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RDepartni ent of ~ evenue ~ <br />Washington State <br />Levy Certification <br />RECEIVED <br />q ,· ri O 2019 L1-t ,.,, U ~ <br />AIKE . OUGARDY <br />KITTITAS COL/HY ASSESSOR <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 to be collected and forward a copy to the assessor. <br />In accordance with RCW 84 .52 .020, I, _C.,;....._hr_is_H_el~g._es_o_n _____________ _ <br />(Name) <br />Fire Chief for _______ ....;;_.;;_.;_.c..=-. _____ ~ ___ F_ir_e_D_is_tr_i_ct_#_3_-_E..;;.a"""s'-'-toc;..n ___ ., do hereby certify to <br />(Title) (District Name) <br />the Kittitas County County legislative authority that the Commissioners _______ ___._____ -----'----------- <br />(Name of County) (Commissioners, Council, Board, etc .) <br />of said district requests that the following levy amounts be collected in 2020 /as provided in the district 's <br />budget, which was adopted following a public hearing held on <br />Regular Levy: $76.322.34 I <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 amoW1t to be levied) <br />(Year of Collection) <br />12/06/19 / <br />(Date of Public Hearing) <br />Date: 12/06/19 <br />To ask about the a,·ailability of tllis publication in an alternate format for the \isually impaired, please call (360) 705-6 715. <br />Teletype (TTY) users, please call (360) 705-6718. For tax assistance, call (360) 534-1400 . <br />REV 64 0!00e (w) (2·21/12)