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Refrfffit@ 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 qert!fication of levies under RCW 84.52.070. <br />Woshington Stote <br />Form 64 SL00 <br />ll0v 3 0 /i]?l <br />ln accordance with RCW 94.52.020, I Chris Helgeson (Name), <br />Fire chief ffitte), for Ki$$3t.9.puntv Fire Di?:li.t t |District name), <br />do hereby certify to the Kittitas i(lij[]i';i'i (Node"b!"countySCounty legislative authority <br />that the Commissioners (Cammissioners, Council, Board, etc.)of said district requests <br />that the following levy amounts be collecls6 ;p 2022 (Year of collection)as provided in the district's <br />budget, which was adopted following a public hearing held on 11-08'2021 Qote af public hearing). <br />r levies <br />Excess levies <br />rExamples of other levy types may include EMS, school district transportation, or construction levies. <br />Examples of other amounts may'include levy error correction or adjudicated refund amount. Please include <br />a description he "other"options. <br />Signature:oaterM <br />To request this document in an alternate format, please complete the form dor.wa.g.ovlAccessibilityReque.st <br />or cali 36A-705-6705.Teletype (TTY) users please dial711. <br />REV 64 ALOA (Sl27l2!t Page 1 of 1 <br />s 209,990.00Total certified levy request <br />amount, which includes the <br />amounts below. <br />Administrative refund a mount <br />Non-voted bond debt amount <br />Other* <br />General levy Other levy*Levy <br />t-.,l <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other* <br />General <br />(n/a for school <br />districtsi <br />Enrichment <br />ischool <br />districts only) <br />Other <br />Bond Cap. projectLevy