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RDepartrn ellt of ra. 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, _D;;;;....;;.;ia;.;.;.n;;.;;e....;E;;;..w~in=g'-_____________ _ <br />(Name) <br />_____ ~D~is~tr~ic~t~S~e~c~re~ta=~~ _______ ~,for <br />(Title) <br />__ ----::.K;:.;.ic:..::tt"'-'it.;.;..as;:......;;;.C~0..:...un'_tyJL......;F;....:i.:....re:.....:.;..D_is;..;.t:...::ri..:...ct'_#.;...8'"____, do hereby certifY to <br />(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 12/17/16 <br />Regular Levy: $105,883.91 <br />(State the total dollar amount to be levied) <br />Excess Levy: _$~O~.~OO~ ________________ __ <br />(State the total dollar amount to be levied) <br />$40,287.50 <br />(State the total dollar amount to be levied) <br />Signature jJ.0-4 t:::s <br />(Date of Public Hearing) <br />Date: 12117/16 <br />DEe 2). 2016 <br />1 st ____ ;;~j :ll _____ ~"ro. --- <br />.. i I i I'L\;) CUUI'~ j\/ uCP\f1D (',' cC,/:~ ... ,~~~lD:·;~~1--.:· <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. For tax assistance, call (360) 534-1400. <br />REV 64 DIODe (w) (2/21/12)