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Deparkment of <br />ROire 7ue <br />Washington State <br />r <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, <br />(Name) <br />for�y r f Lixi Ur- �� , do hereby certify to <br />(Title) (Dis ct Name) <br />the j a County legislative authority that thel �/`.�,r` S ,/� <br />(Name of County) (Commissioners, Council, Board, etc.) <br />of said district requests that the following levy amounts be collected in A6/4 as provided in the district's <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on <br />Regular Levy: o;a Qe) o <br />(State the total dollar amount to be levied) <br />Excess Levy: <br />(State the totsl dollar amount to be levied) <br />Refund Levy: eZ% �%i/. <br />(State the tofal dollar amount to be levied) <br />Signature:' <br />�� 4� /_S : <br />(Date f Public Hearing) <br />DEC 18 2015 <br />Date:F3r <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 />