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Raffifriliil@ <br />Woshington Stote <br />Form 64 01.CI0 <br />DIC -3 <br />Levy Certification <br />Submit this document, or something sirnilar, to the county legislative <br />authority on or before l{ovember 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 assessot. <br />This form is not designed for the certification of levies under RCW g4.5?.070. <br />.1 ): ,,ajj!.,, -, <br />ln accordance with RCW 84.52,020, I Lhar loth- Qo"r zalas, (Nome), <br />S**re**.tJ ffitle),1o, KiltitascountyFireOistrict#4 pistrict nome), <br />do hereby certify to the lfittitas (Name of county)County legislative authority <br />that the Commissioners (commissioners, council, Baard,etc.) of said district requests <br />that the following levy amounts be collected in 2022 $eor af collectionl as provided in the district,s <br />budget, which was adopted following a public hearing held on l2 - | - 2 | (Dote of public heoring). <br />ar levies <br />Excess levies <br />*Examples of other I eW types may include EMS, school district transportation, or construction levies. <br />Examples of other amounts may include levy error correstion or adjudicated refund amount. please include <br />a description when using r"a ptions <br />sig Date:lL-A-L I <br />To regqe_s^t this document in an alternate format, please complete the form ctor,wa,gp-vlAe.gs_Ssjbilityne$l_est <br />or call 350-705{705. Teletype (TTY} users please dial Zt t. <br />REV64ota0 l8l27l2Ll pagelofl <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$ 41,000.00 <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 />t <br />Admlnistrative refund <br />amount <br />Other* <br />General <br />{n/a for school <br />di stri cts) <br />Enrichment <br />(scl-rool <br />districts onlyi <br />Other <br />Bond Cap. projectLevv