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R8veffti E@ <br />Washington Stote <br />W f\ rn t ndt6l p <br />Q t.,ptttL(-(-ol <br />Levy Certification <br />Submit this document to the county legislative arthority on or before November 30 of the year preceding <br />the ycar in which the levy amounts arC to be collected ahd forward e copy to the assessor. <br />In accordance with RCW 84.52.020,1,Sarah <br />(Name) <br />for CiW of Roslvn , do hereby certifu to <br />(Title)(District Name) <br />County legislative authority that thethe <br />(Name of County) <br />of said district requests that the following levy amounts be collected in <br />Council <br />(Commissioners, Council, Board, ctc.) <br />2U2l _ as provided in the district's <br />(Year of Collection) <br />Ni\l 3,' <br />budget, which was adopted following a public hearing herd on lll24l202o : <br />(Date of Public Hearing) <br />Regular Levy <br />(State thc total dollar amount to bc lcvied) <br />Excess Levy: <br />(Statc thc totsl dollar amount to be levicd) <br />Refund Levy: <br />(State the total dollar amount to bc lcvied)r,t"lr:,i .. <br />S <br />To ask about the availability of this publication in an altemate format for the visually impaired. please call (J60) 705-67 15. <br />Teletype (TTY) users, please call Q60D7a5-6i18. For tax assistance, call (360) s:,i-t+tio. <br />REV 64 0100e (w) (U2l/12)