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RDepartmel1l of ~ evenue ~ <br />Wa sh in gt on Stote <br />Levy Certification OEe 1 6 701(1 <br />Submit this document to the county legislative authority on or before November 30 ofthe 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 />St CAt-~ f-o (~ &arrL , for <br />kdHfVlLj (~~) "7f't-Proi-ecJ-lllYl <br />DJ ~tr I et b t{pL/.D 100 .) . do hereby certify to <br />(District Name) 7 <br />the _----"~"""_'_'·-'-I±~ti:....:::..::;.~M=_ ____ County legislative authority that the f500V'cL j AM COrn 1'1/\) y¥idhetlJ <br />(Name of County) (Commissfters, Council, Board. etc .) <br />of said district requests that the following levy amounts be collected in :1017 as provided in the district's <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on I;) / 13/1 &, ~ <br />(Date ~f PubliC Hearing) <br />Regular Levy : <br />(State the total aOllar 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: I') /1 J jJ Co <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. Fortax assistance, call (360) 534-1400. <br />REV 64 DIODe (w) (2/21112)