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R&ufriH (e <br />Woshington Stote Levy Certification <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,Dale Scott Olander <br />(Name) <br />Treasurer , for Kiftitas County Publice Hospital , do hereby certiff to <br />District No.2/EMS Levv <br />the <br />(Title) <br />Kittitas <br />(District Name) <br />County legislative authorify that the Board of Comm <br />budget, which was adopted following a public hearing held on <br />(Name of Counfy)(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 />1il09t20 : <br />(Date of Public Hearing) <br />Regular Levy $1.300-000 00 <br />(State the totrl dollar amount to be levied) <br />Excess Levy s0.00 <br />(State the totrl dollar amount to be levied) <br />Refund Levy $0.00 <br />(State the totsl dollar amount to be levied) <br />Signature:'t)^A A"l4 0r t | rc/ z*zeaDate <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) uscrs, please call (360) ?05-6? I 8. For rax assistance, call (360) 534- l4-00. <br />REV 64 0100e (w) (2/2llr2)