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RS".?uh'iru <br />(@ <br />Woshrngton 5tote 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, Dale Scott Olander <br />(Name) <br />Treasurer Kittitas Counfy Publice Hospital <br />DistrictNo.2/EMS Lew <br />, do hereby certi$ tofor <br />the <br />(Titre) <br />Kittitas <br />(District Name) <br />County legislative authority that the Board of Commissioners <br />(Name of County)(Commissioners, Council, Board, etc.) <br />of said district requests that the following levy amounts be collected in 2021 as provided in the district,s <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on lr/09t20 <br />(Date of Public Hearing) <br />Regular Levy:$ 1.300.000.00 <br />(State the total dollar amount to be levied) <br />Excess Levy:00 <br />(State the total dollar amount to be levied) <br />Refund Levy $0-00 <br />(State the total dollar amount to be levied) <br />Signature: Du,Ao- -9."14 0f Date lo <br />To ask about the availability of this publication in an alternate format for the visually impaired, please call (360) 705-6715. <br />Teletype (TTY) users, please call (360) 705-67t8. For tax assisrance, cail (360) 534- 1400. <br />REV 64 0100e (w) (Z/2llt2)