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DEPARTMENT <br />OF REVENUE <br />WASHINGTON STATE Levy Certification <br />Submit this document to the county Icgislatin authority OD 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 asseSSOl·. <br />In accordance with RCW 84.52.020, I, Debbie L. Lee -=~~~~~------------------------------(Name) <br />Clerk/Treasurer for ____ ~C..::..it;.:.v_'o:..::f..::K..::..i;.:..tt;.:..it:..::a.:;,.s ____ , do hereby certify to <br />(Title) (District Name) <br />the Kittitas County legislative authority that the City Council -------~---~------~--~~-----------------(Name of County) (Commissioners, Council. Board. etc.) <br />of said district requests that the following levy amounts be collected in __ 2_0,;..,1....;7,--_ as provided in the district's <br />(Yeur of Collection) <br />budget, which was adopted following a public hearing held on 12113/2016 <br />(Date of Public Hearing) <br />Regular Levy: $170 ,000.00 <br />(State the total dollar amount to be levied) <br />Excess Levy: <br />(State the total dollar amount to be levied) <br />Signature: Date: 12113116 <br />For tax assistance, visit hup:/ldQJ.wa.gav or call 1-800-647-7706 . To inquire about the availability of this document in an <br />altemate fonnat for the visually impaired, please call (360) 705-6715. Teletype (ITY) users may call 1-800-451-7985 . <br />REV 64 OlOOe (w) (1 0i26/05)