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RDep,rlrn n1 of ~ evenue <br />Washington 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, \Jl;_J/J(}ft\ V Raj(!_ { 11 ___ ____,_____._.;..._ ____ ~---------- <br />(Name) <br />_______ S_e_cr_e_ta_ry~ ______ .for ___ K_itt_i_ta_s;._;;_..:...<>..:...u1_1'L...,_y_F_i_re---"CD--'i.::...st;_;#-'-4-'-----'' do hereby certify to <br />(District Name) (Title) <br />the Kittitas County legislative authority that the Commissioners --------------------------(Name of County) (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 12/04/18 <br />(Date of Public Hearing) <br />Regular Levy: $28,000.00 <br />(State the total dollar amount to be levied) <br />Excess Levy: <br />(State the total do1lar amount to be levied) <br />DEC 1 g ,, · <br />Refund Levy: <br />(State the total dollar amount to be levied) <br />Signature: Date: <br />To ask about the availability of this publication in an alternate format for the visually impaired, please call (360) 705- <br />6715. Teletype (TTY) users, please call (360) 705-6718. For tax assistance, call (360) 534-1400. <br />REV 64 0J00e (w) (2/21/12)