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DEPARTMENT <br />OF REVENUE Levy Certification <br />WASFIINGTON STATE <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, <br />Clerk/Treasurer <br />(Title) <br />the Kittitas <br />(Name of County) <br />Debbie L. Lee <br />(Name) <br />for City of Kittitas _ , do hereby certify to <br />(District Name) <br />County legislative authority that the City Council <br />(Commissioners, Council, Board, etc.) <br />of said district requests that the following levy amounts be collected in 2016 as provided in the district's <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on <br />Regular Levy: <br />Excess Levy: <br />$165,000.00 <br />(State the total dollar amount to be levied) <br />(State the total dollar amount to be levied) <br />Signature: "-Lrj <br />% U <br />12/22/15 <br />(Date of Public Hearing) <br />Date: 12/22/15 <br />DEC ? 6 2015 <br />For tax assistance, visit http://dor.wa.gov or call 1-800-647-7706. To inquire about the availability of this clocument m an <br />alternate format for the visually impaired, please call (360) 705-6715. Teletype (TTY) users may call 1-800-451-7985. <br />REV 64 0100e(w) (10/26/05) <br />