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Levy Certification <br />Submit this document, or something similar, to the county legislative <br />authority on or before November 30 of the year preceding the year in which <br />the levy amounts are to be collected. <br />Courtesy copy may be provided to the county assessor. <br />This form is not designed for the certification of levies under Rcw g4.52.070. <br />t in an alternate format,please complete the form dgf,wa"gavlAseesirblily,Bequesl36A-745-6705.Te <br />ReTtffilEf? <br />Washington State <br />Form 64 0100 <br />l!0t/ 2 3 .. <br />: |j <br />ln accordancerwith RCW 84'52 .OZO,l JAY MCGOWAN {Name),MAYoR ffitre),;sr crry oF cLE ELUM pistrict name), <br />do hereby certify to the KlrrlrAs fiame of county) County legislative authority <br />that the cLE E[uM clw couNcll $ommissioners, council, Board, etc.) al said district requests <br />that the following levy amounts be colleclq6 in 2022 {Yeor of collection) as provided in the district,s <br />budget, which was adopted following a public hearing held on Lol25l2a2t (Date of public hearing), <br />r levies <br />Excess levies <br />*Examples other levy types may include EMS,schooldistrict transportation, or construction leyies. <br />Exarnples of other amounts include levy error correction or adjudicated refund arnount. please include <br />a description usrng "other" options, <br />Signatu Date: <br />To req <br />or call <br />u <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$ gzs,ooo.oo <br />Administrative refund amount <br />Non-voted bond debt amount <br />Other* <br />Levy General levy Other levy* <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />l-i <br />Administrative refund <br />amount <br />Other* <br />General <br />(n/a for school <br />d istricts) <br />Enrichment <br />(school <br />districts only) <br />OtherBondCap. projectLevy <br />REV 64 AIOA {8/27la]-l <br />letype (TTY) users please dial711. <br />Page 1 of 1