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RDep;lftmel)t 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, James L. DeVere ~~~~~~~----------------------------- <br />(Name) <br />_______________ ~~ay~o~r _______________ ,for <br />(Title) <br />__ ----=T:..:o~w.:...:.n~o::-:f:....:S=:.;o:....:u::.::th:..:....=C:..:.;le:....:::E.:..:lu:..:.;m~--. do hereby certify to <br />(District Name) <br />the Kittitas Coun1y legislative authority that the Town Council --------~~~~--------~~~----------------(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 11/15/16 <br />(Date of Public Hearing) <br />Regular Levy: $118 ,000.00 <br />(State the total dollar amount to be levied) <br />Excess Levy : NOV 18 2016 (State the total dollar amount to be levied) <br />(State the total dollar amount to be levied) <br />1 st . ______ ..... ml_ .. ___ 3rd_. __ _ <br />I,ll i li'/l,S CUUrJ1 Y BO,l\flD OF COIJlMIS~;iONr::1S Refund Levy: <br />Signature : Date: 11101116 <br />To ask about the availability of this publication in an altemate fonnat 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) (2/21/12)