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00,� <br />Delmroiwrnl of <br />Revenue (CA <br />Washington State <br />Levy Certification <br />DEC 15 ?% <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, Chris Cutli <br />(Name) <br />r <br />Secretary , for Kittitas County Fire District #4 , do hereby certify to <br />(Title) (District Name) <br />the Kittitas <br />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 2017 as provided in the district's <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on 12/05/16 V111., <br />(Date of Public Hearing) <br />Regular Levy. <br />Excess Levy: <br />Refund Levy: <br />Signature: <br />26,000.00 <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: / 7— 5 41. . <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 />