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RDepartm e nt 0f ~ evenue ,.,:::: <br />Washington State <br />Levy Certification NOV 22 ";)11 <br />Submit this document to the county legislative authority on or before November 30 ofthe 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.:.,:Ii=:za=.:b:.::e..:.:th.:.,;A:..:.:.:llQ,go;:;,;o::..:d=--___________ _ <br />Treasurer , for <br />(Title) <br />(Name) <br />Kittitas County Public Hospital <br />District No.1 <br />(District Name) <br />, do hereby certify to <br />the ____ --=-K~i~tt~it:::a:::..s _____ County legislative authority that the Board of Commissioners <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 10/26/17 <br />(Date of Public Hearing) <br />Regular Levy : $25 ,000.00 <br />(State the total dollar amount to be levied) <br />Excess Levy: $1,42 6,13 7 .50· <br />(State the total dollar amount to be levied) <br />Refund Levy: $0.00 <br />(State the total dollar amount to be levied) <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 0100e (w) (2/21112)