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Woslungton Srcte <br />{fi5n.- <br />Levy Certification <br />Submit this document to the county legislalive authorify on or before November 30 of the year preceding <br />the year in which the lery amounts are to be collected and fonvard a copy to the assessor. <br />In accordance with RCW 84.52.020,1,James L. DeVere <br />Mayor for <br />(Name) <br />Torvn os South Cle Elum <br />budget, which was adopted following a public hearing held on <br />. do hereby cenify to <br />(1'itlc)(District Namc) <br />the *- * Kittitas County legislative authoriry that the Town Council <br />(Narnc of County) (Commissioners. Council, Board. ctc.) <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 />tt/t7/24 : <br />(Datc of Public l-loaring) <br />Regular [,evy;s 127.000.00 <br />(Statc thc total dollar amount to be lcvicd) <br />Excess [,evy:l{OV 24 <br />(State thc total dollar amount to be levicd) <br />Refund Levy <br />(Stalc thc total dollar amount to be lcvied) <br />Signature:Date: 1l/17 20 <br />To ask aboutthe availability of this publication in an ahemate format forthe visually impaired. please call (360) 705-67 l5 <br />Teletype (TTY) users, please call (360) 705-67 I 8. For tax assistance. call (360) 534- I 400. <br />REV 64 0 I 00e (t) (2t2ttl2l