HomeMy WebLinkAboutResolution 12-080-CCBOAR.D OF COUNTY COMMISSIONERS
Grant County, Washington
IN THE MATTER 4F ACCEPTING
A CERTAIN C4UNTY ROAD ANDiQR
R#GHTS-t�F-WAY KNOWN AS The
East 10 feet of Patton Blvd as
shown on ASPI Commerce Park
Major Plat AFN1050013
Resolution Na. 12-�-CC
Order Ac�epting Donation
WHEREAS, the Board of County Commissianers of Grant County, Washington,
were petitioned to accept portions af certain County road right-ofi-way described as
fol(ows:
Legal description: That porEion of County Road and Right-ofi-Way known as
The East 10 feet o£ Patton Blvd a� shown oan ASPI Cammerce Fark Major Plat
AFN1050013 Section 4 T19N R28E.W.M, ALL in Grant Caunty.
AND as shawn an Attached Exhibits A
WHEREAS, a quitcfaim deed for the described right-of-way, as shown an the plat but nat
formerly dedicated, was received by Grant Caunty from the Gity of Moses Lake.
WHEREAS, the Baard af County Commissioners did cansider the report given by the
County Road Engineer, together with any evidence for or objection against said
acceptation and
WHEREAS, the above described County road and right-of-way is useful as part of the
County road system and the public will be benefitted by the acquisition of said road and
rights-of-way.
NOW, THEREFORE, BE IT RESOLVED that the Board of County Commissioners
accepts the County road and rights-of-way �s described above,
T)nne this !/+�'� dav of ,(�ec�z►n �r-, 2012
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Ric ard Sfievens, Chair
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Cindy rter, Vice C air
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Constituting #he Board of Caunty Commissioners of Grant County, Washingtan
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RECORD �I1TA PER SURVFY PERFORMED 8Y JdHN fl. SWIFT �, '� ,„.-
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OATEO ,lUNE 2, 1971, A COP7 dF yt�{�CH 15 DN FiLE WITN
THk POHT OF NO5E5 W(E ��
� FECOfiO OATA PER THAT QEEO FILED UNCIER hFN 1016096, `��-+
� RECORD5 OF" CRANT COUNTY N�,
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� RECORO ➢ATA P�R ASPI CDMM�RCE PAftK SHf]ftT PIAt
FItEO IN $OOK 9 OF SHflRl Pt,AiS, PAG£S ii ANp ♦2,
UNpER AFN 10�1196, RECORDS OF CRAN7 CIXINTY �,
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OF PATTON BIVC! 9ETM'EEN 22N0 AVE, MJp
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ON 1HC SAIAE LINE AS PER SURVEY PERfORMED
BY .tOHN 0 SYAFT AN� ASSOC FOft YNE GENERAL
SERVICES A04itNI5iFiAT107V DA?ED ,IUNE y, tg7t, �
CqPY Of WHICH :S C7FJ FlI.E WiTM 1HE PDAT QF
i,tOSES [AKE.
�Q�IIPMENT USED
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NEREBY pECiJi
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7HAT TtiE OtS7F
CORRfCiLY TO
8£tffF• AND 1N
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DAIE OF Sl
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Philip J. Blc
Registratian
321 S, 8ee
Moses _ake�
AUDITOR'c
FllEO Ff7R RECORp A'
THIS �{,__OAY pF
�? �, ANb RECOR
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.��� ' �,1e,r'c� ����ic�; F�r�r�k �rat�;r�rr�tti�ara��l Ur�t��a}�
December 3, 2012
Derek Pohle, Director
Grant County Public Works
124 Enterprise Street SE
Ephrata, Wasllington 98823
Grant County Council
P.O. Box 37
�phrata, Washington 98823
Re: Right of Way Donation
Patton Boulevard
Tax Parcel No. 122152000
Dear Mr. Pohle:
North American Foreign Trade Zone Industries, a Washington Limited Liability Coinpany (ASPI
affiliated entity) hereby quitclaims, by way of the attached deed, to Grant County the following
described parcel of land abutting Patton Boulevard:
The Southwesterly ten feet of the ASPI Commercial Parlc Plat; said parcel being described as the
ASPI Commercial Park Major Plat, except therefrom Lots 1 through 4 of said ASPI Commercial
Parlc Major Plat and being a portion of Tax Parcel No 122152000.
This will correct an oversight to include said 10 foot strip as a dedication when the plat was
originally submitted. This donation is made voluntarily and with fiill lcnowledge of our intention
to receive just compensation therefore. We hereby release Grant County from obtai�lin� an
appraisal of the acquired property.
Sii erely yours,
y .�". Chen
President of ASPI Group, Inc.
Managing Member of North American
Foreign Trade Zone Industries, LLC
Cc: Fred Slcimier, Western Pacific Engineering
1600 Lind Ave. S.W., 5uite 220
Ren�on, Vllashington 980.�i5
4�5.264.1000 FAX 425.264.1268
www.ASPIGroup.conn
When recorded rettzrn tQ: I309884 12l1�I2012 I0.47 At� QCD
PUBLiC WORKS R 73.00�����-a�rt�,v�,, �t�A.�-�__� ;->~>,;s
.,�o vt "_ .. _.,`-_.. �wz...r�. ., .
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12antn» tXTrz�i„«,�.,�._C�Q11�Jr
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+QUIT CLAI� DE�ED
THE GRAiv'T��.{S}, Iv'or�h Americau Foreign Trade Zone Industries, LLC, a WashizagtQn Lir�ited Liability
Company, for and in cazasidez-ation oiDedicatian of Public Raad Riglit of G�'ay aild no other cash consideration,
canveys and quit clainls to Grant County, the fotlawing described real estate, situated in tlle Caunty of Grant, State
of Washington, together with ali after acquired title of tl�e grantar{s} here�i:
See Legal Descrzption Aitached
This conveya�ce sha31 r�pre�ent a declaratzon and ded"zcatioz� of pubiic raad righ� af �vay for Patton Boulevard and
aIl typical pnblic utilities associated therewit�a, and sl2all revert to the Gra��tar, at the option of tixe Grantor, i�a t�ae
event t�at said Patton Boulevard is ever abandoned. Grantor is prati�iding na warraz�ty as ta the condition ai t�le
property.
Abbr�viated Legai: A portion af Northcvest quarter ot Sectiou 04, Tawns2up 19 North, Ra�ge 28 East, VJ.M.,
lying adjacent to Pattan Boulevard.
Tax I�arcei Number(s): Adjacent to Parcel No. i 22152000
Dated: N`t�venaber 12, 2012
,
ti
i _
Andy C.P. Chen, Nlanager
STATE OF �ASKII�;GTUN
ss.
CtJUNTY 0�` KING
I certify tl�at I I�naw or have satisfactary evidence fi.�at A.��'DY` C.F. Chen (is/arej d3e person(s} wlaa appeared
before me, and said person(s) acknawledged tl�at l�e signed tlus inst�-uz��ent, an oatli stated ti�at ize was duly
autixarized ta execute the instruinent and acl�zo�viedge it as tl�e Manager of Nortlz Ai�lezican Pc�rei�n Trade Zona
Tnd�siries, LLC ta be t}se free and valuntary act oi such �arty{ies) for the usUs and purpases mez�tioxied ii� tizis
instnzment.
Dated;
�:._..:.:� _. ,;:� , ;,,..
A j� i;, � t_ /', G N c t1#
�iOT��`� pUBI..(G
STr�T� t7E VIj�S#-1(NGT�i�
COM�1iSS101� EXPIRES
FEF3��,::,:� � � 2Q13
.;,�..
�� /
Nata , name prulted ar typed: tv�il,�t,� C��t*�
Notary Publzc in and fer the Stata of IJ�N�ks'i��1
Residing at �jcPttt��:
Iviy a�pozntment expizes: 2 f t 1�3
LPB 12-US(i)rev 12/2005
Page 1 af I
The sou�hwes�erl� ten ieet of the ASPZ Commercial Park Nlajar Pla�,
as recorded in Grant Couniy ma7ar pla� record� Volume 19, �ages 25
ar�� 26, �aid parcel being more specifically be described as �hat
portio� af the Nor�hwest q�arter af Sec�ian 04, Tawnship �9 Nortn,
Rar�ge 28 Eas�, �T_M_, County of Grant, State of Washington,
desc�ibed as followu:
BEGINNING at the northwest corner af said ASPT Commerciai
Fark Maaar Piat, said point �eing on �he Northwesterly right o�
way baundar� line for Pa�ton Boulevard as described in the Quit
Cla�m Deed filed under the Grant Coun�y Auditor`s File Number
5Q8330, as �iled in Book 13, Page 457 of Deeds; �hence North
74°06'33" East, coincident wi�h the northwe�terly boundary line af
said Plat, a distance af 10_00 �Eet ta �he northwest corner ai Lot
1 0� said p7at and to a point that lies 1Q_QO feet northeasterly
o� the northeasterly right of boundary line of said Coun�y Raad
k_nown a� Patton Boulevard; thenc� South 19°53'27" East,
coincident w�th the southwesterly baundary lines oT Zot l and 2�f
said Plaz, a d�stance of 54�_91 feet to the sou�hwest corner o�
La� 2 a�d the nortrwesterly corner af Lot 3 of �aid Pla�, said
caurse being parallel wi�h and 10_00 �eet nor�heasterly af said
County road rigrt af way known as Pat�on Boulevard; thence South
20°00'S8" F�Sfi, coinciderit wi�h the sau�.h�ae�terly boundary lzne of
Lo� 3 and 4 oi said Plat, a distance c�f 727,62 fee� to the
sau�.hwest corner o� Zo� 4 of said Plat and to the soutneas�erly
boundary line of said Plat, sa�d course being par��le� w�th and
10_QO fee� no,-theasterly oz said County road right o� way known as
Pat�on Boulevard; thence �outh 70°06°55" West, cQinciaent with
the sau�heasterly boundary line o� said Plat, a dis�ance oi 10.00
feet. �o the southwes�erly corner of said Plat and to the
northea�terly right aT way boundary lire of said County �oad Known
as Patton Boulevard; �.hence North 20°00'S8" West, coincid�n� wi�.n
the sc�u�h�aesterly boundary Iine oz said tla�c and �the nor�i2eas�erly
right o� way boundary line of the Caunty Roaa knawn as �aL�on
Baulevard, a distance of 727_68 Teet; thence Ivorth 19�53`0�"
West, coincident with the southwesterly baundary lzn.e at sa�d P1a�
and the northeas�erly righ� of way bounaary Iine oi �he ColznGy
Raad known as tattan Boulevard, a dis�ance oi 547.87 ieei.. �o �ne
POINT O� BEGINNING.
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'�'`��'�'�°" ��"�� REAL ESTATE EXCISE T�iX AFFIDAVIT
Thzs form is ycrur receipY
FLEAS� TYPE oR PRItvT CIIAPTER 82.45 RCW — CI��PTER 4�8-6?.A WAC when stamped by cashier.
'T�ItS AFFiI)AVI'I' WIZ,L NOT BE ACCEPTED CTNLESS ALL AREr#.S 41� ALL PAGES ARE E`iTL�LY COMPLETEI?
/CPaharfr nflact nana fnr �.�ctri.nt:nnc5
�'- -` ---- -- -- r_c,- --_ .—__ _-'---`,
Check bax if azvai sale of ro If multi le owners, list ercenta e of ownershi next to name.
Name North American Foreign Trade Zone lndcsstries. LL� Name Grant Coun
x
w
a� Maiting Address 1600 Lind Ave SW #22Q �� Mailing Adc�ress �'d Sox 37
�� City/SfaietZip Renfon. Wa 9$i}57 �� City/StatetZip Eghrata Wa 98823
Phone l�Io. {including azea code} Phone No. {inciudzng azea code)
Send all properry tax ca�spondence to: ❑ Same as $uyer/Grantee List all real and personal propc�rty taY parce2 account �,� �sesset! value(s)
numbers — check box if personal property
Name � 2215200fl ("`(
Maiiing Address n
City/State!Zip n
Phone hTo. {inclading area eode} ❑
� Street address of praperty:
This property is loeaTed in G� �11# �Oii�t#y
Q Check bax if any of tIie listefl parceLs are being segz-egated from anoTher parcet, are part of a boundary line adjustmeat ar parcels being merged
Legat descriptian of gzoperty (if more space is needed, you may atfach a separate sheet to each page of the affidavit)
A portion of Northwest quarter of 8ection 04, Tawnship 19, Narth Range 28, East , W.M., [ying adjacent to !'atton Boulevard
See attached
I Select Land Use Code s:
Select �and Us� Codes
enter any additionai cades:
{See back of last page for instructions)
YES NCJ
Ts this property exempt from properry ta� per chaptez ❑ [�✓
84.36 �CW {nonprofit arganization)?
YES NO
Is i3�is praperty designated as forest fand per chapter 84�33 RCW? ❑ 0
Is this property classified as cun�z�t use (ot�en space, farm and ❑ �
agricultzu�a3, ortimber} (andpe�-chapter$4.34?
Is ii�is property receiving s�cial valuatior� as historical prt�p�t}� ❑ �
pzc� chapt� 84.26 Rt.W?
Ifany answers are y�s, armplete as instructedbe�ow
{1} NCY�'[CE OFCONI'IiVtTANCE {F'tiI2ES'T I.AND ORf:U.i2i2E,N'T USE}
Iti'EW flWAtER(S}: To continue the cutrent designation as forest land or
classification as current use {open space, farm and agriculture, or rimber} tanci,
yau must sign an {3) below. The caunty assessar m�zse then deten��iize if the
land transtecred cantaz�ues to qnalify and r��l indic:ate by signing below. If the
land no Ionger c�uatifies ar yon ds� not wish to continue the d�'rgnation or
classification, it vaill be removetl and the compensating or ac�ditianal taxes wili
be due and payat�le by the seller ar transferor at the time of sale. (RCW
&433. i 9�0 ar RCW 84.34.108). Priar to signing {3} below, you znay cantact
your local ctiunty assessor for mare information.
This land ❑ does ❑ daes nat qualify for conrinuance.
i7EPiJTY ASSESS{3R DATE
(2} N(3TICE OF COMP`LLANt;E (HISTORIC PROPER'I"Y)
NEW O'WNER{S): To eontinue special valuation as historic property,
sign (3} belo�w. If the new owner{s} dc�es not wish to eantinue, all
additional tas calculated pursuant ta chapter 84.26 RCW, shall be due and
payable by the seller ar transferor at the time of sate.
(3) t)WNEi2(S} SIGNA`X`CTi2�E
PRI'�i 1T NAME
Si� ature of
Graator or Grantor's Agent
Name �rint) ;
Date & city of signing:
List aIi persoual property (tangible and intangible} included in selling
price.
If clairnrng an exemption, list WAC number and reason for exemption:
WAC No. {Sectian/Subsection} 458-61A-2Q5t4}
Reasan for exemption
Transfer for a pub(ic purpose-public road right of way
Type of Document C1uit Clairr� Deed
Date of Document 11/"[2112
Gross Selling Price $
*Persnnal Pzaperry {deduct} $
Exemption Claimed {deduct} �
Taxable Selling Price $
Excise Tax : State $
Q.(3t}50 Local $
*Llelinquent Tnterest: State $
Local $
�DeIinqnent Penalty
SttbtOtal
t ►�
/ fl
*State Technalagy Fe� $ 5.Q0
*Affi�avit Pracessing Fee $
Tatal 7�ue $
A�'SL'VIMUM OF' $24.f►0 IS DLTE IN FEE{S� ANp/OR TAX
*SEE I�iS3'R[JCTI{7�iS
�TNI3ER PENALTY (}F PEC2Jt7RX THAT TFTE Ft3R�+GflII\G i5 TRUE AND Cf112RE{"t'.
Signature of
Grantee ar Grantee's Agemt
Name {print)
Date & city of signing:
9 Q.00
Perj�ry: Perjury is a class � felony which is punishable by unprisonmeni in the state eozrectianal institutian for a tnaximum term of not more than five years, ar by a
fine in an amount fixE;d by the court of not mare ti�an five #hovsand daiiars ($5,00{i.04}, or by both imprisamnent and fine {RCW 9A.2fl.420 (1 C)}.
REV 840441ae {6/28I12} 'T�HIS SPACE - TREASt.7REI�.'S USE ONLY CQUNTY ASSESSOR
�epat�ent tif ��
������� �
. i�crs��g�or� 5tc�te gEAI, ESTATE EXCISE TAX t�FFIDAVIT
This form is yonr receipt
PLEp.SE TYPE Ox PRINT C1�AI'TER 82.45 RCW — CH.APTER 458-61A WAC when stamped by cashier.
THLS AFFIDAVIT WILL NO'T BE ACCEPT`ED 1UNLESS ALL A.REAS (JN ALL PAGES ARE F[TLi,Y COlVLPLETED
tCaF+ har'!r nf lact naa�a fnr inctnantinncl
❑ Check box if artial sala of ro e r� — If rnulti le owners, list ercenta e of ownezshi next ta name.
N�� Narth American Foreign Trade Zone Industries, LLC N� Grant Counfy
� �
�� Mailing Address ��Q4 Lind Ave SW #�'224 � z Mailing Address PO Box 37
�� City/ Stat e/ Zip Renton, Wa 98057 �� City/ Stat e i Zip E hra ta Wa 9 8 8 2 3
Phone No. (includuag azea code} Phone No. (including area code)
Send all property tax cortespondence to: Q Saxne as Eiuyer/Grautee �'� �� �� �d personal pro�rky ta.x parcei account List assessed value{s}
numbers — check box if personal property
�� �a�� 5z000 (�
t�z�� Aaa�� ❑
CitytStatel2ip n
Phone No. {including area code} n
� Street address of property:
Thzs property is located in Grant County
❑ Check box if any of the listed parceLs are being se�-egated from anather parcel, are part af a boundary line adjustment or parcels being rnergecL
Legal description af praperty (if more space is needed, you may attach a separate sheet to each page of the affidavit)
A partian af Northwest quarter of Section OA, Township 19, Norkh Range 28, East , V1�.M., lying adjacent to Patton Soulevard
See attached
� Select Land Use Cade s:
Seteet l�and Use Codes
enter any additional cades=
{See back of last page far instructions)
YES NO
Is this property exempt from property tax per chapter Q (�]✓
84.36 RCW (nonprofit organization)?
Y'ES NO
Is this property desi{c;nateci as forest land per chapter 84.33 RCW? [] []✓
Ls this property classified as raurent use (open space, farm �nd ❑ Q✓
agricultuial, or timber) Iand per chapter $4.34?
Is 13�is propedy recziving special vah�arion as histarical Pral�e1tY ❑ �
Per chapter 8426 RGW?
If any answers are yes, complete as ir�smacted below.
(1) NOTICE OF CON [TN UANCE (FOREST I.AND OR CIIRRENT USE}
NEW OW NE12(S): To continne the current designation as forest land or
classification as current use {open space, famz and a�iculture, or timber) land,
yau mast sign on (3) belaw_ The county assessor must then detemune if the
land transferred continues to qualif'y and wi11 indicate by signing below, If the
land no Ionger qualifies or you do nat wish to continue the designation or
classification, it wili be remave,d and the compensaEing or additional taxes will
be due and payable by the seller or transferor at the time of sale. (RCW
84.33.140 or RCW 84.34.108). Prior ta signing (3) belaw, you may conract
yorxr local county assessor for more information.
This land ❑ does ❑ does not qualify far cantinuance.
DEPt.7"TY ASSESSOR BATE
(2) N(�TTCE (3F COMPIdANCE (F�[SI't3RIC P�20PERTY}
h`EW (3WNER{S}: To continue special valuatian as historic properiy,
sign {3) below. If the new owner(s) does not wish ta continue, all
additional tax calculated pursuant to chapter 84.26 RCW, shall be due and
payable by the seller or transferar at the time af sale.
(3) OWNER{S) SIGNATUliE
PRINT NAME
Signature of
Grantor or Grantor's Agent
Name (print)
Date & city of signing:
List a11 persanal praperty (tangible and intangible) included in selling
price.
If claiming an exemptian, list WAC number and reason for exemption:
WAC No. (Sectian/Suhsection) 458-61A 2Q5{4)
Reasan for exemption
Transfer for a pubiic purpose-public road right af way
Type of Document ���t Claim Dsed
Date of T7ocument 11/12/12
�rass Selling Price
*Pcrsonal Prop�rty (deduct)
Exemptian Claimed (deduct)
Taxable Seliing Price
Excise Tax : State
�3•4��� Local
*Deiinquent Interest: State $
Local $
*Delinquent Penaity
Subtotal
*State Technolagy Fee
*Affid�, ✓it Processing F�e
Tatal Due
A MINIMUM OF $10.00 IS 1DUE IN FEE{S) AND/dI2 TAX
�`SEE 1NS'i"RUCTIONS
PENALT`Y OF PER.ITJRY T�� AT'TII.E: FCDREGOIlVG IS TRL"lE Ai'VD CORRECT.
Signature of
Grantee or Grantee's Agent
Name (print)
17atc & city of signing:
0.00
N ��
M ��
� ��
1 1/
M ��
Perjury: Perjury is a class C feiony which is punishable by imprisonmeat in the state eorrectional institution for a ma�:imum term af not mare than five years, or by a
fine in an amount fixed b�#he couit of nat mrne than five thairsand dollars (�5,440.04}, or by both imprisonment and �ue {RCW 9A20.020 (1 C)).
I2EV $4 OOOlae (6128/12} TIIIS SPACE - TIZEASU�tER'S USE C}NLY �'AXPAYER
t��stment of ��
������� �
�°��`�'�°1� �`�'`e R.EAL ESTATE EXCISE TAX AFFIDAVIT
This form is your receipt
PLEASE TYPE Ox PR1NT CTI.APTER 82.45 RCW - CH�APTER 458-61A WAC when stamped by cashier.
THIS AFFIDAVIT WTLL NOT BE ACCEPTED UNLESS ALL -AREAS ON ALL PAGES e`�R.E FI3LLY COMPLETED
fSaP ha�k nf tact naae fnr incintrtinnsl
Check box if artial salo of ro 1 y Tf muIti le owners, list ercenta e of ownerslu next to nawe.
Name North American Eoreign Trade Zone Ipdustries. LL� Name Grant CounN
� �
.'�.�,t z iviaiiing Address 160d Lind Ave SW #220 �� �Iailing Acidress PO Box 37
�� City/State/Zip Renton Wa 98057 ,.�M., � CitylState/Zip ��rata. Wa 98 2�3
Phone No. (including area code} Phone No. (including area cade}
Send all property taac correspondence to: Q Same as BuyedGrantee List aIl real and personai pzopeFty taac parcei aecount �,� �sessed value(s}
numbers - check box if personal propeMy
Name 122152000 (�
Mailing Address �{
c2�yts�t�rzz� n
Phone No. {including area code) �
� Street address of property:
This property is lpcated in GE'aCtt C4unty
❑ Check box if any of the listed parcels are being segregated from another parcel, are part af a boundary lina adjushnent ar parcels being merged.
Lagai deseziptzon af progarty (if more space is needed, yau may attach a separate sheet to each page of tlie affidavit)
A partion af Narthwest quarter of Section 04, Township 19, North Range 28, East , W.M., lying adjacent to Patton Boulevard
See attached
� Select Land Use Cod s:
Seiect Land Use Codes
enter any additional codes:
{See back of last pabe far instructions)
YES NO
Is this property exempt from property tax per chapter ❑ ✓�
$4.36 RCW (nonprofit organizatian}?
XES NO
Is this property designated as forest land per chapter 84.33 RCW? [] (�✓
Is this pro�,rty classzfied as ctnreilt use (open space, farm and ❑ [,�✓
agricultucai, or timber} Iand per ehapter 8�.34?
Is tl�is properiy receiving speciat valuation as histprical property ❑ �✓
per chapter 842b RCW?
If any answeLs are yes, complete as iisst�uctedbelow.
(1) NO3TCE QF C(3iV'T'INI7ANCE (F�RE�"T I.AND CiRC:CIRi2E,'VT USE}
NEW OWNER(S}: Ta continue the current desi�ation as forest land ar
ciassification as current use (open space, farm and agriculture, ar timber) land,
you must sign on (3) below. The caunty assessor must then determine i£the
land �ansferred continues to quatify and will indicate by signing below. If the
Iand no longer qual'rfies or yau do not wish to continae the desi�atian or
classification, it will be removed and the campensating or addilional tax es will
be due and payable by the seller or trarrsferar at the time of sale. (RCW
84.33.140 or RCW 84.34.10$). Prior to signing {3) belaw, you may contact
your tocal counry assessor for more infonnation.
This land ❑ does ❑ does not qualify far continuance.
DEPUTY ASSESSOR DATE
(2) NOTICE OF COMPLIAi\'CE (I3ISTORIC PROP]ERTY}
NEW OWNER(S): To continue special valuation as historic property,
sign (3) below. If the new owner(s) does not wish to continue, all
additional tax catculated pursuant to chapter 8426 RCW, shall be due and
payabie by the seller or transferor at the time of sale.
(3) �WI�iER(S) SiGNATUFtE
PI2INT' hAME
Signature of
Grantor ar Grantor's Agent
Name (print) �
Date & city af sigmng:
List all personal property (tangible and intangible} included in selling
price.
If claiming an exemption, list WAC number and reason for exemption:
WAC Na. (SectianJSubsection} 458-61A 205t4)
Reason for exemption
Transfer for a public purpose-puh{ic road right of way
Type of Dacument Quit Claim Deed
Date of I7ocument 11/12/12
Gross SeJling Price $.
*Personal Praperty (deduct) $
Q.00
Exemption Claimed {deduct) �
Taxable Selling Price $ ���Q
Excise Tax : State $ 0.00
�O,C050 Lacal $ 0.00
*Delinquent Interest: State
Lacal
��elinquent Penalty
Subtatal
*State Technology Fee
*Af��avit Processir.a Fec
Total Due $ ��•�p
A MINIiVItiiVi dF $10.60 iS BLTE IN PEE(S) AlrrI310R TAX
*SEE INSTRUCTTO?�IS
UNDER PEIVAI.TY OF PERNRY THAT °T'IIE FOT2EGOING IS TBUE AND CORi2ECT.
Signature of
Grantee or Grantee's Agent
Name (print)
Date & city of signing:
Perjury: Perjury is a class C feiony which is punishable by imprisonment in the state correctionai institution for a ma�mum term of not more Than five y�us, ar by a
fine in an amount fiYed by the court af not mare than five thousand dollars {$5,440.QQ), or by both imprisonment and iine (l2CW 9A20.020 {1C)).
REV 84 Oa01ae (s/28/I2} THIS SPACE - TREASUI�.ER'S USE �l\TLY COLTNTY ASSESSOR