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R Dl:!pa~tment of ~ evenue ~ <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, I, Shawna Graham ~~~~~~~----------------------------(Name) <br />Treasurer for ------------~~~---------------. (Title) <br />___ ---=Tc..:::h:..::.e-=C:.:i..::.lty'-o::..:f:.....:R:..::.o::..:s:.:..lyo..::n-=----__ --', do hereby certify to <br />(District Name) <br />the ________ ---=-K=-:i..:..:tl..:..:it:=a=-s ________ County legislative authority that the _C..:o..:..:ity"---'C:....:o:...;:u-"-n.:..:;c..:..:il'--____________ _ <br />(Name of County) (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 11/22/16 <br />(Date of Public Hearing) <br />Regular Levy: $210 ,DOO.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: <br />(State the total dollar amount to be levied) <br />Signature: Date: 12/22116 <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 DIODe (w) (2/21112)