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Ro epanment of (~ evenue ,..::: <br />Washington Stole <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, <br />(Name) F, ( t C h; ~ ~ . for K ,;'lh k; lc""" 1:7, ;r.:: c ~ {);w<jlll do hereby certify to <br />(Title) (Distric Name) <br />the <br />V ~ \.. , . '-Fi r e / \ , l' I n r ) 1 0 S County legislative authority that the LV IY\ m , 1" S I 0 (I e (' S <br />(Name of County) (Commissioners, Council, Board, etc.) <br />of said district requests that the following le~ amounts be collected in ~O I g-V"as provided in the district's <br />(Year OfCol~~m) <br />I'J.-/1-/7 : budget, which was adopted following a public hearing held on <br />(Date of Public Hearing) <br />Regular Levy: ~55 I ~(}(). O~ <br />(State the tot:ll dollar amount to be levied) <br />Excess Levy: <br />(State the total dollar amount to be levied) <br />Refund Levy: <br />(State the total dollar amount to be levied) <br />Signature: Date: <br />DEC 22 7.017 <br />To ask about the availability of this publication in an alternate fonnat for the visually impaired, please call (360) 705-6715. <br />Teletype (ITY) users, please call (360) 705-6718. For tax assistance, call (360) 534-1400. <br />REV 64 OIOOe (w) (2121/12)