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Revenue f 11 <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, I, Steve Jensen <br />Chief <br />(Name) <br />. for Fire District 43 • do hereby certify to <br />( title) (District Name) <br />the Kittitas County legislative authority that the Commissioners <br />(Name of County) (Commissioners, Council, Board. etc.) <br />of said district requests that the following levy amounts be collected in 2417 _ as provided in the district's <br />(Year ol'Collection) <br />budget, which was adopted following a public hearing held on 12/7/16 <br />(Date of Public I learing) <br />Regular Levy: $71,000.00 DEC 2 7 ?O1r, <br />(State the total dollar amount to be levied) <br />Excess Levy: $0.00 <br />(State the total dollar amount to be levied) <br />Refund Levy: $0.00 <br />(State the total dollar amount to be levied) <br />Signature: L �Y,,,. ± 1 , . �: T -`:.r Date: > �� <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 />REN 64 0100c (w) (2/2 PI 2) <br />