Laserfiche WebLink
Reffifffit@ <br />Woshington State <br />Forn'r 6q.0100 <br />NOV l8 i <br />Levy Certification <br />submit this document, or something simirar, to the county regisrativeauthority on or before November 3b of the year preceding the year in whichthe 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 revies under Rcw g4.52.070. <br />y/;::(;e w*h Rcw 84's2 o2o' I (Name), <br />do hereby certify to the K; ll;la.S <br />s h,,,tl1 l=. r. D;;{ | (Distict name), <br />ln <br />that the Bnartrl <br />{Nqme of county)County legislative authority <br />(Commissioners, Council, Board, etc.) ofsaid district requeststhat the following levy amounts be collected i aCI?a (Year of collection) as provided in the district,s <br />/rarV <br />(ritte),t( K i\l; <br />n <br />budget, which was adopted following a public hearing hel don It -17 - }0 ) I (Date of public hearins) <br />lar levies <br />Excess levies <br />*Exam ples of other levy may include EMS,school district transportation, or const ruction levies. <br />types <br />Examples of other amou nts may include levy eror correction o r adjudicated refund amount. please includea description en using the options. <br />Signature:Date: ll-17,^erll <br />To request this <br />or call 360-705 <br />inana Iternate format,please complete the form der,Wq.gevl'Acc.qUe$ir*gsggej:-67A5.Teletype <br />I certified levy request <br />amount, which includes the <br />Tota <br />amounts below <br />toq dE D4 <br />m inistrative refund amountAd <br />Non-voted bond debt amount <br />Other* <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />L-J <br />Administrative refund <br />amount <br />Other* <br />REV64 OTOO (8/27/2Ll <br />(rw)users please dial71 I <br />Page L of 1