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Raffiffii E@ <br />Woshington State <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, <br />(Name) <br />0lra .r V-for <br />Levy Certification <br />!Cr\'V. \qsCorcn\ Ccnael€[S hereby certiff to <br />@istrict Name) l6i6\^r\,C* tt!\ <br />County legislative authority thatthe 0 Ofurnn\SS\SOAf S <br />(Title) <br />the U -. \,\-r\n r <br />(Nanre of County)(Commissioners, Council, Board, etc.) <br />of said district requests that the following levy amounts be collected in 2bt\ as provided in the district's <br />(Year of <br />budget, which was adopted following a public hearing held on t\'\Q -.ro <br />(Date of Public Hearing) <br />Regular Levy:15, [aOO . CtO <br />(State the total dollar amount to be levied) <br />Excess Levy <br />(State the total dollar amount to be levied)NOV 3r <br />Refund Levy:ii.;'i,-.." <br />.., '..ilr' , i(State the total dollar amount to be levied) <br />Signature:Date t !' 19,:dolr: <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) 705-6718. For tax assistance, call (360) 534-1400- <br />REV 64 0100e (wlQn1/t2)