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Depariiment of <br />Revenue- <br />Woshfngton State <br />Levy Certification <br />KIT T iTAS CGt);vTy <br />BOARD OF EQl!a '-r.r�nl <br />Submit this document to the county legislative authority on or before November o >te <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, Elizabeth Allgood , <br />(Name) <br />Treasurer <br />(Title) <br />the /Kittitas <br />(Name of County) <br />for Kittitas County Public Hospital <br />District No.2/EMS <br />(District Name) <br />, do hereby certify to <br />County legislative authority that the Board of 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 11/10/16 <br />(Date of Public Hearing) <br />Regular Levy: $1,174,590.00 <br />(State the total dollar amount to be levied) <br />Excess Levy: <br />(State the total dollar amount to be levied) <br />Refund Levy: $20,000.00 <br />(State the total dollar amount to be levied) <br />Signature: Date: I kk <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 />