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R[) 'lxtrtl1lel'l( of ~ evenu e ~ <br />Washington Stote <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, _J:....:a::.,oyc....:...:.M.:..:c:...:G::..:o"-w"-a::;I1"----______________ _ <br />(Name) <br />________ ~M~a~y~o~r ________ .for _____ C=it"'-v...::o'-'-f~C::..:I:::...e_=E~I =ur:..:.;n:...._ ____ , do hereby certify to <br />Critic) (District Name) <br />the Kitittas <br />(Name of County) <br />County legislative authority that the Cle Elum City Council <br />(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 ofColJection) <br />budget, which was adopted following a public hearing held on 11/22/16 <br />(Dale of Public Hearing) <br />Regular Levy : $710 ,000 <br />(Stale the total dollar amount (0 be levied) <br />Excess Levy: <br />(State the total dollar amount to be levied) <br />Refund Levy: <br />(State the totnl dollar amollnllo be levied) <br />Signature: (~C_~~~~ Date: 11 b-3( tb <br />To ask abollt the availability of this publication in an alternate fonnat for the visually impaired, please call (360) 705-6715 . <br />Teletype (TTV) users, please call (360) 705-6718. For tax assistance, call (360) 534-1400. <br />REV 6401 ODe (w) (2/21112)