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R8iluhii {g <br />Woshington Stote <br />RtrCNIVHN <br />{,_i. $i}*tf} <br />r r ni{r5 u, <br />fu?1,".f ,1? {,, u <br />Submit this document to the county legislative authority on or before November 30 of the year preceding <br />the year in which the levy amounts are to be collected and forward a copy to the assessor. <br />In accordance with RCW 84.52.020, I,Clra( lofl'- Ga.zqles <br />(Name) <br />for Kittitas Countv Fire Dist #4 . do hereby certi$r tof <br />Levy Certification <br />@istrictName) <br />County legislative authority that the Commissionersthe <br />(Title) <br />Kittitas <br />iName of County) <br />of said district requests that the following levy amounts be collected in <br />{Commissioners, Council. Board, etc.) <br />2021 as provided in the district's <br />(Yeal of Collection) <br />Date:t/- l7-zo <br />budget, which was adopted following a puhlic hearing held on I : I 7- )O <br />(Date of Public Hearing) <br />Regular Levy:s Ob <br />(State the total dollar amount to be levied) <br />Excess Levy <br />(State the fotal dollar amount to be levied) <br />Refund Levy: <br />(State the total dollar arnount to be levied) <br />Signahre: <br />To ask about the availabilify of this publication in an alternate format for the visually impaired, please call (360) 705-6715. <br />Tefetype (TTY) users, please call (360)70s-6718. For rax assistance, call (360) s:i-r+oo. <br />REV 64 0100e (w) (2/21/12)