Washington Real Estate Excise Tax Affidavit

Tax day has passed, and refunds are being processed! You can still e-file a late tax return here

with TurboTax

Real Estate Excise Tax Affidavit
Real Estate Tax Affidavit for Single Location CodeReal Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)

Form 84 0001a
1

Only for sales in a single location code on or after March 1, 2023.
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 %

Reset form

List percentage of ownership acquired next to each name.

sold.

2 Buyer/Grantee

Seller/Grantor

Name

Mailing address

City/state/zip

Phone (including area code)

3 Send all property tax correspondence to:

List all real and personal property tax
parcel account numbers

Same as Buyer/Grantee

Name

Personal
property?

Assessed
value(s)

$ 0.00
$ 0.00
$ 0.00

Mailing address
City/state/zip

(for unincorporated locations please select your county)
Select Location
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.
Legal description of property (if you need more space, attach a separate sheet to each page of the affidavit).

7 List all personal property (tangible and intangible) included in selling

Select land use code(s)

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)?
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)

6 Is this property designated as forest land per RCW 84.33?

price.

Yes

If claiming an exemption, list WAC number and reason for exemption.
No WAC number (section/subsection)
Reason for exemption

Yes ✔ No
Yes

Is this property classified as current use (open space, farm
and agricultural, or timber) land per RCW 84.34?

Yes

No Date of document

Is this property receiving special valuation as historical
property per RCW 84.26?

Yes

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:
continuance.

does

does not qualify for

____________________________________ ____________________
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

Type of document

0.00
0.00
0.00
0.00

Gross selling price
*Personal property (deduct)
Exemption claimed (deduct)
Taxable selling price
Excise tax: state

0.00
0.00
0.00
0.00
0.00

Less than $525,000.01 at 1.1%
From $525,000.01 to $1,525,000 at 1.28%
From $1,525,000.01 to $3,025,000 at 2.75%
Above $3,025,000 at 3%
Agricultural and timberland at 1.28%

0.00
0.00
Local
0.0000
0.00
*Delinquent interest: state
0.00
Local
0.00
*Delinquent penalty
0.00
Subtotal
5.00
*State technology fee
5.00
Affidavit processing fee
10.00
Total due
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
*SEE INSTRUCTIONS
Total excise tax: state

8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
Signature of grantor or agent _______________________________

Signature of grantee or agent __________________________

Name (print)

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 years, 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.

THIS SPACE TREASURER’S USE ONLY

COUNTY TREASURER
Print on legal size paper.

Page 1 of 6

Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)

Form 84 0001a
1

Check box if partial sale, indicate %

List percentage of ownership acquired next to each name.

sold.

2 Buyer/Grantee

Seller/Grantor

Name

Mailing address

City/state/zip

Phone (including area code)

3 Send all property tax correspondence to:

List all real and personal property tax
parcel account numbers

Same as Buyer/Grantee

Name

Personal
property?

Assessed
value(s)

$ 0.00
$ 0.00
$ 0.00

Mailing address
City/state/zip

7 List all personal property (tangible and intangible) included in selling

Select land use code(s)

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)?
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)

6 Is this property designated as forest land per RCW 84.33?

price.

Yes

If claiming an exemption, list WAC number and reason for exemption.
No WAC number (section/subsection)
Reason for exemption

Yes ✔No
Yes

Is this property classified as current use (open space, farm
and agricultural, or timber) land per RCW 84.34?

Yes

No Date of document

Is this property receiving special valuation as historical
property per RCW 84.26?

Yes

does

does not qualify for

Type of document

0.00
0.00
0.00
0.00

Gross selling price
*Personal property (deduct)
Exemption claimed (deduct)
Taxable selling price
Excise tax: state

0.00
0.00
0.00
0.00
0.00
0.00

Less than $525,000.01 at 1.1%
From $525,000.01 to $1,525,000 at 1.28%
From $1,525,000.01 to $3,025,000 at 2.75%
Above $3,025,000 at 3%
Agricultural and timberland at 1.28%
Total excise tax: state

0.00
0.00
*Delinquent interest: state
0.00
Local
0.00
*Delinquent penalty
0.00
Subtotal
5.00
*State technology fee
5.00
Affidavit processing fee
10.00
Total due
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
*SEE INSTRUCTIONS
0.0000

Local

8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
Signature of grantor or agent _______________________________

Signature of grantee or agent __________________________

Name (print)

Date & city of signing

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.
(02/28/23)

THIS SPACE TREASURER’S USE ONLY

COUNTY ASSESSOR
Print on legal size paper.

Page 2 of 6

Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)

Form 84 0001a

Check box if partial sale, indicate %

List percentage of ownership acquired next to each name.

sold.

2 Buyer/Grantee

Seller/Grantor

Name

Mailing address

City/state/zip

Phone (including area code)

3 Send all property tax correspondence to:

List all real and personal property tax
parcel account numbers

Same as Buyer/Grantee

Name

Personal
property?

Assessed
value(s)

$ 0.00
$ 0.00
$ 0.00

Mailing address
City/state/zip

7 List all personal property (tangible and intangible) included in selling

Select land use code(s)

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)?
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)

price.

Yes

If claiming an exemption, list WAC number and reason for exemption.
No WAC number (section/subsection)
Reason for exemption

Yes ✔ No

6 Is this property designated as forest land per RCW 84.33?

Yes

Is this property classified as current use (open space, farm
and agricultural, or timber) land per RCW 84.34?

Yes

No Date of document

Is this property receiving special valuation as historical
property per RCW 84.26?

Yes

does

does not qualify for

Type of document

0.00
0.00
0.00
0.00

Gross selling price
*Personal property (deduct)
Exemption claimed (deduct)
Taxable selling price
Excise tax: state

0.00
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
Local
0.0000
0.00
*Delinquent interest: state
0.00
Local
0.00
*Delinquent penalty
0.00
Subtotal
5.00
*State technology fee
5.00
Affidavit processing fee
10.00
Total due
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
*SEE INSTRUCTIONS
Less than $525,000.01 at 1.1%

8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
Signature of grantor or agent _______________________________

Signature of grantee or agent __________________________

Name (print)

Date & city of signing

THIS SPACE TREASURER’S USE ONLY

DEPARTMENT OF REVENUE
Print on legal size paper.

Page 3 of 6

Real Estate Excise Tax Affidavit (RCW 82.45 WAC 458-61A)

Form 84 0001a

Check box if partial sale, indicate %

List percentage of ownership acquired next to each name.

sold.

2 Buyer/Grantee

Seller/Grantor

Name

Mailing address

City/state/zip

Phone (including area code)

3 Send all property tax correspondence to:

List all real and personal property tax
parcel account numbers

Same as Buyer/Grantee

Name

Personal
property?

Assessed
value(s)

$ 0.00
$ 0.00
$ 0.00

Mailing address
City/state/zip

7 List all personal property (tangible and intangible) included in selling

Select land use code(s)

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)?
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)

price.

Yes

If claiming an exemption, list WAC number and reason for exemption.
No WAC number (section/subsection)
Reason for exemption

Yes ✔ No

6 Is this property designated as forest land per RCW 84.33?

Yes

Is this property classified as current use (open space, farm
and agricultural, or timber) land per RCW 84.34?

Yes

No Date of document

Is this property receiving special valuation as historical
property per RCW 84.26?

Yes

does

Type of document

*Personal property (deduct)
Exemption claimed (deduct)
Taxable selling price
Excise tax: state

0.00
0.00

Less than $525,000.01 at 1.1%
From $525,000.01 to $1,525,000 at 1.28%

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5.00
5.00

From $1,525,000.01 to $3,025,000 at 2.75%
Above $3,025,000 at 3%
Agricultural and timberland at 1.28%
Total excise tax: state

does not qualify for

0.0000

0.00
0.00
0.00
0.00

Gross selling price

Local

*Delinquent interest: state
Local
*Delinquent penalty
Subtotal
*State technology fee
Affidavit processing fee

10.00
Total due
A MINIMUM OF $10.00 IS DUE IN FEE(S) AND/OR TAX
*SEE INSTRUCTIONS

8 I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT
Signature of grantor or agent _______________________________

Signature of grantee or agent __________________________

Name (print)

Date & city of signing

Print form

THIS SPACE TREASURER’S USE ONLY

TAXYPAYER
Print on legal size paper.

Page 4 of 6

Instructions

Note: To report a transfer of a controlling interest in real property, please use the Real Estate Excise Tax Affidavit Controlling
Interest Transfer Return, Revenue Form No. 84-0001B. This form is available online at dor.wa.gov/REET. This affidavit must be
fully and accurately completed. If it is not, the county has the authority to reject the affidavit. See WAC 458-61A-303(6)
Section 1:
If the sale involves property in more than one location code, use the Multiple Location Real Estate Excise Tax Affidavit.
If the sale is less than 100%, check the box “Check if partial sale” and fill in the percentage sold.
Enter the name(s) of seller/grantor exactly as listed on the legal conveyance document including the method of holding title.
Attach additional page if necessary to fully list all grantors.
Section 2:
Enter the name(s) of buyer/grantee exactly as listed on the legal conveyance document including the method of
holding title. List the percentage acquired after each name. Attach additional page if necessary to fully list all grantees.
Section 3:
• Enter the name and address where you would like all future property tax information sent.
• Enter the tax parcel number and current assessed value for real and personal property being conveyed in this
county. Check the box to indicate personal property.
Section 4:
• Enter the street address of the property.
• Enter the county if in unincorporated area. Enter city name if located within a municipality.
• Enter the legal description of the property. Attach an additional page if necessary.
Section 5:
Enter the appropriate land use code for the property. Please list all codes that apply on the lines provided in section 5.
See WAC 458-53-030(5) for a complete list.
64 - Repair services
9 - Land with mobile home
26 - Paper and allied products
27 - Printing and publishing
10 - Land with new building
65 - Professional services
28 - Chemicals
11 - Household, single family units
(medical, dental, etc.)
29 - Petroleum refining and related
12 - Multiple family residence (2-4
71 - Cultural activities/nature
industries
Units)
exhibitions
30
Rubber
and
miscellaneous
plastic
13 - Multiple family residence (5+
74 - Recreational activities
products
Units)
(golf courses, etc.)
31 - Leather and leather products 32 14 - Residential condominiums 15 75 - Resorts and group camps
Stone, clay and glass products 33 Mobile home parks or courts 16 80 - Water or mineral right
Primary metal industries
Hotels/motels
81 - Agriculture (not in current use)
34 - Fabricated metal products
17 - Institutional Lodging
83 - Agriculture current use
35 - Professional scientific
(convalescent homes, nursing
RCW 84.34
and controlling instruments;
homes, etc.)
86 - Cannabis grow operations
photographic and optical goods;
18 - All other residential not coded
87 - Sale of Standing Timber
watches/clocks manufacturing
19 - Vacation and cabin
88 - Forest land designated
39 - Miscellaneous manufacturing 50 21 - Food and kindred products 22
RCW 84.33
Condominiums-other than residential
- Textile mill products
91 - Undeveloped Land (land only)
53 - Retail Trade - general
23 - Apparel and other finished
94 - Open space land RCW 84.34
merchandise 54 - Retail Trade - food
products made from fabrics,
95 - Timberland classified
58 - Retail trade - eating & drinking
leather, and similar materials 24 RCW 84.34
(restaurants, bars)
Lumber and wood products
96 - Improvements on leased land
59 - Tenant occupied, commercial
(except furniture)
properties
25 - Furniture and fixtures
•

Check yes if the seller was receiving a property tax exemption or deferral under RCW 84.36, 84.37, or 84.38 (nonprofit
organization, senior citizen, or disabled person, homeowner with limited income).
• Check yes if the land is primarily used for timber as defined by RCW 84.34 and 84.33 or agriculture as defined by RCW
84.34.020 AND the county assessor has signed that the land does qualify for continuance in the Notice of Continuance in
Section 6. See ETA 3215 for additional information. If the sale involves multiple parcels in which one or more parcel(s) is
classified as above and one or more parcel(s) is not included in these classifications, you must complete the predominate
use worksheet which can be found at dor.wa.gov/REET.
Section 6:
Indicate whether the property is designated as forest land per chapter 84.33 RCW, classified as current use (open space, farm,
agricultural, or timber) per chapter 84.34 RCW, or receiving special valuation as historic property per chapter 84.26 RCW.
Section 7:
• List personal property included in the selling price of the real property. For example, include tangible (furniture,
equipment, etc.) and intangible (goodwill, agreement not to compete, etc.).
• Use Tax is due on personal property purchased without payment of the sales tax. Report use tax on your Combined Excise
Tax Return or a Consumer Use Tax Return, both available at dor.wa.gov.
• If you are claiming a tax exemption, cite the specific Washington Administrative Code (WAC) number, section and
subsection and provide a brief explanation. Most tax exemptions require specific documentation. Refer to the appropriate
WAC to determine documentation requirements. WAC 458-61A is available online at dor.wa.gov/REET.
• Enter the type of document (quit claim deed, statutory warranty deed, etc.), and date of document (MM/DD/YYYY).
• Enter the selling price of the property.
• Selling price: For tax purposes, the selling price is the true and fair value of the property conveyed. When property is
conveyed in an arm’s length transaction between unrelated persons for valuable consideration, there is a presumption
that the selling price is equal to the total consideration paid or contracted to be paid, including any indebtedness. Refer to
RCW 82.45.030 for more information about selling price.
• Deduct the amount of personal property included in the selling price.
• Deduct the amount of tax exemption claimed per WAC 458-61A.
Print on legal size paper.
Page 5 of 6

•

Calculate the state excise tax:

Instructions Continued

The state portion of excise tax is calculated using a graduated tax rate structure. The amount of tax increases as the
amount of the transaction increases. Each portion of the sales amount is taxed at a different rate.
Exception: Property designated as farm and agriculture or timberland is taxed at 1.28% per 83.34 RCW.
Instructions:
1. Enter the sale amount that falls within the specific threshold in column A.
2. Multiply the amount in column A by the state rate in column B. Enter the results in column C.
3. Enter the amount in column C on the appropriate threshold line on page 1 of the affidavit.
Example: This is how the state REET tax would be calculated on a sale totaling $1,600,000:

Threshold
0 to $525,000
525,000.01 – 1,525,000
1,525,000.01 to 3,025,000
3,025,000.01 and above
Totals

Column A

Column B

Column C

Amount within threshold
525,000
1,000,000
75,000
0
$1,600,000

State rate
1.1%
1.28%
2.75%
3.0%

Tax
5,775
12,800
2,062.50
0
$20,637.50

Calculate the state excise tax due using this chart:

Threshold
0 to $525,000

Column A

Column B

Column C

Amount within threshold

State rate
1.1%

Tax

525,000.01 – 1,525,000

1.28%

1,525,000.01 to 3,025,000

2.75%

3,025,000.01 and above

3.0%

Totals
Enter the total state tax due on the Excise Tax: State line.
•
•

•
•

Enter the local tax due due. This rate is based on the location in which the property is located. A list of local rates can
be found at dor.wa.gov/REET.
Due Date, interest and penalties: Tax is due at the time of sale/transfer. If tax is not paid within one month of the date
of sale/transfer, interest and penalties will apply. The interest rate is variable and determined per RCW 82.32.050.
Delinquent penalties are 5% one month after the due date; 10% two months after the due date; and 20% three months
after the due date. (RCW 82.45.100)
State technology fee: A $5.00 Electronic Technology Fee is due on all transactions. (82.45.180)
Affidavit processing fee: A minimum of $5.00 shall be collected in the form of tax and processing fee. A processing fee
is due on all transactions where no tax is due and on all taxable transactions where the tax due is less than $5.00. (RCW
82.45.180)

Section 8:
• Both grantor (seller) and grantee (buyer), or the agent of each, must sign this form, certifying that all the information
provided is correct. Note: Original signatures required on the “County Treasurer” copy.
• Signatures may be required on the “Assessors” copy. Check with your county.
• Real Estate Excise Tax is a specific lien on the property. The filing of the affidavit may result in a lien on the parcel(s)
involved in the transfer if the proper tax is not paid at the time of transfer. RCW 82.45.070
Audit:
All transactions are subject to audit by the Department of Revenue. An audit will confirm the proper amount of tax was
paid and that any claim for exemption is valid. Failure to provide documentation as requested may result in the denial of
any exemptions claimed and the assessment of additional tax with applicable interest and penalties. WAC 458-61A-301(9)
Note: In the event of an audit, it is the taxpayer’s responsibility to provide documentation to support the selling price or
any exemption claimed. This documentation must be maintained for a minimum of four years from date of sale. (RCW
82.45.100)
Ruling requests:
You may request a ruling on the taxability of the property transfer. Go to our website at dor.wa.gov/rulings or fax your
request to 360-705-6655.
Where to send completed forms:
Completed forms must be submitted to the County Treasurer’s or Recorder’s Office where the property is located.

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.
Print on legal size paper.

Page 6 of 6

Extracted from PDF file 2023-washington-rev-84-0001a.pdf, last modified June 2020

Download This Form

Print This Form

More about the Washington REV 84-0001a Other TY 2023

Completed forms must be submitted to the County Treasurer's or Recorder’s Office where the property is located.

We last updated the Real Estate Excise Tax Affidavit in January 2024, so this is the latest version of REV 84-0001a, fully updated for tax year 2023. You can download or print current or past-year PDFs of REV 84-0001a directly from TaxFormFinder. You can print other Washington tax forms here.

eFile your Washington tax return now

eFiling is easier, faster, and safer than filling out paper tax forms. File your Washington and Federal tax returns online with TurboTax in minutes. FREE for simple returns, with discounts available for TaxFormFinder users!

File Now with TurboTax

Related Washington Other Forms:

TaxFormFinder has an additional four Washington income tax forms that you may need, plus all federal income tax forms. These related forms may also be needed with the Washington REV 84-0001a.

Form Code	Form Name
REV 84-0002ea	Real Estate Excise Tax Supplemental Statement
REV 84-0003e	Real Estate Excise Tax Mobile Home Affidavit
REV 84-0001Be	Real Estate Excise Tax Controlling Interest Affidavit Tax Credit
REV 84-0004e	Real Estate Excise Tax Refund Request
REV 84-0005e1	Real Estate Excise Tax Statement of Taxes Collected
REV 84-0013	Real Estate Excise Tax Rates

Download all WA tax forms View all 5 Washington Income Tax Forms

Form Sources:

Washington usually releases forms for the current tax year between January and April. We last updated Washington REV 84-0001a from the Department of Revenue in January 2024.

Show Sources >

Historical Past-Year Versions of Washington REV 84-0001a

We have a total of six past-year versions of REV 84-0001a in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:

2023 REV 84-0001a

Real Estate Tax Affidavit for Single Location Code

2022 REV 84-0001a

Real Estate Tax Affidavit for Single Location Code

2021 REV 84-0001a

Real Estate Tax Affidavit for Single Location Code

2020 REV 84-0001a

Real Estate Tax Affidavit for Single Location Code

2019 REV 84-0001a

Real Estate Excise Tax Affidavit

2018 REV 84-0001a

Real Estate Excise Tax Affidavit

TaxFormFinder Disclaimer:

While we do our best to keep our list of Washington Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.

Washington Real Estate Excise Tax Affidavit

Real Estate Excise Tax AffidavitReal Estate Tax Affidavit for Single Location Code

More about the Washington REV 84-0001a Other TY 2023

eFile your Washington tax return now

Related Washington Other Forms:

Form Sources:

Historical Past-Year Versions of Washington REV 84-0001a

TaxFormFinder Disclaimer:

Real Estate Excise Tax Affidavit
Real Estate Tax Affidavit for Single Location Code