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Rffrufr,il8(E <br />Woshington State <br />Submif this document to the county legislative authority on or before November 30 of the year preceding <br />the year in which fhe levy arnounts are to be collected and forward a copy to the assessor. <br />In accordance with RCW 84.52.020,1, 6!r&.non f Brrg,\'!t]Of <br />(Name) <br />P\,p..V <br />Levy Certification <br />for lC.{,f,r \etSCq:,rnrlLt Cr4fttptn do hereby certifu to <br />0 on lrn\q5')sQgrS <br />(Commissioners, Counoil, Boad etc,) <br />?b\\ as provided in the district's <br />(Title) <br />the u -. \.!-.County legislativc authority that the <br />(Nane of Corurty) <br />of said district requests that the following levy amounts be collected in <br />Refund Levy <br />fYear of Colhltion) <br />budget, which was adopted following a public hearing held on r \- \q -50 <br />(Date olhrblic !learing) <br />Regular Levy <br />(State the total amounl to be levied) <br />Excess Levy: <br />(State the total dollar amount to be levied)|lNV 3i <br />',"t <br />(State the total dollar amount to be levied) <br />Signature;Date: \t-lq"&t1\ <br />To ask about the availability of this publication in an alternatc format for the visually impaired, please call (360) 705-6715 <br />Teletype (TTY) users, please call (36q7A5-6718. Fortax assistance, call (360) 534-1400. <br />REV 64 0lOoe (wl (2/21/12)