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RDepar !,rnent of (@ evenue ~ <br />Washingtbn State <br />Levy Certification DEe 1 9 '),li1(; <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 assesso~. <br />In accordance with RCW 84.52.020, I, ...,;D=:...,:;ia::::n.:..:e:...,;E::.w.:..:..:.:in;.::.<g"--______________ _ <br />(Name) <br />_____ ~D~i=st~r.:..:ic~t~e~c~rt=a~ly~ ____ ~"for <br />(Title) <br />_---=Kc.::;i:..:,tt:..:.i t==a:.=.s_=C~o:...:u==n:..:.ty.c...;;;,.F..::ir_=e_=D:::....:..::is..::tr:...:.ic.::..;t:...,;#.:...;8=______') do hereby certify to <br />(District Name) <br />the Kittitas County legislative authority that the F ire Commi ss ion e rs ----~~~=---------(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 />(D ate of Public Hearing) <br />Regular Levy: $105,883.91 <br />(State the total dollar amount to be levied) <br />Excess Levy: $1,058.83 <br />(State the total dollar amount to be levied) <br />Refund Levy: <br />(State the total dollar amount to be levied) <br />Signature: i=-..£l..~~""'l---~~~~'==~,...e:.=::=:~==;:;::: Date: 12/17116 <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) (2/21112)