Washington Real Estate Excise Tax Statement of Taxes Collected

Real Estate Excise Tax Statement of Taxes Collected
REV 84-0005e1
Real Estate Excise Tax Statement of Taxes Collected

Form 84 0005

Real Estate Excise Tax
Statement of Taxes Collected

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County:
Report starting MM/DD/YY:

Report ending MM/DD/YY:

Beginning affidavit #:

Ending affidavit #:

Total no. of affidavits
(including mobile homes):

Total no. of mobile home
affidavits:

1. Total state and local tax collected (do not subtract tax refunded)
(Do not include refunds made, tax collected on mobile homes,
and penalties and interest) ....................................................................................... $
2. Total state and local tax on mobile homes ............................................................... $
3. Total of lines 1 and 2 .............................................................................................. = $ 0.00
4. Refunds during month .............................................................................................. $
5. Local tax collected (county/city)
5a. Capital projects .................................................................................................. $
5b. Conservancy land acquisition and maintenance ................................................ $
5c. Affordable housing ............................................................................................. $
6. Subtract lines 4, 5a, 5b and 5c .............................................................................. -

$ 0.00

7. Net state tax collected (Line 3 minus line 6) .......................................................... = $ 0.00
8. Subtract administrative fee (1.3% from state only, line 7) ..................................... - $
9. Total tax being remitted (line 7 minus line 8) ........................................................ = $ 0.00
10. Add total delinquent penalty collected ............................................................... + $ 0.00
11. Add total state delinquent interest collected ...................................................... + $ 0.00

For tax assistance, contact your local County Treasurer/Recorder or visit dor.wa.gov/REET or call
360-704-5905. To request this document in an alternate format, please complete the form
dor.wa.gov/AccessibilityRequest or call 360-705-6705. Teletype (TTY) users please dial 711.
REV 84 0005 - Single (7/31/24)				

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Real Estate Excise Tax Statement of Taxes Collected
12. Add total $5.00 state technology fee collected ................................................... + $ 0.00
12a. Subtract 1/2 of line 12 (retained by county for deposit to the special
0.00
real estate and property tax administration assistance account ..... 0.00
- $
13. Total to be returned to State Treasurer* (add lines 9, 10, 11, 12, minus 12a) ........ $ 0.00
*If this item does not agree with the amount depositied with the State Treasurer’s Office on the monthly
Cash Receipts Journal Summary (state form A8), list all adjustments which caused the difference below with
explanation.
Adjustments:
Date:

Reason:

+

=

Date:

Reason:

-

=

14. Total amount remitted to the state treasurer (less adjustments) ........................... $ 0.00
List voided affidavit numbers:
or list missing series:

to

Signature:

Date:

Phone:

Name:

Distribution:	 Original - Department of Revenue, attached to Affidavit Batch
		

Copy - State Treasurer’s Office, attached to monthly Cash Receipts Journal Summary

		

Copy - Retained by County Treasurer

REV 84 0005 - Single (7/31/24)				

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