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Rai?uiiud @ <br />Washingtan State <br />Levy Certification <br />Submit this doeument to the county lqislafive authority on or before November 30 of the year precedingthe year in which the levy amounts are to be collected u"no fotrur"o <br />" copy to the assessor. <br />ln accordance with RCW 84.52.A20,1,Sclrrnidt <br />(Narne) <br />Chief <br />(Title) <br />for . Kittitas Coun8 Fire pistrict I , <io hereby certify to <br />(DisrrictName) <br />the . , Kittilas - County legislative authority that the Board of CommissionersfNameofCorrnty) @ <br />of said district requests that the followi:rg levy amounts be collected in 2a'J as provided in the dis*ict,s <br />(Yearof Collection) <br />budget, which was adopted following a public hearing held on <br />(Date of Public Hearing) <br />Regular Levy:$300,000.00 <br />Excess Levy: <br />Refund Levy: <br />Signature: <br />(State the tot&l dollar amount to be levied) <br />(Stat€the total dollar amount to be levied) <br />(State the totrl dollar amount to be levicd) <br />NOV 75 <br />4a{- <br />! i:r ! ....-.---- '$L <br />1,-i L {.. .. " .,!t Date: 11124120 <br />To.askabtrt,theavailabilifyofthispublicationinanalternatoformatforthevisuallyimpaired,pleasecall (360)7os-67t5.Teletype (TTY) users, prease calr (360) 7as-6719. For fax assistance, call (360) sli-r+aa. <br />REV 64 0100e (w) (2l2tlt2)