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Rafiifflit@ 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 84.52.070. <br />Washington Stote <br />Form 54 0100 <br />ln accordance with RCW 94.52 .OZO,l Tracey Epenesa (Name), <br />Clerk ffitle),1or Kittitas County Cemetery Dist 1 @istrict name), <br />do hereby certify to the Kittitas (Name of county) County legislative authority <br />that the Commissioners (Commissioners, Council, Board, etc.) of said district requests <br />that the following levy amounts be collecls6 1n 2022 (Year of coltection) as provided in the district's <br />budget, which was adopted following a public hearing held on L210912021 @ote of public hearing). <br />ular levies <br />Excess levies <br />*Examples 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 w en using the "other" options <br />Signature:Date: Ll-J1'-el <br />To request this document in an alternate format, please complete the form dor.wa.gov/AccessibilityRequest <br />or call 360-705-6705. Teletype (TTY) users please dial 71 1. <br />REV 64 0Lo0 (8/27/2t) Page 1 of 1 <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />s17000.00 <br />Administrative refund amount s10.8e <br />Non-voted bond debt amount I)UY J U <br />Other* <br />General levy Other levy*Levy <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />L-l <br />Administrative refund <br />amount <br />Other* <br />General <br />(nla f or school <br />d i stri cts ) <br />Enrichment <br />(school <br />districts only) <br />Other I <br />Levy Bond Cap. project <br />*