Form Rev 84 0003e - Mobile Home Real Estate Excise Tax Affidavit
Download a blank fillable Form Rev 84 0003e - Mobile Home Real Estate Excise Tax Affidavit in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Rev 84 0003e - Mobile Home Real Estate Excise Tax Affidavit with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6M
H
OBILE
OME
Reset This Form
R
E
E
T
A
EAL
STATE
XCISE
AX
FFIDAVIT
Submit to County Treasurer of the county
Chapter 82.45 RCW
This form is your receipt when stamped
in which property is located.
Chapter 458-61A WAC
by cashier.
FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY
PLEASE TYPE OR PRINT
INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED
Name
Name
Street
Street
City
State
Zip Code
City
State
Zip Code
Name
Name
Street
Street
City
State
Zip Code
City
State
Zip Code
PERSONAL PROPERTY
REAL PROPERTY
PARCEL or ACCOUNT NO.
PARCEL or ACCOUNT NO.
LIST ASSESSED VALUE(S): $
LIST ASSESSED VALUE(S): $
REVENUE TAX
MAKE
YEAR
MODEL
SIZE
SERIAL NO. or I.D.
CODE NO.
Date of Sale
AFFIDAVIT
Taxable Sale Price ............................................ $
I certify under penalty of perjury under the laws of the State of
0.00
Excise Tax:
State .......................................... $
Washington that the foregoing is true and correct.
Select Location
0.00
Local ......................................... $
Signature of
Delinquent Interest: State .............................. $
Grantor/Agent
Local ............................. $
Name (print)
Delinquent Penalty .......................................... $
Date and Place of Signing:
0.00
Subtotal ............................................................ $
5.00
State Technology Fee ....................................... $
Signature of
Affidavit Processing Fee .................................. $
Grantee/Agent
10.00
Total Due ......................................................... $
Name (print)
If exemption claimed, WAC number & title:
Date & Place of Signing:
WAC No. (Sec/Sub)
WAC Title
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX.
TREASURER’S CERTIFICATE
If, in selling (or otherwise transferring ownership of) a mobile home
I hereby certify that property taxes due
which possesses a tax lien, the seller does not inform the buyer (new
County on the mobile home described hereon have been paid to and
owner) of such a lien, the seller is guilty of deliberate deception as it
including the year
.
applies to Fraud and/or Theft as defined in Title 9 and 9A RCW (RCW
9.45.060, RCW 9A.56.010 (4d), and RCW 9A.56.020).
Date
County Treasurer or Deputy
THIS SPACE - TREASURER’S USE ONLY
PLEASE NOTE: This completed document cannot be
saved to your hard drive without the full version of
Print This Form
Adobe Acrobat. If you are not using the full version of
Adobe Acrobat, you must complete this form, then print.
REV 84 0003e (6/28/12)
COUNTY TREASURER
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial