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REvuriri t@ <br />Woshington Stote <br />Levy Certification <br />(District Namc) <br />County legislative authority that the . Board of Fire Commissioners <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,John Sinclair <br />(Name) <br />Fire Chief for Kiftitas Countv Fire Protection Dist 2 do hereby certifo to <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 tut9t20 <br />(Date of Public Hearing)a <br />the <br />(Title) <br />Kittitas <br />Regular Levy:$5^500.766.33 <br />(State the total dollar amount to be levied) <br />00 <br />(State thc total dollar amount to bc tcvied) <br />t.lOV 1g <br />Excess Levy: <br />'i.':1- -. <br />:.,i1,, , i ' <br />Refund Lcvy $766.33 <br />(State the total dollar amount to be levied) <br />Signature:Date: ll/19120 <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 (w) (2l2tlr2)