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Rairuniii E@ <br />Woshington Stote <br />Levy Certification <br />Submit thls document to the county legislativc authorlfy on or before November 30 of the year prccedlng <br />the year ln which the levy smounts are to be collected and forvard I copy to the assessor. <br />In accordance with RCW 84.52.020,1,Christonher Helaeson <br />(Name) <br />Fire Chief for Kittitas Counfw Fire District #3 . do hereby certiff to <br />the <br />(Titte) <br />Kittitas Countv <br />(District Name) <br />County legislative authority that the _ CoFmissioner * <br />(Commissioners, Council, Board, etc.)(Name of County) <br />of said district requ€sts that the following levy amounts be collected in 2t2l as provided in the district's <br />(Year of Collection) <br />budget, which was adopted following a public hearing held on I <br />(Date of Public Hearing) <br />Regular Levy:.50 <br />(State the total dollar rmount to be levied) <br />Excess Levy: $0.00 <br />(State the total dollnr amount to be levied) <br />s*\l ?4 <br />Refund Levy;$o.oo t/ <br />(Slate the total dollar amount to be levied) <br />'fY5'5{L <br />Signature:-oate: "t i. 0 3 -J oao <br />To nsk about the availability of this publication in an alternate format for the visually impaired, please call (360) 705-6715, <br />Teletype(TTY)users,pleasecall(360)705-6718. Fortaxassistance,call(360)534-1400. <br />REv 64 0100e (w) (Uzlll2t