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o D epartm en t o f ~ ft.eVenUe ~ <br />Woshlngton Swte <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, _E=.....<ry""n'-'A~. M;....;;;.;;..ic;..;.a;..;.:ll:-e_f ____________ _ <br />(Name) <br />__________ ~D~i~str~l~·c~t~S~e~cr~e~ta~~~ __________ ;,for <br />(Title) <br />____ ::;..K_itt_l:..;.· ta;.;..s,-C-"--,-o_un.....:;ty""-F_i..;;.re.:....-D.....:;i::;..st,,,-ri,-,,c..;;.t ..:..7 ___ , do ; hereby certify to <br />(District Name) <br />the Kittitas County legislative authority that the Fire Commissioners --------~--..:..;.;..----------(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 11129/17 <br />(Date of Public Hearing) <br />Regular Levy: $1,420,158.10 <br />(State the total 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: t 1/29/17 <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 OIOOe (w) (2/21/12)