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R~venue(@ Levy Certification NOV 1 7 ' Washington 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 />_-'-h-J...ij:;.....;'/?I£=-=------=&~@,=..ciE<------,. for <br />(Title) <br />(Name) <br />C,£(k ~,{I~ ~ ~ do hereby certify to <br />(District ame) . <br />the ~S County legislative authority that the h/V? clu4l1/sPtMt'ILS <br />(Name of County) (CQmmissioners, Council, Board, etc.) <br />of said district requests that the following levy amounts be collected in ;1tJ/7 as provided in the district's <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on 1I/I@0e : <br />(Date of Pub ic Rearing) <br />Regular Levy: <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: # <br />" <br />To ask about the availability ofthis publication in an alternate format for the visually impaired, please call (360) 705-6715 . <br />Teletype CTTY) users, please call (360) 705-67 I 8. For tax assistance, call (360) 534-I 400. <br />REV 64 OIOOe (w)(2/21112)