HomeMy WebLinkAbout*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
REQUEST SUBMITTED BY: SHILO NELLIS
CONTACT PERSON ATTENDING ROUNDTABLE: DAVE BREN
CONFIDENTIAL INFORMATION: ❑YES ® NO
DATE: 09/1 7/24
PHONE: 509-754-6082
•
.Now
.
a . . .
®Agreement / Contract
low
DAP Vouchers
®Appointment / Reappointment
❑ARPA Related
❑ Bids / RFPs / Quotes Award
❑ Bid Opening Scheduled
❑ Boards / Committees
❑ Budget
❑Computer Related
El County Code
❑Emergency Purchase
El Employee Rel.
❑ Facilities Related
❑ Financial
❑ Funds
❑ Hearing
❑ Invoices / Purchase Orders
❑ Grants — Fed/State/County
Ell -eases
❑ MOA / MOU
❑ Minutes
❑ Ordinances
❑ Out of State Travel
[:]Petty Cash
❑ Policies
❑ Proclamations
❑ Request for Purchase
❑ Resolution
❑ Recommendation
❑ Professional Serv/Consultant
❑ Support Letter
❑ Surplus Req.
❑Tax Levies
❑Thank You's
❑Tax Title Property
❑WSLCB
GRANT COUNTY MAPLE AND GRAPE DRIVE RECONSTRUCTION PROJECT
EASEMENTS OF PARCELS 2, 37 147 17.
If necessary, was this document reviewed by accounting? ❑ YES ❑ NO 0 N/A
If necessary, was this document reviewed by legal? W YES ❑ NO ❑ N/A
DATE OF ACTION:
APPROVE: DENIED ABSTAIN
D1:
D2:
D3:
4/23/24
DEFERRED OR CONTINUED TO:
E
� e" ) y�l, ED
Q
L5
Y ' M11VT� .Ct - 111094
' 0 9 t 1
PANT C0UN"r,1Y '4 EFFS
-
TRANSMITTAL
UNIVERSAL FIELD SERVICES, INC.
I H MAIN STREET SUITE 105
EDMONDS, WA 98020
Tel: (206-550-3221)
kbutterfield a ufsm.com
0 - M'11
Eson1 LN.1 4gILL,
.
4M M
RECEIVED
DATE: September 5, 2024 SEP 0 6 2024
l ")
7 � SS ,03
TO: Bob Bersanti, Grant County Design Engineer W:L LZ ] � �� T FCY.J" l 4 � ! ita7
FROM: Kristin Butterfield, Acquisition Agent
RE: Grant County Maple and Grape Drive Reconstruction Project
Project Parcel ## 2 — Andria Dawn Merrill— signed documents transmittal
') Please find attached original signed documents:
I� 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:
M 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:
Andria Dawn Merrill
20535 Adrian Rd. NE
Soap Lake, WA 98851
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, WA 98823
Document Title: Public Roadway Easement
Grantor: Andria Dawn Merrill, a single person
Grantee: Grant County, a political subdivision of the State of Washington
Abbreviated Legal Description: Ptn. of S-10, T-19N, R-28E, W.M., in Grant County, WA
Additional Legal Description is on Exhibit B
Assessor's Tax Parcel Number: 17-0478-017
Project: Maple and Grape Drive Reconstruction Project
Project Parcel Number: 2
The Grantor, Andria Dawn Merrill, a single 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 the Northeast quarter of the Southwest quarter of Section 10,
Township 19 North, Range 28 East, W.M., Grant County, Washington, described as follows:
Beg-i-n-ni-ng- at- the West quarter corner- of- said- Section 1-0-; thence South- 89045'32" East a-lon-g- the- m-i-d--
section line, also known as the center line of Maple Drive, a distance of 1325.28 feet to an intersection
with the center line of Grape Drive;
thence continuing along said mid -section line, a distance of 312.63 feet; thence South 00014'28" West
perpendicular to said mid -section line, a distance of 15 feet to the Northeast corner of the Bill Conley
Plat and the true point of beginning;
thence South 89045'32" East parallel to the mid -section line, a distance of 110.00 feet; thence
South 00025'47" West, a distance of 235 feet; thence North 89045'32" West, a distance of 110.00 feet;
thence North 00025'47" East, a d-istance of 235 feet to the true point of beginning.
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.
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
Andrea Dawn Merrill
PW-0011*
State of Washington
ss.
County of Grant
On this day personally appeared before me Andrea Dawn Merrill, 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, fo�$he uses
and purposes therein mentioned. Given under my hand and official seal this 'day of
20QY.
NOTARY PUB IC in and
Residing at
41 -
My Commission Expires:
2 of 4
Accepted by Grant County
By:
Printed Name: Cindy Carter,
Title: Chair
Date:
Approved as to form:
By:
Printed Name:
Title: County Attorney
Date: L44 1Z,L
3 of 4
EXHIBtT A
0
EISTNG 3W
CU N T
If
R/
hi APLE DR.
tFk::.uawW'rltis.�fyM+2�r�.:est4rwri#�n.gwz�wanwu» _. .. yqyup�s�.r�vy
'. n .,rrwv;0% O NI _+.^Ism .
Y'. .. gwuMn.ae
PROPOSED
C UN'W"Y R f
.
EA-SEMEN7
x
w
•*'
cc
S71A. 13+12.79 TO
STA. , 4- 22-8
PARCEL #17-04-713017
ERRILLi, ANDRIA DAWN
333 MAPLE
D OSES LAKE WA, � 9-8,837
4 of 4
Department ofExcise Tax Affidavit (RCW 82.45 WAC 458-61A)
Real Estate
Revenue(c; sales l s in a single location code on or after March 1, 2023.
4:�� .or _a e� g
Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed.
Form 84 0001 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 AndrEfa Dawn Merrill, a single person Name Grant County, State of Washington
Mailing address 20535 Adrian Rd. NE
City/state/zip Soap Lake, WA 98851
Phone (including area code) 509-431-7689
3 Send all property tax correspondence to: ❑ Same as Buyer/Grantee
Name Grantor
Mailing address
City/state/zip
Mailing address P.C. 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
17-0478-017
Personal
Assessed
property?
value(s)
❑
$ 30,750.00
❑
$ 0.00
n
$ 0.00
4 Street address of property 9327 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,
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 0 No
Is this property receiving special valuation as historical
property per RCW 84.26? ❑ Yes 0 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
% List all personal property (tangible and intangible) included in selling
price.
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 oadwa-y Egement
Date of document L:� "." ����� f
Gross selling price
3,014.55
*Personal property (deduct)
0.00
Exemption claimed (deduct)
3,014.55
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
8 1 CERTIFY UNDER PENALTY OF PE RY THAT THE FOREGOING IS TRUE A CORRECT
i . nature of grantee or atzent
Signature of grantor or agent 8
I 4-fl• Cind Carter Chair
Name (print)Name (print y
Date & city of signing '� Date & city cif signing
v � �
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
EXHIBIT "B"
The North 15 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 West quarter corner of said Section 10;
thence South 89145'32" East along the mid -section Line, also known as the center Line of
Maple Drive, a distance of 1325.28 feet to an intersection with the center Line of Grape
D rive;
thence continuing along said mid -section Line, a distance of 312.63 feet;
thence South 00014'28" West perpendicular to said mid -section Line, a distance of 15 feet
to the Northeast corner of the Bill Conley Plat and the true point of beginning;
thence South 89045'32" East parallel to the mid -section Line, a distance of 110.00 feet;
thence South 00025'47" West, a distance of 235 feet; thence North 89045,32" West, a
distance of 110.00 feet;
thence North 00025'47" East, a distance of 235 feet to the true point of beginning.
EXCEPT ROADS
Situate in the County of Grant, State of Washington.
Grant County Tax Parcel No. 17-0478-017
REAL PROPERTY VOUCHER
AGENCY NAME
Grant County
P.O. Box 37
Ephrata, WA 98823
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.
SIGNATURE (IN INK) FOR EACH CLAIMANT
DATED
q1V
GRANTOR OR CLAIMANT (NAME, ADDRESS) TIN/SSN:
Andrea Dawn Merrill
20535 Adrian Rd. NE
Soap Lake, WA 98851
PROJECT NO. AND TITLE
Maple and Grape Drive Reconstruction Project
FEDERAL AID NO.
N/A
PARCEL NO.
2
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:
1,650 SF in public roadway easement +
$3,014.55
IMPROVEMENTS:
Gravel, chain link fence w/ gate, swing fence, planter w/ bark, 6 mature trees +
$49057.20
DAMAGES:
Cost to Cure +
Proximity -+-
Other +
$0.00
$0.00
$0.00
$0.00
SPECIAL BENEFITS
JC (Just Compensation) Amount
$79100.00 (R )
REMAINDER:
Uneconomic Remnant +
Excess Acquisition +
$0.00
$0.00
DEDUCTIONS:
Amount Previously Paid
Performance Bond
Salvage Amount
Pre Paid Rent
Other
$0.00
$0.00
$0.00
$0.00
$0.00
ADMINISTRATIVE SETTLEMENT +
$1,080.00
STATUTORY EVALUATION ALLOWANCE +
$0.00
ESCROW FEE -+--
$0.00
REAL ESTATE EXCISE TAX +
$0.00
OTHER:
$0.00
ACQU ITION AGENT
DATE
Voucher No.
TOTAL AMOUNT PAID
A
RIZEDI ENT F R E—NCY
",
JJJ 1\Cindy Carter, Chair
DAT
if Z
9-rI%it&V I-* --
TRANSMITTAL
UNIVERSAL FIELD SERVICES, INC.
I I I MAIN STREET SUITE 105
EDMONDS, WA 98020
Tel: (206-550-3221)
kbutterfield@ufsm. com
DATE: September 5, 2024
RECEIVED
SEP 0 6 2024
NT k _
TO: Bob Bersanti, Grant County Design Engineer
r
FROM: Kristin Butterfield, Acquisition Agent lj
RE: Grant County Maple and Grape Drive Reconstruction Project
Project Parcel # 3 — Jerry and Carol Smith I— 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:
M 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:
Jerry and Carol Smith
9351 Maple Dr. 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 Recording Mail to:
GRANT COUNTY DEPARTMENT OF PUBLIC WORKS
P.O. Box 37
Ephrata, WA 98823
Document Title-, Public Roadway Easement
Grantors: Jerry Smith and Carol Smith, husband and wife
Grantee: Grant County, a political subdivision of the State of Washington
Abbreviated Legal Description: Ptn. of 10-19N-28E, in Grant County, WA
Additional Legal Description is on Exhibit A
Assessor's Tax Parcel Number: 17-0478-045
Project: Maple and Grape Drive Reconstruction Project
Project Parcel Number: 3
Public Roadway Easement
The Grantors, Jerry Smith and Carol Smith, 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 s 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:
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 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.
1 of 5
fT\-
DATED THIS D/�Y OF a � , 2(��.
A
ry Srr-Ath
Carol Smith
State of Washington
ss.
County of Grant
On this day personally appeared before me Jerry and Carol Smith, 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 m ntioned. Given under my hand and official seal this��day
of �' , 2.
..`.��`�`���•►ti�'p��. BUii11 j•�
��
0.�'oi�T•N*V,% N Y PUBIC in andTo Sta of Washington•;i ,
r� Residing at
4ptjOTARy
,0 '0%
My p Commission Expires:_
PUBLIC .`.
WE
onVWAS,
2 of 5
Accepted by Grant County
By: ,
PrintPri Name: bindy Carter,
Title: Chair
Date: a
Approved as to form:
By:
Printed Name:
rx&401�Zj��r�
Title: Cou�y Attorney
Date: _�Zg��
3of5
4of5
1001-11107001
Parcel 1:
The West 120 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, as per plat of Bill Conley, described
as follows:
Beginning at the West quarter corner of said Section 10; thence South 89'45'32" East along
the mid -section line, also known as the centerline of Maple Drive, a distance of 1,325.28 feet
to an intersection with the centerline of Grape Drive; thence continuing along said mid -section
line, a distance of 312.63 feet; thence South 00014'28" West perpendicular to said mid -section
line, a distance of 15 feet to the Northeast corner of the Bill Conley Plat; thence South 89045'32"
East parallel to the mid -section line, a distance of 110.00 feet to the true point of beginning;
thence continuing South 89045'32" East, a distance of 240 feet; thence South 00025'47" West,
a distance of 235 feet; thence North 89045'32" West, a distance of 240 feet; thence North
00025'47" East, a distance of 235 feet to the true point of beginning.
Parcel 2:
The East 120 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, as per plat of Bill Conley, described
as follows:
Beginning at the West quarter corner of said Section 10; thence South 89045,32" East along
the mid -section line, also known as the centerline of Maple Drive, a distance of 1,325.28 feet
to an intersection with the centerline of Grape Drive; thence continuing along said mid -section
line, a distance of 312.63 feet; thence South 000 14'28" West perpendicular to said mid -section
line, a distance of 15 feet to the Northeast corner of the Bill Conley Plat; thence South 89045'32"
East parallel to the mid -section line, a distance of 110.00 feet to the true point of beginning;
thence continuing South 89045'32" East, a distance of 240 feet; thence South 00'25'47" West,
a distance of 235 feet; thence North 89045'32" West, a distance of 240 feet; thence North
00025'47" East, a distance of 235 feet to the true point of beginning.
Situate in the County of Grant, State of Washington
Grant County Tax Parcel No. 17-0478-045
5 of 5
OA
Department of Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
Revenue only for sales
in a single location code on or after March 1, 2023.
.
Washington State This affidavit will not be accepted unless all areas on all pages are fully and accurately completed.
Form 84 0001
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 Jerry Smith and Carol Smith, husband and wife Name Grant County, State of Washington
Mailing address 9351 Maple Dr. NE
city/state/zip Moses Lake, WA 98837
Phone (including area code) 509-760-3746
3Send 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
17-0478-045
Personal Assessed
property? value(s)
❑ $ 44,625.00
❑ $ 0.00
❑ $ 0.00
4 Street address of propertv 9351 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"
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, ❑ Yes ❑ N o
complete the predominate use calculator (see instructions)
6 is this property designated as forest land per RCW 84.33? ❑Yes ONo
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 Roadway Easement
Date of document
Gross selling price
3,564.00
*Personal property (deduct)
0.00
Exemption claimed (deduct)
3,564.00
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
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
f
I CERTIFY UNDER PENALTY OF PERJURY THAT THE O.REGO NG IS TRUE AND CORRECT
Signature of grantor or agen Signature of grantee or went _ V Vv
Name (print) Name (print; Cindy Carter, Chair
Date & cit Y of si nin �' 1r4,kJ- Date &city of signing
g
Perjury in the second degree is a class C felony which is punishable by confinement in a state correctional institution for a maximu 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.20.021M(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
Aul"w
s Wkz
The North 15 feet of the following:
Parcel 1:
The West 120 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, as per plat of Bill Conley, described
as follows:
Beginning at the West quarter corner of said Section 10; thence South 89045'32" East along
the mid -section line, also known as the centerline of Maple Drive, a distance of 1,325.28 feet
to an intersection with the centerline of Grape Drive; thence continuing along said mid -section
line, a distance of 312.63 feet; thence South 00'1428" West perpendicular to said mid -section
line, a distance of 15 feet to the Northeast corner of the Bill Conley Plat; thence South 89045,32"
East parallel to the mid -section line, a distance of 110.00 feet to the true point of beginning;
thence continuing South 89'4532" East, a distance of 240 feet; thence South 00025'47" West,
a distance of 235 feet; thence North 89045'32" West, a distance of 240 feet; thence North
00025'47" East, a distance of 235 feet to the true point of beginning.
Parcel 2:
The East 120 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, as per plat of Bill Conley, described
as follows:
Beginning at the West quarter corner of said Section 10; thence South 89045,32" East along
the mid -section line, also known as the centerline of Maple Drive, a distance of 1,325.28 feet
to an intersection with the centerline of Grape Drive; thence continuing along said mid -section
line, a distance of 312.63 feet; thence South 000 14'28" West perpendicular to said mid -section
line, a distance of 15 feet to the Northeast corner of the Bill Conley Plat; thence South 89045,32"
East parallel to the mid -section line, a distance of 110.00 feet to the true point of beginning;
thence continuing South 89045'32" East, a distance of 240 feet; thence South 00025'47" West,
a distance of 235 feet; thence North 89045'32" West, a distance of 240 feet; thence North
00025'47" East, a distance of 235 feet to the true point of beginning.
Situate in the County of Grant, State of Washington
Grant County Tax Parcel No. 17-0478' 045
REAL PROPERTY VOUCHER
AGENCY NAME
Grant County
P.O. Box 37
Ephrata, WA 98823
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.
SIGNATURE (IN INK) FOR EACH CLAIMANT
DATED
GRANTOR OR CLAIMANT (NAME, ADDRESS) TIN/SSN:
Jerry and Carol Smith
9351 Maple Dr. NE
Moses Lake, WA 98837
•
PROJECT NO. AND TITLE
Maple and Grape Drive Reconstruction Project
FEDERAL AID NO.
N/A
PARCEL NO.
3
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:
3,600 SF in public roadway easement +
$39564.00
IMPROVEMENTS:
Gravel, fence, trees and lawn +
$69219.75
DAMAGES:
Cost to Cure +
Proximity +
Other +
$0.00
$0.00
$0.00
$0.00
SPECIAL BENEFITS
JC (Just Compensation) Amount
$99800.00 ( R )
REMAINDER:
Uneconomic Remnant +
Excess Acquisition +
$0.00
$0.00
DEDUCTIONS:
Amount Previously Paid
Performance Bond
Salvage Amount
Pre Paid Rent
Other
_
$0.00
$0.00
$0.00
$0.00
$0.00
ADMINISTRATIVE SETTLEMENT +
$1,285.00
STATUTORY EVALUATION ALLOWANCE +
$0.00
ESCROW FEE --f--
$0.00
REAL ESTATE EXCISE TAX +
$0.00
OTHER:
$0.00
ACaUISI ION AGENT
DATE
Voucher No.
TOTAL AMOUNT PAID
$119085.00 ( R )
tZ A ENT O GEN i Y
i
? Cindy Carter, Chair
DATE
Lr-M-.)Li IWALUIt+
TRANSMITTAL
UNIVERSAL FIELD SERVICES, INC.
I I I MAIN STREET SUITE 105
EDMONDS, WA 98020
Tel: (206-550-3221)
kbutterfield@ufsm. com
DATE: August 7, 2024
TO: Bob Bersanti, Grant County Design Engineer
A VA
14EUM
1
RECEiV=`�D
AUG 0 9 2024
zt
fu
n Diu Y T" " N"" '"-U " Pv`iN'T 0 Vj 0i0t .
FROM: Kristin Butterfield, Acquisition Agent
RE: Grant County Maple and Grape Drive Reconstruction Project
Project Parcel # 14 — Loren J. Ramm — signed documents transmittal
1) Please find attached original signed documents:
M Public Roadway Easement
® Real Estate Excise Tax Affidavit with Exhibit B
® Real Property Voucher
® IRS V- 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
NOTE: The County Assessor's office has confirmed that no signature is required in Block 6 of
the Real Estate Excise Tax Affidavit (Current Use Classification), as the acquisition is in
easement.
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:
Loren Ramm
9686 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, WA 98823
Document Title: Public Roadway Easement
Grantor: Loren J. Ramm, as his separate estate
Grantee: Grant County, a political subdivision of the State of Washington
Abbreviated Legal Description: Ptn. SW 1/4of NE 1/4, Section 10, T19N, R28E,
in Grant County, WA
Additional Legal Description is on Page 1
Assessor's Tax Parcel Number: 17-0478-006
Project: Maple and Grape Drive Reconstruction Project
Project Parcel Number: 14
Public Roadway Easement
The Grantor, Loren J. Ramm, as his 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, 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 that portion of the Southeast Quarter of the Southwest Quarter of the
Northeast Quarter of Section 10, Township 19 North, Range 28 East, W.M., Grant County,
Washington, 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.
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 3� DAY OF , 20
Loren J. R VIM
State of Washington
ss.
County of Grant
On this day personally appeared before me Loren J. Ramm, 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 for the uses an purposes therein
menti ned. Given under my hand and official seal this day of ,
20
NOTARY PUBLIC and for the Stat of Washington
Residing at GC/
My Commission Expires: �
2 of 4
Accepted by Grant County
By:
Printed ame:
Cindy Carter.
Title: Chair
Date'
s
Approved as to form:
By: A94�
Printed Name:
Title: C � xz
Attorney
Date: /
3 of 4
4 of 4
Department of Real Estate Excise10
Tax Affidavit (RCW 82.45 WAC 458-61A)
Revenue(cjJnly for sales in a single location code on or after July 1, 2024.
Washington State 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 % sold. List percentage of ownership acquired next to each name.
1 Seller/Grantor 2 Buyer/Grantee
Name Loren J. Ramm, as his separate estate Name Grant County, State of Washington
Mailing address 9686 Maple Dr. NE
City/state/zip Moses Lake WA 98837
Phone (including area code) 509-760-5437
3Send 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
17-0478-006
Personal
Assessed
property?
value(s)
❑
$ 45,400.00
❑
$ 0.00
❑
$ 0.00
4 Street address of property 9686 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
5 118 -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 O No
complete the predominate use calculator (see instructions)
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? m 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/BEET for 458-6j Ap�ion odes*
Exemption No. (sec/sub)
Reason for exemption
Under threat of eminent domain.
Type of document Public ROIToadway Easement
Date of document �� �.,.��1 CM441L
Gross selling price
8,086.50
*Personal property (deduct)
0.00
Exemption claimed (deduct)
8,086.50
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 I.NSITRUCTIONS I
I CERTIFY UNDER PENALTY OF PERJURY THAT THE FO GOING IS TRUE AND CORRECT
Signature of grantor or agent - Signature of ornntpp nr a-ae ,-/ _ . , r
Name (print) 'L -k Name (print Cindy Carer, Cif Irr
Date & city of signing 7— ;5 tJ '2 0 4 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,xc)).
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
IWAMMI I A to man
The South 30 feet of that portion of the Southeast Quarter of the Southwest Quarter of the
Northeast Quarter of Section 10, Township 19 North, Range 28 East, W.M., Grant County,
Washington, 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.
Situate in the County of Grant, State of Washington.
Grant County Tax Parcel No. 17-0478-006
REAL PROPERTY VOUCHER
AGENCY NAME
Grant County
P.O. Box 37
Ephrata, WA 98823
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.
SIGNATURE (IN INK) FOR EACH CLAIMANT
DATED
X
-3�v�90
GRANTOR OR CLAIMANT (NAME, ADDRESS) TIN/SSN:
Loren J. Ramm
9686 Maple Dr. NE
Moses Lake, WA 98837
PROJECT NO. AND TITLE
Maple and Grape Drive Reconstruction Project
FEDERAL AID NO.
N/A
PARCEL NO.
14
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:
11,980 SF in public roadway easement
+
$8,086.50
IMPROVEMENTS:
Gravel, fencing
+
$29982.30
DAMAGES:
Cost to Cure - move irrigation & fence posts out of acquisition area +
Proximity +
Other +
$19530.00
$0.00
$0.00
$0.00
SPECIAL BENEFITS
JC (Just Compensation) Amount
$129600.00
( R )
REMAINDER:
Uneconomic Remnant
Excess Acquisition
+
+
$0.00
$0.00
DEDUCTIONS:
Amount Previously Paid
Performance Bond
Salvage Amount
Pre Paid Rent
Other
$0.00
$0.00
$0.00
$0.00
$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 slT NAG T
DATE
QC1
Voucher No.
TOTAL AMOUNT
$129600.00
PAID
( R
A ED AGENT FOR GENCY
1 Cindy Carter, Chair
1
DATE
� 7,r
TRANSMITTAL
UNIVERSAL FIELD SERVICES, INC.
111 MAIN STREET SUITE 105
EDMONDS WA 98020
Tel: (206-550-3221)
kbutterfield@ufsm. com
DATE: August 7, 2024
N
or i
RECEIVED
AUG 0 9 2024
�h� �},c,� C ��r °g. i"�Cy{� lSFP�p�', �,
1 9i 'S I W Y.i� ¢f 3. R +a' Y e 1 C0,4
TO: Bob Bersanti, Grant County Design Engineer
FROM: Kristin Butterfield, Acquisition Agent
RE: Grant County Maple and Grape Drive Reconstruction Project
Project Parcel # 17 — Richard and Robyn Ramirez — signed documents transmittal
1) Please find attached original signed documents:
N Public Roadway Easement
Z Real Estate Excise Tax Affidavit
� Real Property Voucher
� Construction Memorandum of Understanding
� 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
Z Construction Memorandum of Understanding, at bottom of page
The Construction Memorandum of Understanding is to be incorporated into the construction
contractor's documentation.
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:
Richard and Robyn Ramirez
4362 Shorecrest Dr. 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, WA 98823
Document Title: Public Roadway Easement
Grantors: Richard J. Ramirez and Robyn Ramirez, husband and wife
Grantee: Grant County, a political subdivision of the State of Washington
Abbreviated Legal: Ptn. E112 W112 SE114 NW114, S-10, T-19N, R-28E, W.M. in Grant
County, WA
Additional Legal Description is on Page I
Assessor's Tax Parcel Number: 17-0329-000
Project: Maple and Grape Drive Reconstruction Project
Project Parcel Number., 17
Public Roadway Easement
The Grantors, Richard J. Ramirez and Robyn Ramirez, 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 the East half of the West half of the Southeast quarter of the Northwest
quarter of Section 10, Township 19 North, Range 28 East, Willamette Meridian.
LESS the North 568.32 feet.
LESS the West one half of the following described property:
The South 378.86 feet of the East half of the West half of the Southeast quarter of the Northwest
quarter of Section 10, Township 19 North, Range 28 East, W. M., EXCEPT the Southerly 30 feet
thereof.
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
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
Date
State of Washington
ss.
County of Grant
On this(11V
f6 y of , 2Q, ,before me personally appeared Richard J.
%Ramirez and Robyn Ramirez, t 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.
BU7f
�t: p''' "' ���''� N� RY PUB I C i n n y� . �N .; VIA a d t e Stat of Washington
a Residing at/A6 P
%Ap?ARY ; _ My Commission Expires.
•
pueLG •
WE 0
I F//,'w was
♦�����liill!ltti����
2 of 4
Accepted by Grant County
By:
P ,
Printed Name; Cindy Carter,
Title: Chair
Date:
f.
Approved as to form:
By:
Print4d Name:
Title: County torney
Date: ¢
I I
3 of 4
4 of 4
Department of Real Estate 10
Excise Tax Affidavit (RCW 82.45 WAC 458-61A)
Revenue i single location code on or after Jul 1 2024.
Only for sales n a s g e Y,
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 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 Richard J. Ramirez and Robyn Ramirez, husband and wife Name Grant County, State of Washington
Mailing address ,4362 Shorecrest Dr. NE
City/state/zip. Moses Lake, WA 98837
Phone (including area code) 509-750-4299
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
17-0329-000
Personal
Assessed
property?
value(s)
❑
$ 40,125.00
❑
$ 0.00
❑
$ 0.00
4 Street address of propertv NNA Maple Dr. NE, Moses Lake, WA 98837This property is located in Grant 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
5 118 -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 m 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 N o
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 0 No
Is this property receiving special valuation as historical
property per RCW 84.26? ❑ Yes 0 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
Signature
Print name Print name
81 CERTIFY UNDER PENALTY OF-PEJUURY THAT THI
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 f g Ap i$� des*
Exemption No. (sec/sub) 4 0
(5y
Reason for exemption
Under threat of eminent domain.
Type of document Public Roadway Easement
Date of document E 41 c2Z -it
Gross selling price _
2,683 .80
*Personal property (deduct)
0.00
Exemption claimed (deduct)
2,683.80
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 Loca 1
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 ,
IS TRU&AND CORRECT
Signature of grantor or Signature of grantee or agen IQ: )
Name (print) Mel rint) Cindy Carter, C air
Date & city of signing e Date & city of signing r rf
Perjury in the second degY
ree is a cl ss C felony which is punishable by confinement in a state correctional institution fora aximum 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.20.02161)(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
The South 30 feet of the East half of the West half of the Southeast quarter of the Northwest quarter
of Section 10, Township 19 North, Range 28 East, Willamette Meridian.
LESS the North 568.32 feet.
LESS the West one half of the following described property:
The South 378.86 feet of the East half of the West half of the Southeast quarter of the Northwest
quarter of Section 10, Township 19 North, Range 28 East, W.M., EXCEPT the Southerly 30 feet
thereof.
Situate in the County of Grant, State of Washington
Grant County Tax Parcel No. 17-0329-000
REAL PROPERTY VOUCHER
AGENCY NAME
Grant County
P.O. Box 37
Ephrata, WA 98823
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 claims -*
r'
SIGNATURE (IN INK) FOR EACH CILs
DATED
GRANTOR OR CLAIMANT (NAME, ADDRESS) TIN/SSN:
Richard J. and Robyn Ramirez
4362 Shorecrest Dr. NE
Moses Lake, WA 98837
X
PROJECT NO. AND TITLE
Maple and Grape Drive Reconstruction Project
FEDERAL AID NO.
N/A
PARCEL NO.
17
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:
4,970 SF in public roadway easement +
$29683.80
IMPROVEMENTS:
+
$0.00
DAMAGES:
Cost to Cure +
Proximity +
Other +
$0.00
$0.00
$0.00
$0.00
SPECIAL BENEFITS
JC (Just Compensation) Amount
$2,700.00 ( R )
REMAINDER:
Uneconomic Remnant +
Excess Acquisition +
$0.00
$0.00
DEDUCTIONS:
Amount Previously Paid
Performance Bond
Salvage Amount
Pre Paid Rent
Other
$0.00
$0.00
$0.00
$0.00
$0.00
ADMINISTRATIVE SETTLEMENT +
$0.00
STATUTORY EVALUATION ALLOWANCE +
$0.00
ESCROW FEE +
$0.00
REAL ESTATE EXCISE TAX +
$0.00
OTHER:
+
$0.00
ACQULtITION,APENT
DATE
Voucher No.
TOTAL AMOUNT PAID
$29700.00 (R )
H
IZED\AGE
TIf OR N Y IV
Cindy Carter, Chair.,
DATE
��
Grantors: Richard J. Ramirez and Robyn Ramirez, husband and wife
Grantee: Grant County, a political subdivision of the State of Washington
Abbreviated Legal: Ptn. E112 W112 SE114 NW1/4, S-10, T-19N, R-28E, W.M. in
Grant County, WA
Assessor's Tax Parcel Number 17-0329-000
Project. Maple and Grape Drive Reconstruction Project
Project Parcel Number: 17
CONSTRUCTION MEMORANDUM OF UNDERSTANDING
between
Grant County, apolitical subdivision of the State of Washington
and
Richard J. Ramirez and Robyn Ramirez, husband and wife
The purpose of this document is to memorialize the understanding of Grant County (the County)
and Richard and Robyn Ramirez (the Property Owners) with respect to the details related to the
County's acquisition of property acquired in Public Roadway Easement from the undersigned
Property Owners.
The County and the undersigned Property Owners hereby agree to the following:
As part of the project referenced above, the County has agreed to provide one (1)
curb cut on the southern frontage of the Property Owners' parcel, approximately
twenty-four (24) feet wide. The western edge of the curb cut is to be twenty (20) feet
from the western boundary of the subject parcel, as depicted on the attached exhibit.
Page 1 of 2
RANCvE 20E, Y�.M-
EC_,,Ti0N 10
To TAL Mq Ct L
TAY
sm.
p Ap, rau PP-CPSATY 0w%(R AFT-R,
lei
p JY.
STA. 14*;IF 7A4. TO
2 2 5% 7 CC
1704MV5, 14`40f- 4R" t- 8 CIW% L 430 _UtW-U$-r OR, ME
WUSEI LAK Ak, 93"7
& 4i'Z?a
W 28
W1.11rs7ltm5-v MARK P. 4 �l 0Sri
wtr ok
00A
APLE CA. A.W f
Sm,!A 1,
TAWN lt*EXWOK, KY
C-_&AAklpt CA- L— OWNTY RJW
N
w
E,
G.-R-ANT C'(1RATTY PUBLIC VIURKS GEPARTMENT
S Sc ,24 LN%RPkfcSE
"I'll-IRATA IWASSHING-Ul 98823
P9
pmzosw
UAFLE M. Z"ITY ColUaTy RD..
1 7-v
J L
o7
_4
f"t rmnst is, CrAl"ll 4m
91
, L-l-WANIly R/W
C,
Y sm
t4+ n v fr,
PARCM t_7047aot? 4
MAnr Cp.
00a.S. LMM W&. %IM7
&
TO, w0or A,
on MAPLE oq-
039SI
MAPLE AND GRAPF. CIR,
REC, NSTRUCTION PROJECT
OF IWAY P LAN - IAAFLE
CRP 18-05
CS100-NEt) 6Y: BOB WERSANII
,HECXED BY: DAVE aREN
tPIPIROVED UY, lf..Wvf"UREN I I
21
.BqSIONS FJY; 1309 BERSANII
f
'
,A M REVIS- -ED 5/18/2024
3 ( U
ED, NO.: STPUF 3- 9, 91i 4 1,
4