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Raiufftit€z <br />Woshington Stote <br />Form 64 0100 <br />NO\/ 7.4 <br />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 34.52.070. <br />ln accordance with'RCW 84.52.02A,1 Jerica Pascoe (Name), <br />Finance Director ffiile),1o, city of Eilensburc pistrict nome), <br />do hereby certify to the Kittitas county (Name of county) County legislative authority <br />that the council (Commissioners, Council, Boord, etc.) of said district requests <br />that the following levy amounts be colleclsi in 2022 (Year of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on tVoVza2t (Date of pubtic hearing). <br />ular levies <br />Excess levies <br />*Exampl es 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 descripti using the her" options. <br />Signatu Date: L I <br />To re ts d o r.wa.g ovlAccessi b il ityRequestq <br />ll <br />uest th <br />36A-705-6705. Teletype (TTY) users please <br />document in an alternate format,please complete the form <br />0r ca <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$ 3,600,000.00 <br />Administrative refund amount <br />Non-voted bond debt amount <br />Other* <br />General levy Other levy*Ievy <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />$ t7s,ooo.oo <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 />Other I <br />Bond Cap. projectLevy <br />REV 54 OLoO (8/27lzLl <br />dial 71 1, <br />Page 1 of 1