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RDeparllnelJt of (~ evenue <br />Washington State <br />Levy Certification DEC 1 6 70 16 <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, ...;N:...=an:.::a:..:D~YJ..:k:.:....-_____________ _ <br />(Name) <br />_______ ..::C...:...te':-'-r-'-'k _______ " for Kittitas County Cemetery District # 1 ,do hereby certify to <br />(Title) (District Name) <br />the <br />budget, which was adopted following a public hearing held on <br />Regular Levy: $14 ,000.00 I <br />(State the total dollar amount to be levied) <br />Excess Levy: ~$O~.~O~O __ ~ ______ ~~ <br />(State the total dollar amount to be levied) <br />Refund Levy: ~$!:..::O;,.:.;.O;...::O ________ _ <br />(State the total dollar amount to be levied) <br />Signature: <br />(Date of Public Hearing) <br />Date: 12/15116 <br />To ask about the availability ofthis 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 0100e (w) (2/21112)