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D It,trttt7er11 of <br />R60knue <br />Washington 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, <br />William J. Powers Jr, <br />Chairman, Board of Fire Commissioners , for <br />('title) <br />the K ittitas <br />(Name ol'Counly) <br />(Name) <br />Sno ualmie Pass Fire & Rescue , do hereby certify to <br />(District Name) <br />County legislative authority that the Board of Fire Commissioners <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 <br />Regular Levy: $300.000.00 <br />(State the total dollar amount to be levied) <br />Excess Levy: $65,185 <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: <br />f <br />11/10/16 <br />(Date of Public 1 searing) <br />Date: <br />12016 <br />To ask- about the availabi.l'tty of'this puhlicaliott in an alternate fcrrntal fpr the -Vi'tialIN itttpa3r,pd..1)foct e. call {360) 705- <br />6715. Teletype (TTY) uwrs, please call.060) 705-018. Ft�r tttx a4sistancw, sal[ (�6[)] 53:;-I�li]U. <br />ItN,V 64 0100e (w) (2/21/12) <br />