/-9 upon confirmation of payment A copy of the W-9 will not be included in the final paper or electronic acquisition folder, After Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantors: Chris Willis and Michelle Willis, husband and wife Grantee: Grant County, ■a Political subdivision of the State of Wa Abbreviated Legal Descrishington Lion: Ptn. S-10, T-19 N� R-28 E. W. in Grant Co Additional Legal Description is on Page I unty, WA Assessor's Tax Parcel Number: 17-0364-000 Project: Maple and Grape Drive Reconstruction Project Project Parcel Number: 5 Public.Roadway Easemen-1 The Grantors, Chris Willis and Michelle Willis, husband and wife, for and in consideration of Ten and No/100ths Dollars, ($10.00) and other good and valuable considerat'" n, receipt of which is hereby acknowledged, convey and grant to Grant County, a Political subdoivi State of Washington and its assigns, Granteesion of the , a non-exclusive perpetual easement for public roadway purposes, including but not limited to construction maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following pr Grant County, Washington, to the sameoperty situated in ' extent and purpose as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: The North 30 feet of that portion of the Northeast Quarter of the Southwest Quarter of Section 10 Township 19 North, Range 28 East, W.M., Grant'County, Washington, described as follows: Beginning at a point 350 feet West of the center Sectio Grant County, Washinn 10, Township 19 North, Range 28 E. W.m., ton' the South 217.8 feet; thence West 148.9 feet, more or less 0 East line of the property deeded to Simon P. Brooks by Deed , recorded December 28, 1950, under Auditor's File No. 166305; thence Northerly along the said Easterly boundary line of the Brook's feet; thence East 149 feet, more or less, to the Point of property 217.8 Beginning. Situate in the County of Grant, State of Washington. As depicted in Exhibit A attached hereto and made a part hereof by this reference. This conveyance shall include all such rights in the above -described land as shall I I be necessary for Grantee's Easement purposes, including the rights of ingress and egress. Any and all of Grantor's access rights, whether existing or future, shall be established by, governed by and subject to RCW 36.75.130, or as hereafter may be amended, and applicable County Policy. 1 of 4 This grant of easement is a covenant running with the land and shall be binding upon the heirs personal representatives . successors and assigns of both parties. 7 It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County, Washington unless and until accepted and approved hereon in writing. DATED THIS DAY OF 2d0�f' Cyr'is Willis Michelle Willis State of Washington ss. County of Grant On this day personally appeared before me Chris and Michelle Willis, to me known to be the individuals described in and who executed the within and foregoing instrument, and acknowledged that they signed the same as their free and voluntary act and deed, forjhe- uses an rAses therein me tioned. Given under my hand and official seal this 116rk-%, of 2 day 8 U rzN 0 0 OtAOTARy doom 4mma Q"ft GOP 40 Pusvo 4cbi OF WASk� 11111fillI410 NOTARY PUB IC YKd Residing at My commission Expires:, 2 of 4 Accepted by Grant County By: t Printed Name: Cindy Carter, Title: Chair. - Date: I Approved as to form: By: Printed Name: Title: County, Attorney Date: - plfiiT ; 3 of 4 E XH I el .1 � A' PROPOSED 3.0 OUNTY RD.., A.- E ASM ENT MAPLE DR. 77 7,17 K/r 'for RO E- 30w c0-J RD. EASEMENT STA. 18+26.,83 STA, 19-2 - PARCc-,L- 5F�I,,,,2170364 000 Wl.".LIS, CHRI' d§Hlt-.R I ST & WCHELLE 9421�) MAPIE DR. + LAKE `9882,-i7 M 0'; U-1 4 of 4 .d De artment of(RCW $2.45 WAC 458-01A) pReal_ Excise Tax Affidavit .. .. Revenue location code on or after.Mar�ch 1 20230 Only for sales �n a single , Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. Form 84 1 a This form is your receipt when stamped by cashier. Please type or print ❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name. 1 Seller/Grantor 2 Ruyer/Grantee Name Chris Willis and Michelle Willis, husband and wife Mailing address 9425 Maple Dr. NE city/state/zip Moses Lake, WA 98837 Phone (including area code) 509-793-4997 3Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Grantor Mailing address City/state/zip Name Grant County, State of Washington Mailing address P.O. Box 37 City/state/zip Ephrata, WA 98823 Phone (including area code) 509-754-6082 List all real and personal property tax parcel account numbers 17-0364-000 Personal Assessed property? value(s) ❑ $ 33,025.00 El $ 0.00 R $ 0.00 Street address of propert 9425 Maple Dr. NE, Moses Lake, WA 98837 This property is located in JGrant Count (for unincorporated locations please select your county) ❑ 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. r _ . rr• . t _egal description of property (if you need more space, attach a separate sheet to each page or the amaavit). See attached Exhibit "B" 5 118 -All other residential not elsewhere coded Enter any additional codes (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes ® No Is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, ❑Yes ®No complete the predominate use calculator (see instructions) 6 Is this property designated as forest land per RCW 84.33? Oyes ®No Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes ® No Is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes ® No 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print name Signature Print name 7 List all personal property (tangible and intangible) included in selling price. NONE if claiming an exemption, list WAC number and reason for exemption. WAC number (section/subsection) 4_58-61A-206(3) Reason for exemption Under threat of eminent domain. Type of document Public Roadway Easement IF - - - 0 Date of document S /l b Gross selling price 7,514.91 *Personal property (deduct) 0.00 Exemption claimed (deduct) 7,514.91 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75% 0.00 Above $3,025,000 at 3% 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Tota I due 10.00 A MINIMUM OF $10.00 iS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS it 1 CERTIFY UNDER PENALTY OF PE URY THAT THE FOREGOING IS TRUE AND CORRECT I" ( Signature of grantor or agent Signature of grantee or agent Name (print) .. r Name (print)Cindy Carter, Ch�ir Date & city of signing Date & city of signing Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maximurd term of five ears, or by a fine in an amount fixed by the court of not more than $10,000, or by both such confinement and fine (RCW 9A.72.030 and RCW 9A.20.021�1)(c)). To ask about the availability of this publication in an alternate format for the visually impaired, please call 360-705-6705. Teletype (TTY) users may use the WA Relay Service by calling 711. REV 840001a (02/28/23) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1of6 EXH I B IT cc BY) The North 30 feet of that portion of the Northeast Quarter of the Southwest Quarter of Section 10, Township 19 North, Range 28 East, W.M. Grant County, Washington, described as foLLows: 9 Beginning at a point 250 feet West of the center of said •section; thence West, a distance of 100 feet; thence South, a distance of 217.8 feet; thence East, a distance Of 100 feet; thence North, a distance of 217.8 feet to the True Point of Beginning. Situate in the County of Grant, State of Washington. Grant County Tax ParceL No. 17-0338-000 AGENCY NAME PROPERTY VOUCHER Grant County I hereby certify under penalty of perjury that the items and amounts liste proper charges against the Agency, that the samed herein are P.O. Box 37 Ephrata, WA 98823 or any part thereof has not been paid, and that I am authorized to si n fo g r the claimant. SIGNATURE (IN INK) FOR EACH CLAIMANT DATED OR OR CLAIMANT (NAME, ADDRESS)9 TIN/SSN: � FRA nd MichelleWillis aple Dr. NE Moses Lake, WA 98837 PROJECT NO. AND TITLE Maple and Grape Drive Deconstruction ' Prod ect FEDERAL AID NO. �� NSA PARCEL NO. In full, complete and final payment and settlement for the title o r interest conveyed or released, as fully set forth in: Public Roadway Easement LAND: DATED E:::$ AMOUNT 4,482 SF in public roadway easement IMPROVEMENTS: Gravel, fence, planter, bar] keystone+ $7,514,91 DAMAGES: border, arborvitae, concrete lawn airirrigation+ Cost to Cure - re p within acquisition area Proximity i $39611.15 Other + $19530.Q0 SPECIAL EENEFITS + $0.00 + $0.00 JC (Just Compensation) Amount $0.00 REMAINDER: Uneconomic Remnant - $1Z,700.00 (R ) Excess Acquisition DEDUCTIONS: + $0.00 Amount Previously Paid � $0.00 Performance Bond Salvage Amount $0.00 Pre Paid Rent $0.00 ®then $0.00 ADMINISTRATIVE SETTLEMENT $0.00 STATUTORY EVALUATION ALLOWi4NCE $0.00 ESCROW FEE REAL ESTATE EXCISE TAX 11—� OTHER: + $0.00 + $0.00 $0.00 ACQUISITI ENT DATE Voucher No. T TOTAL AMOUNT PAID D A E; T FORAGE yru - DATE Cindy Carter,LPA-321 $129700.00 (R ) 10Chair ! g4q TRANSMITTAL UNIVERSAL FIELD SERVICES, INC.' I I I MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) kbutterfield@ufsrw.com DATE: July 22, 2024 TO: Bob Bersanti, Grant County Design Engi eer FROM: Kristin Butterfield, Acquisition Agent RE: Grant County Maple and Grape Drive Reconstruction Project Project Parcel # 6 — Sandra Lauckner — signed documents transmittal 1) Please find attached original signed documents: Public Roadway Easement Real Estate Excise Tax Affidavit with Exhibit B Real Property Voucher IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the Countyys signature(s) on: Public Roadway Easement, on Page 3 Real Property Estate Excise Tax Affidavit, in "Signature of Grantee" block Real Voucher, at bottom of page DO NOT forward payment to property owner until document has been recorded 3) Recording and Release of Payment: Take the Public Roadway Easement and Real Estate Excise Tax Affidavit to the County Courthouse for recording, along with a check to Grant County Treasurer in the amount of $10.00 and a check to Grant County Auditor in the amount of $306.50. When you have the recording numbers, you may remit the check by certified mail to: Sandra Lauckner 9441 Maple Drive NE Moses Lake, WA 98837 4) Please email a copy of the recorded Easement and a co jDv of the check to me to me at kbutterfield@ufsrw.com. Please do not hesitate to contact me if you have any questions. *NOTE: Please retain the original W-9; it contains Private Personal Information and the original is provided for your Accounting Department records. For security purposes, we shred file copies of the W-9 upon confirmation of payment. A copy of the W-9 will not be included in the final paper or electronic acquisition folder. After Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantor: Sandra Lauckner, as a separate estate Grantee: Grant County, a political subdivision of the State of Washi-ngt.o.n Abbreviated Legal "Description: Ptn. NE 1/4, SW '/4, Sec. 10, Twn. 19N, Rng. 28E Willllam.ette.�Meridian, in Grant County, WA Additional Legal Description is on Page 1 Assessor's Tax Parcel Number: 17-0338-000 Project: Maple and Grape Drive Reconstruction Project Project Parce[tXumber: 6 Public Roadway Easemew.'i The Grantor, -Sandra Lauckner, as a separate estate, for and in consideration of Ten and No/1 00ths Dollars, ($10.00) and other good and valuable consideration, receipt of which is hereby acknowledged, conveys and grants to Grant County, a political subdivision of the State of Washington and its assigns, Grantee, a non-exclusive perpetual easement for public roadway purposes, includingbut not limited to construction, maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following property situated in Grant County, Washington, to the same extent and purpose as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: The North 30 feet of that portion of the Northeast Quarter of the Southwest Quarter of Section 10, Township 19 North, Range 28 East, W.M., Grant County, Washington, described as follows: Beginning at a point 250 feet West of the center of said section; thence West, a distance of 100 feet; thence South, a distance of 217.8 feet; thence East, a distance of 100 feet; thence North, a distance of 217.8 feet to the True Point of Beginning. Situate in the County of Grant, State of Washington. As depicted in Exhibit. A attached hereto and made a part her by this reference, This conveyance shall include all such rights in the above -described land as shall be necessary for Grantee's Easement purposes, including the rights of in and egress. Any and all of 1 of 4 Grantor's access rights, whether existing or future, shall be established by, governed by and subject to RCW 36.75.130, or as hereafter may be amended, and applicable County Policy. This grant of easement is a covenant running with the land and shall be binding upon the heirs, personal representatives, successors and assigns of both parties. It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County, Washington unless and until accepted and approved hereon in writing. 0-11n DATED THIS DAY OF J tot,, 20 gandra Lauckner State of Washington ss. County of Grant On this day personally appeared before me Sandra Lauckner7 to me known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that she signed the same as her free and voluntary act and deed f )c1he uses antposes therein mentio. ed. Given under my hand and official seal this ./kday of 20 sur NV A T 0 A via PUBLIC C Wool 0 V1 JFIV�`, Opwe %xsWiP 2 of 4 Accepted by Grant County 1 By: (� PrintedName: tindy Carter, — Title: Chair Date: ��Lc 3 of 4 Approved as to form: By:= Printed Name: , Title: Count Attorney Date:. EXHIBIT RAW PLE DR4 r. - R0 ej EASEMENT COUNTY RD. Ln 5. RCEL#1703'38000 441 iMAPLE D, ES LAKE WA,,, MAPLE AND GRAPE DR. WdEb W e%£#:"` .11 F tj 4 of 4 Department of(RCW 82.451NAC 458-61A) pExcise Tax AffidaVit idea l Estate Revenue(c i Osingle location code on or after Jul 1 2024. Only for sales n a s g Y, Washington State This affidavit will. not be accepted unless all areas on all pages are fully. and accurately completed. a This form is your receipt when stamped by cashier. Please type or prim. Form 84 0001❑ Check box if partial sale, indicate % sold. List percentage of ownership acquired next to each name. �. Seller/Grantor 2 Buyer/Grantee Name Sandra Lauckner, as a separate estate Name Grant County, State of Washington Mailing address 9441 Maple Dr. NE City/state/zip Moses Lake, WA 98837 Phone (including area code) 509-572-5565 3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Grantor Mailing address City/state/zip Mailing address P.O. Box 37 City/state/zip Ephrata, WA 98823 Phone (including area code) 509-754-6082 List all real and personal property tax parcel account numbers 17-0338-000 Personal Assessed property? value(s) ❑ $ 26,200.00 R $ 0.00 ❑ $0.00 4 Street address of property 9441 Maple Dr. NE, Moses Lake, WA 98837 This property is located in lGrant Count {for unincorporated locations please select your county ❑ 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. .egal description of property- (if you- need more- space, attach- a- separate- sheet to- each page of the- affidavit)-. See Exhibit B 5 18 -All other residential not elsewhere coded Enter any additional codes (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes ® No Is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) []Yes ®No 6 Is this designated as forest land per RCW 84.33? ❑Yes ®No property g Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes ® No Is this property receiving special valuation as historical' property per RCW 84.26? ❑ Yes O No 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print name Signature Print name 7 List all personal property (tangible and intangible) included in selling price. NONE If claiming an exemption, enter exemption code and reason for exemption. *See dor.wa.gov/REST TfrAVA- Reason mp _5ydes* Exemption No. (sec/sub) �� for exemption Under threat of eminent domain. Type of document .Public Roadw- .-%ay Easement Date of document 14 fol "'- �2� Gross selling price 10;120:00 *Personal property (deduct) 0.00 Exemption claimed (deduct) 10,120.00 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75% 0.00 Above $3,025,000 at 3% 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Loca 1 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM 0 10.00 IS DUE IN FEE(S) AND/OR TAX fl * `EE INSTRUCTIONS 1 CERTIFY UNDER PENALTY OF PE RY THAT HE FOREGOING IS T UE AND CORRECT ! r Signature of grantor or agent ' ature of grante Name (print) Name (print) Cindy Carter, Chair Date & city of signing '�--- Date & city of signing Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maxim m term of five ears, or by a fine in an 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)). 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 callir g— 71.1.. REV 84 0001a (06/03/24) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1 of 6 FM�MIK The North 30 feet of that portion of the Northeast Quarter of the Southwest Quarter of Section 10, Township 19 North, Range 28 East, W.M., Grant County, Washington, described as follows: Beginning at a point 250 feet West of the center of said section; thence West, a distance of 100 feet; thence South, a distance of 217.8 feet; thence East, a distance of 100 feet; thence North, a distance of 217.8 feet to the True Point of Beginning. Situate in the County of Grant, State of. Washington. Grant County Tax Parcel No.: 17-0338-000 REAL PROPERTY VOUCHER TRANSMITTAL UNIVERSAL FIELD SERVICES, INC. I I I MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) kbutterfield@ufsrw.com DATE: August 1, 2024 RECEIVOED Mumma G RA N'T C 0 U N Tf P U M I C t.jp-tui o RK 8 TO: Bob Bersanti, Grant County Design Engi eer FROM: Kristin Butterfield, Acquisition Agent RE: - Grant County Maple and Grape Drive Reconstruction Project Project Parcel # 7 — Robin and Iris Boyd — signed documents transmittal 1) Please find attached original signed documents: Public Roadway Easement Real Estate Excise Tax Affidavit with Exhibit B Real Property Voucher IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the County's signature(s) on: Public Roadway Easement, on Page 3 Real Property Estate Excise Tax Affidavit, in "Signature of Grantee" block Real Voucher, at bottom of page DO NOT forward payment to property owner until document has been recorded I 3) Recording and Release of Payment: Take the Public Roadway Easement and Real Estate Excise Tax Affidavit to the County Courthouse for recording, along with a check to Grant County Treasurer in the amount of $10.00 and a check to Grant County Auditor in the amount of $306.50. When you have the recording numbers, you may remit the check by certified mail to: Robin and Iris Boyd 9459 Maple Drive NE Moses Lake, WA 98837 4) Please email a copy of the recorded Easement and a coPZ of the check to me to me at kbutterfield@ufsrw.com. Please do not hesitate to contact me if you have any questions. *NOTE: Please retain the original W-9; it contains Private Personal Information and the original is provided for your Accounting Department records. For security purposes, we shred Me copies of the W-9 upon confirmation of payment A copy of the W-9 will not be included in the final paper or electronic acquisition folder. After Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantors: Robin and Iris Boyd, husband and wife Grantee: Grant County, a political subdivision of the State of Washington Abbreviated Legal. PTN NE114 of the SW 114, STR 10-19N-28E, W.M. in Grant County, WA Additional Legal Description is on Page I Assessor's Tax Parcel Number: 17-0339-000 Project: Maple and Grape Drive Reconstruction Project Project Parcel Number. 7 Public Roadway Easement The Grantors, Robin and Iris Boyd, husband and wife, for and in consideration of Ten and No/1 00ths Dollars, ($10.00) and other good and valuable consideration, receipt of which is hereby acknowledged, convey and grant to Grant County, a political subdivision of the State of Washington and its assigns, Grantee, a non -'exclusive perpetual easement for public roadway purposes, including but not limited to construction, maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following property situated in Grant County, Washington, to the same extent and purpose as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: The North 30 feet of that portion of the .Northeast Quarter of the Southwest Quarter of Section 10, Township 19 North, Range -28 East,W.M., Grant County, Washington, described as follows: Beginning at a point 200 feet West of the center of said Section 10; thence South 217.8 feet; thence West 50 feet; thence North 217.8 feet; thence East 50 feet, to the Point of Beginning. Situate in the County of Grant, State of Washington As depicted on Exhibit A attached hereto and made a part hereof This conveyance shall include all such rights in the above -described land as shall be necessary for Grantee's Easement purposes, including the rights of ingress and egress. Any and all of Grantor's access rights, whether existing or future, shall be established by, governed by and subject to RCW 36.75.130, or as hereafter may be amended, and applicable County Policy. 1 of 4 This grant of easement is a covenant running with the land and shall be binding upon the heirs personal representatives, successors and assigns of both parties. It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County, Washington unless and until accepted and approved hereon in writing. State of Washington ss. County of Grant On t h i day of �V 20�.V, before me personally appeared Robin Bo d and Iris Boyd, to me known to be the individuals described in and who executed the within y and foregoing instrument, and acknowledged that they signed the same as their free and voluntary act and deed, for the uses and purposes therein mentioned. 6 U 4,� lose A k 'IN ENT �%w & E�W®� t4OTARV, VW UBLVO • � 0-1 WAS�`4��a` Residing at - /(,�'�� My Commission Expires: 2 of 4 Accepted by Grant County By: Printed Name:dindy� Carter, Title: Chair Date: 17-f+ 3 of 4 Approved as to form: By: �t Printed Name. Title: Count Attorney Date: _24 EXHIBIT . RAN RAN MAPLE R.. let 1,40 ' R,° d' PROPOSED 30 CUNY RD. EASEMENT ta �O 51.53, TO STAB 2—" 2. �, 5 PARCEt #,. . BOYD;, ROBINIRIS 94�549 MAPLE DR., Most-S LAKE WA, 98837 ID GRAPE DR - MAPLE At " _ T t Mora 4 of 4 Department of(R��/11.82.45 WAC 45$-61A) p Excise Tac AffidaVlt Real Estate Revenue in single location code on or after March 1 2023. Only for sales a s g Washington Stote ` This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. This form is your receipt when stamped by cashier. Please type or print. ❑Check box if partial sale, indicate f sold. List percentage of ownership acquired next to each `name. �. Seller/Grantor 2 Buyer/Grantee Name Robin and iris Boyd, husband and wife _ Mailing address 9459 Maple Dr. NE City/state/zip Moses Lake, WA 98837 Phone (including area code) 509-318-9950 - 3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Grantor Mailing address City/state/zip Name Grant County, State of Washington Mailing address P•0• Box 37 City/state/zip Ephrata, WA 98823 Phone (including area code) 509-754-6082 List all real and personal property tax parcel account numbers 17-0339-000 Personal Assessed property? value(s) ❑ $19,375.00 ❑ $ 0.00 ❑ $ 0.00 4 Street address of propert 9459 Maple Dr. NE, Moses Lake, WA 98837 - This property is located in Grant County (for unincorporated locations please select your county) 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. .egal description of property (if you need more space, attach a separate sheet to each page of the affidavit). See attached Exhibit "B" 5 118 -All other residential not elsewhere coded Enter any additional codes (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes 0 No Is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) ❑Yes ®No 6 Is this property designated as forest land per RCW 84.33? E]Yes ®No Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes ®No Is this property receiving special valuation as historical property per RCW 84.26? El Yes ® No 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print name Signature Print name I CERTIFY UNDER PENALTY OF PERJLIRY THAT r Signature of grNtor or agent Name (print) E-0-2 L Date & city of signing 20� 7 List all personal property (tangible and intangible) included in selling price. NONE if claiming an exemption, list WAC number and reason for exemption. WAC number (section/subsection) 458-61A-206(3) Reason for exemption Under threat of eminent domain. Type of document Public Roadwav Easement Date of document.10 Gross selling price ^ 5,407.20 *Personal property (deduct) 0.00 Exemption claimed (deduct) 5,407.20 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75% 0.00 Above $3,025,000 at 3 % 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee. 5.00 Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE N-S-TR lCTIONS _ FOREGOING IS TRUE AND CORRECT Signature of grantee or went 1 i/�{i Name(print)Cindy Carter, Chaim Date & city of signing 7-A- 7,4 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 ears, or by a fine in an 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)). 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 (02/28/23) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1 of 6 The North 30 feet of that portion of the Northeast Quarter of the Southwest Quarter of Section 10) Township 19 North, Range 28 East, W.M., Grant County, Washington, described as follows: Beginning at a point 200 feet West of the center of said Section 10; thence South 217.8 feet; thence West 50 feet; thence North 217.8 feet; thence East 50 feet, to the Point of Beginning. Situate in the County of Grant,, State of Washington. Grant County Tax Parcel No. 17-0339-000 REAL PROPERTY VOUCHER TRANSMITTAL UNIVERSAL FIELD SERVICES, INC. 111 MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) kbutterfield@ufsrw.com PATE: August 1, 2024 TO: Bob Bersanti, Grant County Design En9ier FROM: Kristin Butterfield, Acquisition Agent eN RE: - Grant County Maple and Grape Drive Reconstruction Project Project Parcel # 8 — Chad Carroll — signed documents transmittal 1) Please find attached original signed documents: ® Public Roadway Easement ® Real Estate Excise Tax Affidavit with Exhibit B ® Real Property Voucher ® IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the Countys signature(s) on: ® Public Roadway Easement, on Page 3' ® Real Property Estate Excise Tax Affidavit, .in "Signature of Grantee" block Z Real Voucher, at bottom of page Please call me when you've obtained the County's -signatures on the documents listed in Paragraph 2 above. I will pick them up and hand -deliver them to the escrow officer. Please do not hesitate to contact me if you have any questions. 'NOTE: Please retain the original W-9; it contains Private Persona Information and the or a/ I igin is provided for your Accounting Department records. For security purposes, we shred file copies of the W-9 upon confirmation of payment. A copy of the W-9 will not be included in the final paper or electronic acquisition folder. After Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantor: Chad J. Carroll, an unmarried person Grantee: Grant County, a political subdivision of the State of Washington Abbreviated Legal Description: Ptn. Of 10-1 9N-28E, in Grant County, WA Additional Legal Description is on Page I Assessor's Tax Parcel Number: 17-0471-000 Project: Maple and Grape Drive Reconstruction Project Project Parcel Number: 8 It" E;V_1 I I V-1 11; The Grantor, Chad J. Carroll, an unmarried person, for and in consideration of Ten and No/1 00ths Dollars, ($10.00) and other good and valuable consideration, receipt of which is hereby acknowledged, conveys and grants to Grant County, a political subdivision of the State of Washington and its assigns, Grantee, a non-exclusive perpetual easement for public roadway purposes, including but not limited to construction, maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following property situated in Grant County, Washington, to the same extent and purpose as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: The North 15 feet of that portion of Section 10, Township 19 North, Range 28 East, W.M., Grant County, Washington, described as follows: Beginning at the Northeast corner of the Northeast Quarter of the Southwest Quarter of said Section 10; thence Westerly along the Northerly line of said subdivision, a distance of 125 feet to the true point of beginning; thence continuing Westerly along the Northerly line of said subdivision, a distance of 75 feet; thence Southerly parallel to the Easterly line of said subdivision, a distance of 217.8 feet; thence Easterly parallel to the Northerly line of said subdivision, a distance of 75 feet; thence Northerly parallel to the Easterly line of said subdivision, a distance of 217.8 feet to the true point of beginning. Situate in the County of Grant, State of Washington. As depicted in Exhibit A attached hereto and made a part hereof by this reference 1 of 4 This conveyance shall include all such rights in the above -described land as shall be necessary for Grantee's Easement purposes, including the rights of ingress and egress. Any and all of Grantor's access rights, whether existing or future, shall be established by, governed by and subject to RCW 36.75.130, or as hereafter may be amended, and applicable County Policy. This grant of easement is a covenant running with the land and shall be binding upon the heirs, personal representatives, successors and assigns of both parties. It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County, Washington unless and until accepted and approved hereon in writing. DATED THIS � DAY OF , 2 Chad J. Car oll State of Washington ss. County of Grant On this day personally appeared before me Chad J. Carroll, to me known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that he signed the same as his free and voluntary act and deed, ore uses and rposes therein me do ed. Given under my hand and official seal this � `day of 26� Residing at S My Commission Expires: 2 of 4 of Washington Accepted by Grant County By: E Printed Name: Cady Carter, Title: chair Date: Approved By: Printed Name: Title: County Attorney Date: 3 of 4 - _. __ _ 04 tno .. _ ... •*.. 3'i �.tacttitiEd'iau:' +wixr�atvn+sm�a ih�NiiN4lrb�hr9� r+r Mlp+l!!w?'Q i S Tk 220,5 w Ll�* r'4^,11~41'. '.. i2Ns•xwayw�i �Aw.w�wr+�wd+ aew.w+Wwur rp� >K�twa+-� w-Wnxlwiewnx ,�tisuXwtf�UR wrrw�r±Mw LA { Ml Li Ld Zli, ate,. IL cc, Li`134 Owl PAO ,. : ,. nWH+lthS!'SUF:...',.. .. -- •r+wW ' Kt' .aArR11�.,Alte EEdunkiVuw4t#PoINtU'woklYd �F4:N �, wletlkl'wtwrw NhM'N'aaftly�h! TA. +.5 ti. WAC 458-61A)Department ofReal Estate Excise Tay Affidavit(RCV8245 Revenue l in a single location code on or. after Jul 1, 2024. Only for sales g Y Woshington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. r 4 `� This form is your receipt when stamped by cashier. Please type orprint. Check box if partial sale indicate % sold. - List percentage of ownership acquired next to each name. ❑ p i �. Seller/Grantor 2 Buyer/Grantee Name Chad J. Carroll, an unmarried person Name Grant County, State of Washington Mailing address 9473 Maple Dr. NE city/state/zip Moses Lake, WA 98837 Phone (including area code) 509-350-9737 3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Grantor Mailing address City/state/zip Mailing address P.O. Box 37 city/state/zip Ephrata, WA 98823 Phone (including area code) 509-754-6082 List all real and personal property tax parcel account numbers 17-0471-000 Personal Assessed property? value(s) ❑ $ 21, 650.00 ❑ $ 0.00 ❑ ,$ 0.00 4 Street address of property 9473 Maple Dr. NE, Moses Lake, WA 98837 This property is located in lGrant County_ (for unincorporated locations please select your county} ❑ 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. .egal description of property (if you need more space, attach a separate sheet to each page of the affidavit). See Exhibit "B" 5 [1-8 -All other residential not elsewhere coded Enter any additional codes (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes ® No is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, ❑Yes ®No complete the predominate use calculator (see instructions) 6 Is this ro ert designated as forest land per RCW 84.33? ❑Yes ®No p p Y g Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes ® No Is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes ® No 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 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 signature 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) doesn`t wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print name Signature Print name 7 List all personal property (tangible and intangible) included in selling price. NONE If claiming an exemption, enter exemption code and reason for exemption. *See dor.wa.gov/REST fT5rA1--%6(5) mAp'on.odes* Exemption No. (sec/sub) Reason for exemption Under threat of eminent domain. Type of document Public Roadway Easement Date of document :1 ---- 3 0 9�6aq Gross selling price 3,189.38 *Personal property (deduct) 0.00 Exemption claimed (deduct) 3,189.38 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75% 0.00 Above $3,025,000 at 3 % 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Su btota 1 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Total due .10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS i I CERTIFY UNDER PENALTY OF PE UR7T;.0JR-EGOING E FIS T E AND CORRECT Signature of granto or ag t ` Signature of grantee or agent Name (print) Name (printjCindy Carter, Chair Date & city of signing F" D to tic city of signing a - * �'- "` 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 ears, or by a fine in an amount fixed b the court of not more than $10,000, or both such confinement and fine (RCW 9A.72.030 and RCW 9A.20.021(1)(c)). v _ Y 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 (06/03/24) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1 of 6 The North 15 feet of that portion of Section 10, Township 19 North, Range 28 East, WM., Grant County, Washington, described as follows: Beginning at the Northeast corner of the Northeast Quarter of the Southwest Quarter of said Section' 10; thence Westerly along the Northerly line of said subdivision, a distance of 125 feet to -the true point of beginning; thence continuing Westerly along the Northerly line of said subdivision, a distance of 75 feet; thence Southerly parallel to the Easterly line of said subdivision, a distance of 217.8 feet; thence Easterly parallel to the Northerly line of said subdivision, a distance of 75 feet; thence Northerly parallel to the Easterly line of said subdivision, a distance of 217.8 feet to the true point of beginning. Situate in the County of Grant, State of Washington. Grant County Tax Parcel No. 17-0471-000 REAL PROPERTY VOUCHER TRANSMITTAL UNIVERSAL FIELD SERVICES, INC. I I I MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) kbutterfleld@ufsrw.com DATE: August 1, 2024 TO:. Bob Bersanti, Grant County Design er Engi e FROM: Kristin Butterfield, Acquisition Agent 7(Z�5 RE: Grant County Maple and Grape Drive Reconstruction Project Project Parcel # 9 — Shawnia J. Skidmore — signed documents transmittal 1) Please find attached original signed documents: ® Public Roadway Easement ® Real Estate Excise Tax Affidavit with Exhibit B ® Real Property Voucher ® IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the County's signature(s) on: ® Public Roadway Easement, on Page 3 ® Real Property Estate Excise Tax Affidavit, in "Signature of Grantee" block ® Real Voucher, at bottom of page DO NOT forward payment to property owner until document has been recorded 3) Recording and Release of Payment: Take the Public Roadway Easement and Real Estate Excise Tax Affidavit to the County Courthouse for recording, along with a check to Grant County Treasurer in the amount of $10.00 and a check to Grant County Auditor in the amount of $306.50. When you have the recording numbers, you may remit the check by certified mail to: Shawnia J. Skidmore 9481 Maple Drive NE Moses Lake, WA 98837 4) Please email a copy of the recorded Easement and a copy of the check to me to me at kbutterfield@u1srw.com. Please do not hesitate to contact me if you have any questions. *NOTE: Please retain the original W-9; it contains Private Personal Information and the original is provided for your Accounting Department records. For security purposes, we shred file copies of the W-9 upon confirmation of payment. A copy of the W-9 will not be included in the final paper or electronic acquisition folder. After Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantor: Shawnia. J. Skidmore, as a separate estate Grantee: Grant County, a political subdivision of the State of Washington Abbreviated Legal Description: Ptn. NE 1/4, SW 1/4, S 10, T 19N) R 28E, Willamette Meridian, in Grant County, WA Additional Legal Description is on Page I Assessor's Tax Parcel Number: 17-0478-000 Project:., Maple and Grape Drive Reconstruction Project Project Parcel Number: 9 Public Roadway Easement The Grantor, Shawnia J. Skidmore, as a separate estate, for and in consideration of Ten and No/1 00ths Dollars, ($10.00) and other good and valuable consideration, receipt of which is her acknowledged, conveys and grants to Grant County, a political subdivision of the State of Washington and its assigns, Grantee, a non-exclusive perpetual easement for public roadway purposes, including but not limited to construction, maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following property situated in Grant County, Washington, to the same extent and purpose as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: The North 30 feet of that portion of the Northeast Quarter of the Southwest Quarter of Section 10, Township 19 North, Range 28 East., W.M., Grant County, Washington, described as follows: Beginning at the center of Section 10; thence Southerly along the Easterly line of the Southwest quarter of Section 10, a distance of 187.8 feet; thence Westerly parallel to the East and West centerline of said Section, a distance of 115 feet; thence Northerly parallel to the East line of the Southwest quarter of Section 10, a distance of 187.8 feet to a point to the East and West centerline; thence Easterly along the said centerline, a distance of 115 feet to the Point of Beginning, EXCEPT the West 5 feet. Situate in the County of Grant, State of Washington. As depicted in Exhibit A attached hereto and made a part hereof by this reference. 1 of 4 This conveyance shall include all such rights in the above -described land as shall be necessary for Grantee's Easement purposes, including the rights of ingress and egress. Any and all -of Grantor's access rights, whether existing or future, shall be established by, governed by and subject to RCW 36-75.* 130, or as hereafter may be amended, and applicable County Policy. This grant of easement is a covenant running with the land and shall be binding upon the heirs personal. representatives, successors and assigns of both parties. It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County, Washington unless and until accepted and approved hereon in writing. DATWTHIS I lawnia J. Skid State of Washington ss- County of Grant AY OF 2 On this day personally appeared before me Shawnia J. Skidmore, to me known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that she signed the same as her free and voluntary act and deed forlbe uses anjJ.,purposes therein mentioned. Given under my hand and official seal this 'day of 2 6 U T At %N r &F— p 0 AW NO ARC( PUBLIC in and or e St of Washington q 0 t "Ift OTAR ly woo owl Residing at "a % My Commission Expires: /,I Puf3010 cbmm 0 OF Ww�q //III I I 11 111POW4, 2 of 4 Accepted by Grant County By:IA PrintedName:. Cindy Carter, Title: Chair,Date:�Z�7 r2 3 of 4 Approved as to form: Printed Name: Title: CountyttQrney Date: EXHIBIT RAN - MAPLE DR-, QL ar -o. Jr All i 'PROPOSED 15 _ oUNr ` RD, 5. EASEME 'T w TA , + ., 4 5 PARCEL SKID O Eo SHIAWNJA J, 9481 MAPLE R� Mo LAKE 'W,g� 988-3 ik PL MAPLE 4 D GRAPE FZV W- F flt-foua�:. T OF 1 4 of 4 Department of �ff(RCW 82.45 WAC 45$-61A) Re�i Estate Excise Tax �dar�ft Revenue location code on or after Jul 1, 2024, Only for sales �n a single Y Washington State g This affidavit will not be accepted unless all areas an all pages are fully and accurately completed. r This fora is your receipt when stamped by cashier. Please type or print. ❑ if box Check partial sale, indicate /a sold. List percentage of ownership acquired next to each name. 1 Seller/Grantor 2 Buyer/Grantee Name Shawnia J. Skidmore, as a separate estate Mailing address 9481 Maple Dr. NE City/state/zip Moses Lake, WA 98837 Phone (including area code) 509-572-5565_ 3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Grantor Mailing address City/state/zip Name Grant County, State of Washington Mailing address P.O. Box 37 city/state/zip Ephrata, WA 98823 Phone (including area code) 509-754-6082 List all real and personal property tax parcel account numbers 17-0478-000 Personal Assessed property? value(s) ❑ $ 26,200.00 ❑ $ 0.00 ❑ $ 0.00 4 Street address of propertv 9481 Maple Dr. NE, Moses Lake, WA 98837 This property is located in lGrant County (for unincorporated locations please select your county) ❑ 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. .egal description of property (if you need more space, attach a separate sheet to each page of the affidavit). See Exhibit "B" 5 F1-8- All other residential not elsewhere coded �J Enter any additional codes (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes ® No Is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) ❑Yes ®No 6 is this property designated as forest land per RCW 84.33? Oyes ®No p p Y g Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes 0 No Is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes ® No 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print name 1 CERTIFY UNDER PENALTY OF Signature of gr ntor or agen Name (print) 61w Date & city of signing =�- Signature Print name THAT TA 7 List all personal property (tangible and intangible) included in selling price. NONE if claiming an exemption, enter exemption code and reason for exemption. *See dor.wa.gov/REET TUV mAp ion yesd* Exemption No. (sec/sub) Reason for exemption Under threat of eminent domain. Type of document Public Roadway Easement Date of document �2:3Q 220!�t Gross selling price 3,095.96 *Personal property (deduct) 0.00 Exemption claimed (deduct) 3,095.96 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75% 0.00 Above $3,025,000 at 3 % 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSLRUCTIONS UE4AND CORRECT Signature of grantee or agent\. i /L/ /= i `CA i1 Name( rint)Cind Car -ter, Chbirp Y___ Date & city of signing - `� 'wbf h Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a iinaximurfi term of five ears, or by a fine in an 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)). 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 (06/03/24) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1 of 6 EXHIBIT ((BJ7 The North 30 feet of that portion of the Northeast Quarter of the Southwest Quarter of Section 101 Township 19 North, Range 28 East, W.M., Grant County, Washington, described as follows: Beginning at the center of Section 10; thence Southerly along the Easterly line of the Southwest quarter of Section 10, a distance of 187.8 feet; thence Westerly parallel to the East and West centerline of said Section, a distance of 115 feet; thence Northerly parallel to the East line of the Southwest quarter of Section 10, a distance of 187.8 feet to a point to the. East and West centerline; thence Easterly along the said centerline, a distance of 115 feet to thePoint of Beginning, EXCEPT the West 5 feet. Situate in the County of Grant, State of Washington. Grant County Tax Parcel No. 17-0478-000 REAL PROPERTY VOUCHER TRANSMITTAL UNIVERSAL FIELD SERVICES, INC. I I I MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) kbutterfield@ufsrw.com DATE: June 14, 2024 TO: Bob Bersanti, Grant County Design Eng'. eer 4�! e; FROM: Kristin Butterfield, Acquisition Agent RE: Grant County Maple and Grape Drive Reconstruction Project Project Parcel # 11 —Norman Norman and Judy Lynch — signed documents transmittal 1) Please find attached original signed documents: Public Roadway Easement Real Estate Excise Tax Affidavit with Exhibit B Real Property Vouc*her Construction Memorandum of Understanding IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the County's signature(s) on: ® Public Roadway Easement, on Page 3 ® Real Property Estate Excise Tax Affidavit, in "Signature of Grantee" block ® Real Voucher, at bottom of page ® Construction Memorandum of Understanding, at bottom of page DO NOT forward payment to property owner until document has been recorded 1) Recording and Release of Payment: Take the Public Roadway Easement and Real Estate Excise Tax Affidavit to the Count Courthouse for recording, along with a check to Gray nt County Treasurer in the amount of $10.00 and a check to Grant County Auditor in the amount of $306.50. When you have the recording numbers, you may remit the owner's check by certified mail to: Norman and Judy Lynch 9689 Maple Drive NE Moses Lake, WA 98837 4) Please email copies of the fully signed Constr couction MOU and recorded basementa pv of the owner's check to me to me at kbutterfield@ufsrw.com. Please do not hesitate to contact me if you have any questions. *NOTE.- Please retain the original W-9;it contains Private Personal Information and the on final is g provided for your Accounting Department records. For security purposes, we shred file copies of the W-9 upon confirmation of payment. A copy of the W-pa electronic a9 will not be included in the final per or cquisition folder. After Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantors: Norman J. Lynch and Judy A. Lynch, husband and wife Grantee: Grant County, a political subdivision of the State of Washington Abbreviated Legal: PTN NW114 SE114 5-10, T-19N R-28E, W.M., in Grant County, WA g Additional Legal Description Is on Page 1 y Assessor's Tax Parcel Number., 17-0336-000 Project: Maple and Grape Drive Reconstruction Project Project Parcel Number. 11 U-1rublic Roadway Easement The Grantors, Norman J. Lynch and Judy A. Lynch, husband and wife for and in consideration of Ten and No/100ths Dollars, ($10.00) and other good and valuable consid eration receipt of which is hereby acknowledged, convey and grant to Grant County, a political subdivision of the State of Washington and its assigns, Grantee, a non-exclusive perpetual easement for public roadway purposes, including but not limited to construction mainten ance, and repair of all transportation and sidewalk facilities, over, upon and across the e following property situated in Grant County, Washington, to the same extent and purpose as of the i p p rights herein granted had been acquired under Eminent Domain statute of the State of Washington. The North 27 feet of that portion of the Northwest Quarter of the Southeast Quarter of Sectio n 10, Township 19 North, Range 28 East, W.M., Grant County, Washington, which lies Northeaster) of perpetual easement for the United Staes Governmenty the Railroad, Excepting that portion described as follows. Beginning at the East quarter corner of said section; thence North 89046'11" West alongthe East centerline of said Section a distance of 1,317.64 feet - West to the Northeast corner of said subdivision, which point is the true point of beginning; Thence South 00029'43" West along the East line of said subdivision 568.45 feet to the Northeaste rly right-of-way line of the United States Government Railroad; Thence North 42042'14" West along said Northeasterly right-of-way line a distance of 365.21 feet; Thence North 00029'43" East a distance of 301.10 feet to a point on said East-West cent erline of said Section 10; Thence South 89045'32" East a distance of 250 feet to the point of beginning. 9 Situate in the County of Grant, State of Washington As depicted on Exhibit A attached hereto and made a part hereof. 1 of 4 This conveyance shall include all such rights in the above -described land as shall be necessary for Grantee's Easement purposes, including the o p P g rights of ingress and egress. Any and all of Grantor's access rights, whether existing or future, shall be established by, governed b Y g y and subject to RCW 36.75.130, or as hereafter may be amended, and applicable County Policy. . This grant of easement is a covenant running with the land and shall be bindingu the heir on p s, personal representatives, successors and assigns of both parties. It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County,g Washington unless and until accepted and approved hereon in writing. Judy .Lync� Date State of Washington ss. County of Grant On this day of , 2 , before me personally ppeared eared Norman J , Lynch and Judy A. Lynch, to me known to be t e individuals described in and who executed the within and foregoing instrument, and acknowledged that they signed the same as their free and voluntary act and deed, for the uses and purposes therein mentioned. Residing at___[J My Commission 2 of 4 Accepted by Grant County By: IV Printed Name:Ci dy Carter, Title:Chair- Date.11 Approved as to form: Printed Name: ` Title: Couty Attorney Date:fl'�124 3of 4 4 of 4 Department of(RCW 52.45 WAC 458-61A) pReal Tax Affidavit Estate Revenue(cl i a single location code on or after larch 1, 2023, Only .for sales n g Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. Form 84 000 1 a This form is your receipt -when stamped by cashier. Please type or print [I Check if partial artial sale, indicate % sold. List percentage of ownership acquired next to each name. 1 Seller/Grantor 2 Buyer/Grantee Name Norman J. and Judy A. Lynch, husband and wife Mailing address 9689 Maple Dr. NE city/state/zip Moses Lake, WA 98837 Phone (including area code) 509-765-3189 3Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Grantor Mailing address City/state/zip Name Grant County, State of Washington Mailing address P.O. Box 37 City/state/zip E.,phrata, WA 98823 Phone (including area code) 509-754-6082 - List all real and personal property tax parcel account numbers 17-0336-000 Personal Assessed property? value(s) ❑ $ 23,000.00 ❑ $ 0.00 ❑ $ 0.00 Street address of property 9689 Maple Dr. NE, Moses Lake, WA 98837 This property is located in lGrant Count (for unincorporated locations please select your county) ❑ 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. _egal description of property (if you need more space, attach a separate sheet to each page of the affidavit). See attached Exhibit "B" 5 118 -All other residential not elsewhere coded Enter any additional codes - (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes ® No Is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, ❑Yes ®No complete the predominate use calculator (see instructions) 6 Is this property designated as forest land per RCW 84.33? ❑Yes ONo p p Y g Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes ®No Is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes ®No 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print name Signature Print name I CERTIFY UNDER PENALTY OF POU Signature of grantor or c3gent Name (print) ex 0 Date & city of signing 2` 7 List all personal property (tangible and intangible) included in selling price. NONE if claiming an exemption, list WAC number and reason for exemption. WAC number (section/subsection) 458-61A-206(3) Reason for exemption Under threat of eminent domain. Type of document Pa Roadway Easement Date of document - Gross selling price 11,467.58 *Personal property (deduct) 0.00 Exemption claimed (deduct) 11,467.58 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75% 0.00 Above $3,025,000 at 3% 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS THAT THE FOREGOINVIS TRUE AND CORRECT Signature of grantee or agent If �4 I Name (print) Cindy Carter, Choir Date & city of signing 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 ears, or by Y a fine in an amount fixed b 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)). 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 (02/28/23) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1of6 EXHIBIT cc Byy The North 27 feet of that portion of the Northwest Quarter of the Southeast Quarter of Section 10, Township 19 North, Range 28 East, W.M., Grant County, Washington, which lies Northeasterly of the Perpetual easement for the United Staes Government Railroad Excepting that portion described as follows: , Beginning at the East quarter corner of said section; thence North 89046'11 " West along the East-West centerline of said Section a distance of 1,317.64 feet to the Northeast corner of said subdivision, which point is the true point of beginning; Thence South 00029'43" West along the East line of said subdivision 568.45 feet to the Northeasterly right-of-way line of the United States Government Railroad; Thence North 42042'14" West along said Northeasterly right-of-way •line a' distance of 365.21 feet; Thence North 00029'43" East a distance of 301.10 feet to a point on said East-West centerline of said Section 10; Thence South 8904532" East a distance of 250 feet to the point of beginning. Situate in the County of Grant, . State of Washington AGENCY NAME I hereby certify under penalty of perjury that the items and amounts listed herein are Grant County proper charges against the Agency, that the same or any part thereof has not been paid, and that I am authorized to sign for the claimant. P.O. Box 37 Ephrata, WA 98823 SIGNATURE (IN INK) FOR EACH CLAIMANT DATED X GRANTOR OR CLAIMANT (NAME, ADDRESS) TIN/SSN: Norman J. and Judy A. Lynch X 0AA. 9689 Maple Dr. NE Moses Labe, WA 98837 PROJECT NO. AND TITLE Maple and Grape Drive Reconstruction Project FEDERAL AID NO. PARCEL NO. N/A 11 In full, complete and final payment and settlement for the title or interest conveyed or released, as fully set forth in: Public Roadway Easement DATED $ AMOUNT LAND: 7,281 SF in public roadway easement + $119467.58 IMPROVEMENTS: Gravel and lawn in acquisition area + $19451.50 DAMAGES: Cost to Cure - move mailbox out of acquisition area + $80.00 Proximity + $0.00 Other + $0.00 $0.00 SPECIAL BENEFITS JC (dust Compensation) Amount REMAINDER: $13,000.00 ( R ) Uneconomic Remnant + $0.00 Excess Acquisition - + $0.00 ��1 DEDUCTIONS: Amount Previously Paid $0.00 Performance Bond $0.00 Salvage Amount $0.00 Pre Paid Rent $0000 Other $0.00 ADMINISTRATIVE SETTLEMENT + STATUTORY EVALUATION ALLOWANCE + ESCROW FEE + $0.00 REAL ESTATE EXCISE TAX + $0.00 OTHER: $0.00 Ac UI ION °AG T _. — DATE Voucher No. TOTAL AMOUNT PAID Alf IPlRJ1'Z AGENT F R GE Y r r DATE $139000.00 R ) r V Cindy Carter, Chair q.70. J i pa_,A91 lnl,?nla I\ V - Grantors: Norman J. Lynch and Judy A. Lynch, husband and wife Grantee: Grant County, a political subdivision of the State of Washington Abbreviated Legal: PTN NW114 SE114 S-10, T-19N R-28E, W M., in Grant County, WA Assessor's Tax Parcel Number: 17-0336-000 Project: Maple and Grape Drive Reconstruction Project Project Parcel Number: 11 CONSTRUCTION MEMORANDUM OF UNDERSTANDING between Grant County, apolitical subdivision of the State of Washington and Norman J. Lynch and Judy A. Lynch, husband and wife The purpose of this document is to memorialize the understanding of Grant County (the County) and Norman ("Jim') and Judy Lynch (the Property Owners) with respect to the details related to the County's acquisition of property acquired in Public Roadway Easement from the undersigned Property Owners. The County and the undersigned Property Owners hereby agree to the following: As part of the project referenced above, the County has agreed to provide one (1) continuous curb cut on the northern frontage of the Property Owners' parcel located at 9689 Maple Drive NE, Moses Lake, WA, as described below and as depicted on the attached exhibit: Curb cut between and in line with the eastern edge of the residence's garage driveway and the western edge of the large shop's front door, a distance of approximately 78 feet. 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[,+.: �'"h't; : Yn. �. ti .>�� 7Y'' as n'r:i w. by . ', `Fw: .. �:�' +*. �;�y,�,, .,�,f t T t�`��' "C?��•�� L 1 � �-'x'7ti� �'�",r, o y �K r., 1 F J x a. � �pz 2 5• Y,••,` S ii•;3.�-a�.l`�-��`�;+�Jr�irr k��S.::�?iS.�.dT��fd.:•.7:��"is�L ♦aS`�"::'n,�i +;k'� �.Y`' '�. ��t.::', :+ \� i r.-..�3r!' ,�•A..h'..."r Y .:,. ",!•T-.+�,'�'_ �;4if:r3':"!zw�Yi.:. _.,`1'�'�'.T:.... �4r. "�. ► �1y' le. n..Y a s`.ti. r.,t 4y �•.a.M 4' ,P 1'y. .r,:i- .+ .J.:Y .:r� LN.2 Q' � :w.,il \tr 3 's rti v� • a'Y. ii�:•_L_ { •h: TRANSMITTAL UNIVERSAL FIELD- SERVICES, INC. I I I MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) kbutterfield@ufsrw.com DATE: July 15, 2024 TO: Bob Bersanti, Grant County Design E' eer ; ,a FROM: Kristin Butterfield, Acquisition Agent RECEIVED JUL 16 2024 N T I C 0 U N W PR B L I C WA10 F S RE: Grant County Maple and Grape Drive Reconstruction Project Project Parcel # 12 — Venus Crow — signed documents transmittal 1) Please find attached original signed documents: Public Roadway Easement Real Estate Excise Tax Affidavit with Exhibit B Real Property Voucher IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the County's signature(s) on: Public Roadway Easement, on Page 3 Real Property Estate Excise Tax Affidavit, in "Signature of Grantee" block Real Voucher, at bottom of page DO NOT forward payment to property owner until document has been recorded Take, the Public Roadway Easement and Real Estate Excise Tax Affidavit to the County Courthouse for recording, along with a check to Grant County Treasurer in the amount of $10.00 and a check to Grant County Auditor in the amount of $306.50. When you have the recording numbers, you may remit the check by certified mail to: Venus Crow 9729 Maple Drive NE Moses Lake, WA 98837 4) Please email a copy of the recorded Easement and a copy of the check to me to me at kbutterf1eld@ufsmcom. Please do not hesitate to contact me if you have any questions. *NOTE: Please retain the original W-9; it contains Private Personal Information and the original is provided for your Accounting Department records. For security purposes., we shred file copies of the W-9 upon confirmation of payment. A copy of the W-9 will not be included in the final paper or electronic acquisition folder. After Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantor: The heirs or devisees of Loyd Junior Crow, deceased and Venus Marie Crow, as her separate estate Grantee: Grant County, a political subdivision of the State of Washington Abbreviated Legal Description: PTN NW 1/4SE 1/4, STR 10-19-28E, W.M., Grant County, Washington Additional Legal Description is on Page I Assessor's Tax Parcel Number: 17-0462-000 Project: Maple and Grape Drive Reconstruction Project Project Parcel Number: 12 The Grantor, The heirs or devisees of Loyd Junior Crow, deceased and Venus Marie Crow, as her separate estate, for and in consideration of Ten and No/100ths Dollars, ($10.00) and other good and valuable consideration, receipt of which is hereby acknowledged, conveys. and grants to Grant County, a political subdivision of the State of Washington and its assigns, Grantee, a non-exclusive perpetual easement for public roadway purposes, including but not limited to construction, maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following property situated in Grant County, Washington, to the same extent and purpose'as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: The North 30 feet of that portion of the Northwest Quarter of the Southeast Quarter of Section 10, Township 19 North, Range 28 East, W.M., Grant County, Washington, described as follows: Beginning at the East quarter corner of said section; thence North 89046'11" West along the East-West centerline of said section, 1317.64 feet to the Northeast corner of said subdivision, which paint is the true point of beginning of the property herein described; thence South 00029'43" West along the east line of said subdivision 568-45 feet to the northeasterly right-of-way line of the United States Government Railroad; thence North 42'42'14" West along said northeasterly right-of-way line 365.21 feet; thence North 0002943" East 301.10 feet to a point on said East-West centerline of said Section 10; thence South 89'45'32" East 250 feet to the point of beginning. Situate in the County of Grant, State of Washington. As depicted in Exhibit A attached hereto and made a part hereof by this reference. 1 of 4 This conveyance shall include all such rights in the above -described land as shall be necessary for Grantee's Easement purposes, including the rights of ingress and egress. Any and all of Grantor's access rights, whether existing or future, shall be established by, governed by and subject to RCW 36.75.130, or as hereafter may be amended, and applicable County Policy. This grant of easement is a covenant running with the land and shall be binding upon the heirs, personal representatives, successors and assigns of both parties. It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County) Washington unless and until accepted and approved hereon in writing. DATED THIS DAY OF�J20 Is -IV C�� Venus Marie Crow State of Washington ss. County of Grant On this day personally appeared before me Venus Marie Crow, to me known to be the individual described in and who executed the within and foregoing instrument and acknowledged that she signed the same as her free and voluntary act and deed'for the uses and purposes therein mentioned. Given under my hand and official seal this L�0' day of U/V 20 EN Al JV_RTP tAOTAF, UB it in a fforfh ate of Washington qC A e Residing at PUB00 MY Commission Expires: WE *,cbNMi0#. -OF 2 of 4 Accepted by Grant County Printed Name: Chdy Carter, Title: Chair Date: Approved as to form: g By: - - Printed Name: g 1 Title: Count Attorney Date: 3 of 4 IR APM OR, 'oli, �'.' 1� Ll .. ,.,F'� .N.4r. ...,....l�,f,...q.�.-2 . a`,...., •Wk?iM 'k...w .. .. __ PROPOSED 30, COU4 TY ME-NT S TA .--` A, 43.349729 MAPLE OR, y MOSES LANE W MAPLE AND GRAPE OR, RECOIL STRU C ONPRO-. C a kT ` t TV �� -"ll 4 of 4 Department of�AffidavitRC1N 82.45 WAC 458-61 A) pRealExcise Tax Estate Revenue i single location code on or after March 1 2023. Only for sales n a s g Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. Form 84 0001 a This form is your receipt when stamped by cashier.. Please type orprint. ❑ Check box if partial sa e, indicate /o sold. List percentage of ownership acquired next to each name. 1 Seller/Grantor 2 Buyer/Grantee Name The heirs or devisees of Loyd Junior Crow, deceased and Name Grant County, State of Washington Venus Marie Crow, as her separate estate Mailing address 9729 Maple Dr. NE P.O. Box 37 Mailing address city/state/zip Moses Lake, WA 98837 City/state/zip Ephrata, WA 98823 Phone (including area code) 509-765-5883 Phone (including area code) 509-754-6082 3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Grantor Mailing address City/state/zip — List all real and personal property tax parcel account numbers 17-0462-000 Personal Assessed property? value(s) ❑ $ 45,400.00 ❑ $ 0.00 ❑ $ 0.00 4 Street address of property 9729 Maple Dr. NE, Moses Lake WA 98837 This property is located in lGrant Count —71ffor unincorporated locations please select your county) ❑ 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. .egal description of property (if you need more space, attach a separate sheet to each page of the affidavit). See attached Exhibit "B" 5 18 -All other residential not elsewhere coded Enter any additional codes - (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes ® No is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) ❑Yes ®No 6 Is this property designated as forest land per RCW 84.33? ❑Y p p Y ges ®No Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes 0 No is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes ® No 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print name Signature Print name 7 List all personal property (tangible and intangible) included in selling price. NONE If claiming an exemption, list WAC number and reason for exemption. WAC number (section/subsection) 458-61A-206(3) Reason for exemption Under threat of eminent domain. Type of document Public Roadwav Easement Date of document --� Gross selling price 5,067.90 *Personal property (deduct) 0.00 Exemption claimed (deduct) 5,067.90 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75% 0.00 Above $3,025,000 at 3% 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE RUCTIONS _ I CERTIFY UNDER PENALTY OF PERJIRY THAT THE FOREGOING. IS TRUE AND CORRECT Signature of grantor or agent // Signature of grantee or agent V-/U/UAV Name (print) i le >a Lf_lName (print; Cindy Carter, Chair Date & city of signing Date & city of signing — - % ?- Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maximurd term of five ears, or by a fine in an 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)). 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 (02/28/23) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1 of 6 EXHIBIT"B" The North 30 feet of that portion of the Northwest Quarter of the Southeast Quarter of Section 10, Township 19 North, Range 28 East, W.M., Grant County, Washington, described as follows: Beginning at the East quarter corner of said section; thence North 89046'11 " West along the East-West centerline of said section, 1317.64 feet to the Northeast corner of said subdivision, which point is the true point of beginning of the property herein described; thence South 00029'43" West along the east line of said subdivision 568.45 feet to the northeasterly right-of- way line of the United States Government Railroad; thence North 42042'14" West along said northeasterly right-of-way line 365.21 feet; thence North 00029'43" East 301 A 0 feet to a point on said East-West centerline of said Section 10; thence South 89'45'32" East 250 feet to the point of beginning; Situate in the County of Grant, State of Washington. Grant County Tax Parcel No. 17-0462-000 REAL PROPERTY VOUCHER TRANSMITTAL UNIVERSAL FIELD SERVICES, INC. 111 MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) kbutterfleld@ufsrw.com DATE: July 15, 2024 TO: Bob Bersanti, Grant County Design Engi eer FROM: Kristin Butterfield, Acquisition Agent RE: Grant County Maple and Grape Drive Reconstruction Project Project Parcel # 13 — Kevin and Rose Foster — signed documents transmittal 1) Please find attached original signed documents: ® Public Roadway Easement ® Real Estate Excise Tax Affidavit ® Real Property Voucher ® IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the County's signature(s) on: ® Public Roadway Easement, on Page 3 ® Real Property Estate Excise Tax Affidavit, in "Signature of Grantee" block ® Real Voucher, at bottom of page 1111111111111p�iipi�q i�iq 111i 3)- Recording and Release of Payment: Take the Public Roadway Easement and Real Estate Excise Tax Affidavit to the County Courthouse for recording, along with a check to Grant County Treasurer in the amount of $10.00 and a check to Grant County Auditor in the amount of $306.50. When you have the recording numbers, you may remit the check by certified mail to: Kevin and Rose Foster 975►0 Maple Drive NE Moses Lake, WA 98837 4) Please email a copy of the recorded Easement and a copy of the check to me to me at kbutterfield@ufsrw.com. Please do not hesitate to contact me if you have any questions. *NOTE: Please retain the original W-9; it contains Private Personal Information and the original is provided for your Accounting Department records. For security purposes, we shred file copies of the W-9 upon confirmation of payment. A copy of the W-9 will not be included in the final paper or electronic acquisition folder. After Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, VVA 9882-8' Document Title: Public Roadway Easement Grantors: Kevin L. Foster and Rose M. Foster, husband and wife Grantee: Grant County, a political subdivision of the State of Washington Abbreviated Legal: W112 of the SWI14 of the NE114, STR 10-19N-28E, W.M. in Grant County., WA Additional Legal Description is on Page I Assessor's Tax Parcel Number 17-0319-000 Project: Wap/e and Grape Drive Reconstruction Project Project Parcel Number., 13 Public Roadway Easement The Grantors, Kevin L. Foster and Rose M. Foster, husband and wife, for and in consideration of Ten and No/1 00ths Dollars, ($10.00) and other good and valuable consideration, receipt of which is hereby acknowledged, convey and grant to Grant County, a political subdivisioin of the State of Washington and its assigns, Grantee, a non-exclusive perpetual easement for public roadway purposes, including but not limited to construction, maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following property situated in Grant County, Washington, to the same extent and purpose as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: The South 10 feet of the West half of the Southwest Quarter of the Southeast Quarter of the Northeast Quarter Section 10, Township 19 North, Range 28 East, W.M., Grant County, Wash ingtc>n, EXCEPT the road right of way along the South line thereof. Situate in the County of Grant, State of Washington As depicted on Exhibit A attached hereto and made a part hereof. This conveyance shall include all such rights in the above -described land as shall be necessary for Grantee's Easement purposes, including the rights of in and egress. Any and all of Grantor's access rights, whether existing or future, shall be established by, governed by and subject to RCW 36.75.130, or as hereafter may be amended, and applicable County Policy. 1 of 4 This grant of easement is a covenant running with the land and shall be binding upon the heirs, personal representatives, successors and assigns of both parties. It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County, Washington unless and until accepted and approved hereon in writing. Kevin L. Foster State of Washington ss. County of Grant On thisQ day of tt".l IV 2 before me personally appeared Kevin L. Foster and Rose M. Foster, to me known to be the individuals described in and who executed the within and foregoing instrument, and acknowledged that they signed the same as their free and voluntary act and deed, for the uses and purposes therein mentioned. U gj ENT 0�v r lid V%0TARV sop. PUBLVC 6 0• wi4 2 of 4 Accepted by Grant County Printed Name: Cindy Carter, Title:, Chair - - - Date: _ —� Z°7.�i 3 of 4 Approved as to form: By: _ - Printed Name: , Title: Count Attorney v Date: ixt � AMihY11.M1b �1'b WMF irtit Ay}K#?iwi .wwi.(�tiik Nor iwXM w4'in ik�Y .i%wia � Y4 3 �J1rt 34 L r � < 14 7- 6 rail U Y Y RALLS POP +} a: y W.iN� *A#+ ++s.n t !�+ .d s7 rape r'+i!t "It 11114 *IR Department ofReal EstateExcise Tax Affidavit RCW 82.45 WAC 458-61A) Revenue(Only for sales i a single location code on or after March 1 2023. in ng Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. Fir a This form is your receipt when stamped by cashier. Please type or print. Check box if artial sale, indicate / sold. List percentage of ownership acquired next to each name. ❑' p ,. Seller/Grantor 2 Buyer/Grantee Name Kevin L. Foster and Rose M. Foster, husband and wife Mailing address 9750 Maple Dr. NE city/state/zip Moses Lake, WA 98837 Phone (including area code) 509-793-4133 3Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Grantor Mailing address City/state/zip Name Grant County, State of Washington Mailing address P.O. Box 37 City/state/zip Ephrata, WA 98823 Phone (including area code) 509-754-6082 List all real and personal property tax parcel account numbers 17-0319-000 Personal Assessed property? value(s) ❑ $ 53,175.00 El $ 0.00 R $ 0.00 4 Street address of propert 9750 Maple Dr. NE, Moses Lake, WA 98837 This property is located in lGrant Count (for unincorporated locutions please select your county] ❑ 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. .egal description of property (if you need more space, attach a separate sheet to each page of the affidavit). The South 10 feet of the West half of the Southwest Quarter of the Southeast Quarter of the Northeast Quarter of Section 10, Township 19 North, Range 28 East, W.M., Grant County, Washington, EXCEPT the road right of way along the South line thereof. 5 18 -All other residential not elsewhere coded Enter any additional codes (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes ® No Is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) ❑Yes ®No 6 Is this designated as forest land per RCW 84.33? ❑Yes ®No property g Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑Yes 0No Is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes O No 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print name Signature Print name 7 List all personal property (tangible and intangible) included in selling price. NONE if claiming an exemption, list WAC number and reason for exemption. WAC n-u-m-ber (section/subsection) 458-61A-206(3) Reason for exemption Under threat of eminent domain. Type of document Public Roadway Easement Date of document. 4&Q4= Gross selling price - 1,719.99 *Personal property (deduct) 0.00 Exemption claimed (deduct) 1,719.99 Taxable selling price 0.00 Excise tax: state Less than $525,GGG.01 at 1.1% 0-•GG From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75 % 0.00 Above $3,025,000 at 3% 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS 81 CERTIFY UNDER PENALTY OF PERJURY THAT THE FORE G IS TRUE AND CORRECT I Signature of grantor or _ gept �''' a Signature of grantee or ag nt v" Name (print) e!S�o Name (print; Cindy Carter, Chaim' Date & city of signing : �7 fn Date & city of signing " 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 ears, or by Y a fine in an amount fixed b 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)). 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 (02/28/23) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page Iof6 AGENCY NAME I hereby certify under penalty of perjury that the items and amounts listed herein are proper charges against the Agency, that the same or any part thereof Grant County has not been paid, and that I am authorized to sign for the claimant. P.O. Box 37 SIGNATURE (IN INK) FOR EACH CLAIMANT DATED Ephrata, WA 98823 r �.' GRANTOR OR CLAIMANT (NAME, ADDRESS) TIN/SSN: ti )e) Kevin L. and Rose M. Foster 9750 Maple Dr. NE Moses Lake, WA 98837 PROJECT NO. AND TITLE Maple and Grape Drive Reconstruction Project FEDERAL AID NO. PARCEL NO. N/A 13 In full, complete and final payment and settlement for the title or interest conveyed or released, as fully set forth in: DATED $ AMOUNT Public Roadway Easement LAND: 3295-SF in public roadway easement + $1,719.99 _IMPROVEMENTS: -Gravel- and wire fence in acquisition area + $19402.20 DAMAGES: Cost to Cure + $0.00 Proximity + $0.00 Other + $0.00 SPECIAL BENEFITS $0.00 JC (Just Compensation) Amount $39200.00 ( R } REMAINDER: Uneconomic Remnant + $0.00 Excess Acquisition + $0.00 DEDUCTIONS: Amount Previously Paid $0.00 Performance ]Bond $0.00 SaIvage Amount $0-:00- Pre Paid Rent $0.00 Other $.0..00 ADMINISTRATIVE SETTLEMENT + $0.00 STATUTORY EVALUATION ALLOWANCE + $0.00 ESCROW FEE + $0.00 REAL ESTATE EXCISE TAX + $0.00 OTHER: $0.00 ACQ. I.S.L .ORAL T I,, .DATE Voucher No. TOTAL. AMOUNT PAID A k&'L $3,200.00 (R ) AOrb ZEbskgNT FORA V Y DATE Cindy Carter, Chair LPA-321 1012014 TRANSMITTAL UNIVERSAL UNIVERSAL FIELD SERVICES, INC. FIELD SERVICE-S I I I MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) kbutterfield@ufsrw.com DATE: July 227 2024 TO: Bob Bersanti, Grant County Design Engineer FROM: Kristin Butterfield, Acquisition Agent RE: Grant County Maple and Grape Drive Reconstruction Project Project Parcel #15 — Jesse and Dorothy Moore —'signed documents transmittal 1) Please find attached original signed documents: Public Roadway Easement Real Estate Excise Tax Affidavit with Exhibit B Real Property Voucher IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the County's signature(s) on: ® Public Roadway Easement, on Page 3 Real Property Estate Excise Tax Affidavit, in "Signature of Grantee" block Real Voucher, at bottom of page DO NOT forward payment to property owner until document has been recorded 3) Recording and Release of Payment: Take the Public Roadway Easement and Real Estate Excise Tax Affidavit to the County Courthouse for recording, along with a check to Grant County Treasurer in the amount of $10.00 and a check to Grant County Auditor in the amount of $307.50. When you have the recording numbers, you may remit the check by certified mail to: Jesse and Dorothy Moore 9664 Maple Dr. NE Moses Lake, WA 98837 4) Please email a copy of the recorded Easement and a co pv of the check to me to me at kbutterfield@ufsrw.com. Please do not hesitate to contact me if you have any questions. *NOTE: Please retain the original W-9; it contains Private Personal Information and the original is provided for your Accounting Department records. For security purposes, we shred file copies of the W-9 upon confirmation of payment. A copy of the W-9 will not be included in the final paper or electronic acquisition folder. After /IxTier Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantors: Jesse C. Moore and Dorothy A. Moore, husband and wife Grantee: Grant County, a political subdivision of the State of Washington Abbreviated- Legal- Ptn NE Y4Sec 10-19N-28E, Willamette Meridian in Grant County, WA Additional Legal Description is on Pages I and 2 Assessor's Tax Parcel Number: 17-0316-000 Project: Maple and Grape Drive Reconstruction Project Project Parcel Number: 15 Public Roadway Easement The Grantors, Jesse C. Moore and Dorothy A. Moore, husband and wife, -for and in consideration. of Ten and No/1 00ths Dollars, ($10.00) and other good and valuable consideration receipt of which is hereby acknowledged, convey and grant to Grant County, a political' subdivision of the State of Washington and its assigns, Grantee, a non-exclusive perpetual easement for public roadway purposes, including but not limited to construction, maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following property situated in Grant County, Washington, to the same extent and 'purpose as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: The South 30 feet of Southeast quarter of the Southwest quarter of the Northeast quarter of Section 10 Township 19 North, Range 28E.W.M., Grant County, Washington, EXCEPT that portion described as follows: Beginning at the Southeast corner of said subdivision; thence North along the East line, a distance of 303 feet; thence West parallel to the South line of said subdivision, a distance of 400 feet; thence South parallel to the East line of said subdivision, a distance of 303 feet to the South line of said subdivision; thence East along the South line to the point of beginning. AND EXCEPT that portion thereof condemned by the United States of America for railroad spur tract under United States District Court, Eastern District, North Division, Cause Number 295. AND EXCEPT that portion of the Southeast quarter of the Southwest quarter of the Northeast quarter of Section 10, Township 19 North, Range 28 E.W.M., Grant County, Washington, described as follows: Beginning at the Southeast corner of said subdivision; running thence West along the South boundary line, a distance of 426 feet 6 3/4 inches; thence North parallel with the East boundary line of said 1 of 5 subdivision, a distance of 62 feet to the true point of beginning; continuing thence North parallel with the East boundary line of said subdivision, a distance of 12 feet; thence East parallel with the South boundary line of said subdivision, a distance of 10 feef; thence South parallel with the East boundary line of said subdivision, a distance of 12 feet; thence West parallel with the South boundary line of said subdivision, a distance of 10 feet to the true point of beginning. Except roads Situate in the County of Grant, State of Washington As depicted on Exhibit A attached hereto and made a part hereof This conveyance shall include all such rights in the above -described land as shall be necessar y for Grantee's Easement purposes, including the rights of ingress and egress. Any and all of Grantor's access rights, whether existing or future, shall be established by, governed by and subject to RCW 36.75.130, or as hereafter may be amended, and applicable County Policy. This grant of easement is a covenant running with the land and shall be bindingu the heir on p s, personal representatives, successors and assigns of both parties. It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County, Washington unless and until accepted and approved hereon in writing. ,4., -'e '4" Jesse C. Moore Date 2of5 State of Washington ss. County of Grant On this day of , 2( , before me personally appeared p y pp Jesse C. Moore and Dorothy A. Moore, to me known to be the individuals described in and who executed the within and foregoing instrument, and acknowledged that they signed the same as their free and voluntary act and deed, for the uses and purposes therein mentioned. NOTARY PUBLI in and for t Residing at___; My Commission Expires: 3 of 5 ate of Washington �IMIWWMAI Accepted by Grant County By - Printed Name: Cindy Carter, Title: Chair. Date: ?,&t Approved as to fora: y By: Pri ed Name:. , Title: Coun y Attorney Date:` 4of5 EXH BI A. STA. 31+ 21 TOY ,T . 3 2+ 3,36 6 PARCEL #t 170316000 9664 MAPLE DR, NIOSES LAKE 83 Y PROPOSED30 COUNTY R D, EASEMENT ell Oil Owl s: vi APLE DR. MAPLE AND GRAPE -DR, m ayt lice. mvsna 'tlA'of EMU CANT 0"A'r- :MOB 5of5 Department ofVitAffida (RCW 2.45 WAC 458-61A)ReaI Ex ise Tax Revenue Only for sales in a single location code on or after July 1, 2024, Woshington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed. 1 Thisform is your receipt when stamped by cashier. Please type or print. r Check box if artial sale, indicate �/ old. List percentage of ownership acquired next to each name. ❑ p �. Seller/Grantor 2 Buyer/Grantee Name Jesse C. Moore and Dorothy A. Moore, husband and wife Name Grant County, State of Washington Mailing address 9664 Maple Dr. NE City/state/zip Moses Lake, WA 98837 Phone (including area code) 509-989-3544 3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name` Grantor Mailing address City/state/zip Mailing address P.O. Box 37 City/state/zip Ephrata, WA 98823 Phone (including area code) 509-754-6082 List all real and personal property tax parcel account numbers 17-0316-000 Personal Assessed property? value(s) ❑ $ 58,750.00 ❑ $ 0.00 ❑ $ 0.00 4 Street address of property 9664 Maple Dr. NE, Moses Lake, WA 98837 This property is located in lGrant County 771(for unincorporated locations please select your county) ❑ 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. .egal description of property (-if you- need more space, attach a -separate sheet to -each- page, of the -affidavit): See Exhibit B 5 118 -All other residential not elsewhere coded Enter any additional codes (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes 0 No 18 this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, complete the predominate use calculator (see instructions) ❑Yes ®No 6 is this property designated as forest land per RCW 84.33? ❑Yes ®No p p Y g Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes 0 No Is this property receiving special -valuation as historical - property per RCW 84.26? ❑ Yes ® No if any answers are yes, complete as instructed below. (1) NOTICE OF CONTINUANCE (FOREST LAND OR CURRENT USE) NEW OWNERS}: 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print'name Signature Print name 7 List all personal property (tangible and intangible) included in selling price. NONE If claiming an exemption, enter exemption code and reason for exemption. *See dor.wa.gov/REST for ex mp i n des* Exemption No. (sec/sub) 458-6�--A-�6. -� Reason for exemption Under threat of eminent domain, Type of document Public Roadway Easement Date of document s j �CIV - Gross selling price 1,576.05_ *Personal property (deduct) 0.00 Exemption claimed (deduct) 1.576.05 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75 % 0.00 Above $3,025,000 at 3 % 0.00 Agricultural and timberland at 1.28/ 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal Q.00- *State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTCTiONS I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT —Signature of grantor or agent - Signature of grantee or ap-en - g g g Name (print)�� e'` �'`i' o®�' Name (print) Cindy Carter, Chair Date & city of signing ''��'' tI�LA Date & city of signing Perjury in the second degv ree is a class C felony which is punishable by confinement in a state correctional institution for a maximum term of five ears, or by a fine in an amount fixed b 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)). 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 (06/03/24) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1 of 6 amp The South 30 feet of Southeast quarter of the Southwest quarter of the Northeast quarter of Section 10, Township 19 North, Range 28E.W.M., Grant County, Washington, EXCEPT that portion described as follows: Beginning at the Southeast corner of said subdivision; thence North along the East line, a distance of 303 feet; thence West parallel to the South line of said subdivision, a distance of 400 feet; thence South parallel to the East line of said subdivision, a distance of 303 feet to the South line of said subdivision; thence East along, the South line to the point of beginning. AND EXCEPT that portion thereof condemned by the United States of America for railroad spur tract under United States District Court, Eastern District, North Division, Cause Number 295.. AND EXCEPT that portion of the Southeast quarter of the Southwest quarter of the Northeast quarter of Section 10, Township 19 North, Range 28 E.W.M., Grant County, Washington, described as follows: Beginning at the Southeast corner of said subdivision.; running thence West along the South boundary line, a distance of 426 feet 6 3/4 inches; thence North parallel with the East boundary line of said subdivision, a distance of 62 feet to the true point of beg-in-ni-ng-; continuing thence North parallel with the East boundary line of said subdivision, a distance of 12 feet; thence East parallel with the South boundary line of said subdivision, a distance of 10 feef; thence South parallel with the East boundary line of said subdivision, a distance of 12 feet; thence West parallel with the South boundary line of said subdivision, a distance of 10 feet to the true point of beginning. Except roads Situate in the County of Grant, State of Washington Grant County Tax Parcel No.: 17-0316-000 REAL PROPERTY VOUCHER TRANSMITTAL UNIVERSAL FIELD SERVICES, INC. I I I MAIN STREET SUITE 105 EDMONDS, WA 98020 Tel: (206-550-3221) kbutterfield@ufsrw.com DATE: August 1, 2024 TO: - Bob Bersanti, Grant County Design Eng' eer FROM: Kristin Butterfield, Acquisition Agent RE: Grant County Maple and Grape Drive Reconstruction Project Project Parcel # 16 — Gregory Babak — signed documents transmittal 1) Please find attached original signed documents: ® Public Roadway Easement ® Real Estate Excise Tax Affidavit with Exhibit B ® Real Property Voucher ® IRS W-9 Request for Taxpayer Identification *see NOTE below 2) Please coordinate the County's signature(s) on: Z Public Roadway Easement, on Page 3 Z Real Property Estate Excise Tax Affidavit, in "Signature.of Grantee" block Z Real Voucher, at bottom of page DO NOT forward payment to property owner until document has been recorded 3) Recording and Release of Payment: Take the Public Roadway Easement and Real Estate Excise Tax Affidavit to the County Courthouse for recording, along with a check to Grant County Treasurer in the amount of $10.00, and a check to Grant County Auditor in the amount of $306.50. When you have the recording numbers, you may remit the check by certified mail to: Gregory Babak 10696 Maple Drive NE Moses Lake, WA 98837 4) Please email a copy of the recorded Easement and a copy of the check to me to me at kbutterfieid@ufsrw.com. Please do not hesitate to contact me if you have any questions. *NOTE: Please retain the original W-9; it contains Private Personal Information and the original is provided for your Accounting Department records. For security purposes, we shred file copies of the W-9 upon confirmation of payment. A copy of the W-9 will not be included in the final paper or electronic acquisition folder. After er Recording Mail to: GRANT COUNTY DEPARTMENT OF PUBLIC WORKS P.O. Box 37 Ephrata, WA 98823 Document Title: Public Roadway Easement Grantor: Gregory Babak, also shown of record as Gregory I. Babak, as his separate estate Grantee: Grant County, a political subdivision of the State of Washington Abbreviated Legal Description: Ptn. W112 E1/2 SEI/4 NWI/4, 5-10, R-19N, R28E, W.M.3 in Grant County, WA Additional Legal Description is on Page 1 Assessor's Tax Parcel Number: 17-0328-000 Project: Maple and Grape Drive Reconstruction Project Project Parcel Number: 16 t111111 Pill I The Grantor, Gregory Babak, also shown of record as Gregory 1. Babak, as his separate estate, for and in consideration of Ten and No/100ths Dollars, ($10.00) and other good and valuable consideration, receipt of which is hereby acknowledged, conveys and grants to Grant County, a political subdivision of the State of Washington and its assigns, Grantee, a non- exclusive perpetual easement for public roadway purposes, including but not limited to construction, maintenance, and repair of all transportation and sidewalk facilities, over, upon and across the following property situated in Grant County, Washington, to the same extent and purpose as of the rights herein granted had been acquired under Eminent Domain statute of the State of Washington: The South 30 feet of the West half of the East half of the Southeast quarter of the Northwest quarter of Section 10, Township 19 North, Range 28 East of the Willamette Meridian, Grant County, Washington, lying Southwesterly of the United States of America Railroad right of way as described in easement recorded November 18, 1943, under Auditors File No. 104175, records of Grant County, Washington. EXCEPT ROADS Situate in the County of Grant, State of Washington. As depicted in Exhibit A attached hereto and made a part hereof by this reference. 1 of 4 This conveyance shall include all such rights in the above -described land as shall be necessary for Grantee's Easement purposes, including the rights of ingress and egress. Any and all of Grantor's access rights, whether existing or future, shall be established by, governed by and subject to RCW 36.75.130, or as hereafter may be amended, and applicable County Policy. Y This grant of easement is a covenant running with the land and shall be binding upon the heirs personal representatives, successors and assigns of both parties. It is understood and agreed that delivery of this easement document is hereby tendered and that the terms and obligations hereof shall not become binding upon Grant County, Washington unless and until accepted and approved hereon in writing. L11l r DATED THIS DAY OF , 20rD Gregory Babak Gregory I. Babak State of Washington ss. County of Grant On this day personally appeared before me Gregory Babak, also shown of record as Gregory g Y 1. Babak, to me known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that he signed the same as his free and voluntary act and dee for the use nd purposes therein entioned. Given under my hand and official seal this day of , 2 NOTARYPUBLI in and fovthe Stat f Washington Residing at My Commission Expires: 2 of 4 Accepted by Grant County By: Lill Printed Name: �indy Carter, Title:, Chair Date. Approved as to form: By. _ Printed Name. Title: County t orney y Date: L Ll Z. 4 -4 3 of 4 4 of 4 Department ofExcise� � (RCW 82.45 WAC 45$-61A) p Tax Aff idav itReal ��tate Revenue r sales in a single location code on or after March 1, 2023. State Only for g n ll pages are full and accurately completed. WashingtonThis affidavit will not be accepted. unless all areas o a p g Y Y P 'r 4� 1 This form isrour receipt when stamped by cashier. Please type or print. Check box if partial sale indicate sold. List percentage of ownership acquired next to each name. ❑ p , �. Seller Grantor 2 Buyer/Grantee Name Gregory Babak, also shown of record as Gregory I. Babak, Name Grant County State of Washington � as his separate estate Mailing address 10696 Maple Dr. NE City/state/zip Moses Lake WA 98837 Phone (including area code) 509-750-7469 -_ 3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee Name Grantor Mailing address City/state/zip Mailing address P.O. Box 37 City/state/zip Ephrata, WA 98823 Phone (including area code) 509-754-6082 List all real and personal property tax parcel account numbers 17-0328-000 Personal Assessed property? value(s) F-1 53,125.00 ❑ $ 0.00 ❑ $ 0.00 4 Street address of property.9420 Maple Dr. NE, Moses Lake, WA 98837 This property is located in JGrant Count (for unincorporated locations please select your county) ❑ 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. _egal description of property (if you need more space, attach a separate sheet to each page of the affidavit). See attached Exhibit "B" 5 F18 -All other residential not elsewhere coded Enter any additional codes (see back of last page for instructions) Was the seller receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit org., senior citizen or disabled person, homeowner with limited income)? ❑ Yes ® No Is this property predominately used for timber (as classified under RCW 84.34 and 84.33) or agriculture (as classified under RCW 84.34.020) and will continue in it's current use? If yes and the transfer involves multiple parcels with different classifications, ❑Yes ®No complete the predominate use calculator (see instructions) 6 Is this property designated as forest land per RCW 84.33? ❑Yes ®No p p Y g Is this property classified as current use (open space, farm and agricultural, or timber) land per RCW 84.34? ❑ Yes ® No Is this property receiving special valuation as historical property per RCW 84.26? ❑ Yes ® No 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 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 signature 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) doesn't wish to continue, all additional tax calculated pursuant to RCW 84.26, shall be due and payable by the seller or transferor at the time of sale. (3) NEW OWNER(S) SIGNATURE Signature Print name Signature Print name 7 List all personal property (tangible and intangible) included in selling price. NONE If claiming an exemption, list WAC number and reason for exemption. WAC number (section/subsection) 458-61A-206(3) Reason for exemption Under threat of eminent domain. Type of document Public RQadwav Easement Date of document Gross selling price 4,470.30 *Personal property (deduct) 0.00 Exemption claimed (deduct) 4,470.30 Taxable selling price 0.00 Excise tax: state Less than $525,000.01 at 1.1% 0.00 From $525,000.01 to $1,525,000 at 1.28% 0.00 From $1,525,000.01 to $3,025,000 at 2.75% 0.00 Above $3,025,000 at 3% 0.00 Agricultural and timberland at 1.28% 0.00 Total excise tax: state 0.00 0.0050 Local 0.00 *Delinquent interest: state 0.00 Local 0.00 *Delinquent penalty 0.00 Subtotal 0.00 *State technology fee 5.00 Affidavit processing fee 5.00 Total due 10.00 A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX *SEE INSTRUCTIONS i CERTIFY UNDER PENALTY OF PE REGOING iS TRUE AND CORRECT Signature of grantor or agent Signature of grantee or agent Name (print)6�I Name (print) Cindy Carter, Chair on A Date & city of signing2:�4-�''L Date & city of signing � 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 ears, or by a fine in an amount fixed b the court of not more than $10,000, or by both such confinement and fine (RCW 9A.72.030 and RCW 9A.20.021(l)(c)). Y _ 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 (02/28/23) THIS SPACE TREASURER'S USE ONLY COUNTY TREASURER Print on legal size paper. Page 1 of 6 EXHIBIT "B" The South 30 feet of the West half of the East half of the Southeast quarter of the Northwest quarter of Section 10, Township 19 North, Range 28 East of the Willamette Meridian, Grant County, Washington, lying Southwesterly of the United States of America Railroad right of way as described in easement recorded November 18, 1943, under Auditors File No. 104175, records of Grant County, Washington. EXCEPT ROADS Situate in the County of Grant, State of Washington. Grant County Tax Parcel No. 17-0328-000 REAL PROPERTY VOUCHER