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Department of la(g ;:��'���✓7�-..._ i <br />Revenue pe Levy Certification <br />Washington State <br />DEC — g 2o!5 <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,, -.i idIn accordance with RCW 84.52.020, I, Elizabeth Allgood _ <br />(Name) <br />Treasurer for Public Hospital District #1 , do hereby certify to <br />(Title) (District Name) <br />the Kittitas <br />(Name of County) <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 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: $8,300.00 <br />(State the total dollar amount to be levied) <br />Excess Levy: $12289,587.50 <br />(State the total dollar amount to be levied) <br />Refund Levy: $22,000.00 <br />(State the total dollar amount to be levied) <br />10/22/15 <br />(Date of Public Hearing) <br />��& IZA�,Q, <br />Signature: . <br />Date: 11/30/15 <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 />