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-,.,,, <br />DEC -2 ?010 <br />Levy .Certification <br />I <br />Submit this document to the county legislative authority on or before November 30 of the year preceding the <br />year in which the levy amounts are t.o be collected and forward a copy to the assessor. <br />In accordance with RCW 84.52.020, I, <br />(Name) <br />(Title) (District Name) <br />the K; }}:}v.s _ County legislative authority that the <br />(Name of County) (Commissioners, Council, Board, etc.) <br />of said district requests that the following levy amounts be collected in <br />(Year of Collection) <br />budget, which was adopted following a. public hearing held on <br />(Date of Public Hearing) <br />Regular Levy: <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: <br />n --..,.,I <br />(7 D c,-J _ as provided in the district's <br />Date: /}-;;k,-l(j <br />To ask about the availability of this publication in an alternate format for the visually impaired, please call <br />(360) 70.5-6715. Teletype (TIY) users, please call (360) 705-6718. For tax assistance, call (360) 534- <br />1400. <br />REV 64 0l00e (w) (2/21112) <br />RECEIVED <br />NOV 2 5 20'19 <br />KmNA1i tui~ts1~fsoR