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Dejmrtl,le(11 t)i <br />Revenue (CA <br />VV(Ishrnpnlon state <br />Levy Certification <br />Submit this document to the county legislative authority on or before November 30 of the year preceding <br />the year in which the levy amounts are to be collected and forward a copy to the assessor. <br />In accordance with RCW 84.52.020, 1, Jay McGowan <br />(Name) <br />Mayor , for Citv of Cie Elum , do hereby certify to <br />(Title) (District Name) <br />the Kitittas <br />(Name ofCounty) <br />County legislative authority that the Cie Elum City Council <br />(Commissioners, Council, Board, etc.) <br />of said district requests that the following levy amounts be collected in 2017 _ as provided in the district's <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on 11/22/16 <br />Regular Levy: <br />Excess Levy: <br />Refund Levy: <br />$710,000 <br />(State the total dollar amount to be levied) <br />(State the total dollar amount to be levied) <br />(State the total dollar amount to be levied) <br />(Date of Public Hearing) <br />Signature: �� C - Kms- P'0^/ -e — <br />Date: �/ 1 <br />To ask about the availability of this publication in an alternate format for the visually impaired, please call (360) 705-6715, <br />Teletype (TTY) users, please call (360) 705-6718. For tax assistance, call (360) 534-1400. <br />REV 64 0100e (w) (2/21/12) <br />