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Levy Certification NOV 22 <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.:::liza=b:..:::;e.::.th:...::A:...:.:.:.llgc.:o:..:o:..::d=---___________ _ <br />Treasurer , for <br />(Title) <br />(Name) <br />Kittitas County Public Hospital <br />District No. 2/EMS Levy <br />(District Name) <br />, do hereby certify to <br />the Kittitas County legislative authority that the Board of 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 11/1312017 <br />Regular Levy: $1.250.000 .00 <br />(State the total dollar amount to be Jevied) <br />Excess Levy: ~$O~.~O~O __________________ __ <br />(State the total dollar amount to be levied) <br />Refund Levy : $0.00 <br />(State the total dollar amount to be levied) <br />Signature : <br />(Date of Public Hearing) <br />To ask about the availability of this publication in an alternate fonnat 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) (2/21112)