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RDepa nm enl of (~ evenue ~ <br />Washington Stote <br />Levy Certification <br />DEC 15 7016 <br />Submit this document to the county legislative authority on or before NovembeiL3o..ofthtr y~a r pl'ec~,ding <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, -,E=rvn::..<..::.:c..:;.A=.-"M=ic=al=le;..::f __ ~ _________ _ <br />(Name) <br />_____ ~D==is~tr~i~ct~S~ec~J'e~t=a~ry~ _______ ,for __ K~itt:..;;;i:..;;;tac..:s_C.:....o.:....u:.;..:n,,-,ty,,--,--,-F-:;;ir:....:e-,D:..-l::::· s-:;;tr..;;.ic:.;..:t....;7 ___ " do hereby certifY to <br />(Title) (District Name) <br />the Kittitas County legislative authority that the Fire Commissioners ---------===~~--------(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 11/28/16 <br />(Date of Public Hearing) <br />Regular Levy: $1,389 ,078.31 <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: \1. h?J IlD l tp <br />To ask about the availability of this publication in an alternate fonnat for the visually impaired, please call (360) 705·6715. <br />Teletype (ITY) users, please call (360) 705·6718. For tax assistance, call (360) 534·1400. <br />REV 64 OIOOe (w) (2/21/12)