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RSvuh"iH (? <br />Woshington Stote <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 84.52.020,1,Dale Scott Olander <br />(Name) <br />Kittitas County Public Hospital , do hereby certiff to <br />DistrictNo.2/M&O Levy <br />Treasurer <br />Levy Certification <br />(District Name) <br />County legislative authority that the Board of Commissioners <br />(Commissioners, Council, Board, etc.) <br />for <br />the <br />(Title) <br />Kittitas <br />(Name of County) <br />of said district requests that the following levy amounts be collected in z02l as provided in the district's <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on lt/49n0 <br />(Date of Public Hearing) <br />Regular Levy <br />Excess Levy <br />Refund Levy <br />I <br />(State the total dollar amount to be levied) <br />$0.00(stui@ <br />$0.00tstut.@ <br />D"A)-#C/^LSignature Date 'zaza <br />To ask about the availability of this publication in an altemate format for the visually impaired, please call (360) 705-67 t 5 <br />Teletype (TTY) users, please call (360) 705-6718. For tax assistance, call (360) 534-1400. <br />REV 64 0100e (w) (2121/12)