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RDepartmen t of (~ evenue ~ <br />'Wash ington State <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, Elizabeth All goo,d -----~~-------------- <br />Treasurer , for <br />(Name) <br />Kittj tas County Pu bli c Hospital <br />Di s trict No. 2/EMS Levy <br />(District Name) <br />, do hereby certify to <br />the <br />(Title) <br />Kittitas <br />(Name of County) <br />County legislative authority that the Board of Co mm issi0ne rs <br />(Commissioners, Council, Board, etc.) <br />of said district requests that the following levy amounts be collected in 2019 as provided in the district's <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on 11/05/2018 <br />(Date of Public Hearing) <br />Regular Levy ; $1 300 000.00 <br />(State the total dollar amount to be levied) <br />Excess Levy: $0.00 <br />(State the total dollar amount to be levied) <br />Refund Levy: $0.00 <br />(State the total dollar amount to be levied) <br />~ SJ 1-. nil-~ <br />Signature: ~ ~ <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 0I00e (w) (2/21/12)