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RDepartment of ~ evenue <br />Washington State <br />Levy Certification <br />Submit this do(ument 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 (oUected and forward a copy to the assessor. <br />In accordance with RCW 84.52.020, I, -,J::..:a:.:.Y~M=cG:::.o::::..w!!.an=-__ ---:::-::---:-_______ _ <br />(Name) <br />____________ ~M~a.yo~r~ ____________ .for <br />(Title) <br />____ C""'l:-·ty<.....=.:of=-C;;;.;l:.;;;e-=E:.;;;lu::;:m=-__ -', do hereby certify to <br />(District Name) <br />the ____ -=K=itt=.it=a:=-s ____ County legislative authority that the Cle Blum City Council <br />(Name of County) (Commissioners, Council, Board, etc.) <br />of said district requests that the following levy amounts be collected in 2018 as provided in the district's <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on 11/28/17 <br />Regular Levy: $740,000.00 <br />(State the total dollar amount to be levied) <br />Excess Levy; -.;$~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: 11/28117 <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 OlOOe (w) (212lf12)