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Levy Certification <br />subrnit this document, or something similar, to the county legislative <br />authority on or before November 30 of the year preceding the year in whlch <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 />Nov 7l <br />.ln accordance with Rcw 84.52.020, I Debble Lee (Nome),cldlk/Treasurer ffitre),1sp citiy of Klttitas pistrict name), <br />do hereby certify to the Klttltas fiame of county)county legislative authority <br />that the city of Kitthas council $ommissioners, council, Boord, etc.) ofsaid district requests <br />that the following levy amounts be collecls6 ln 2022 ffear of collection) as provided in the district,s <br />budget, which was adopted following a public hearing held on ll'12312o21, {Dote of public hearing). <br />lar levies <br />Excess levies <br />mples er levy types may include E MS, school district transportation, or construction levies. <br />Examples of other amounts may include levy error correction or adjudicated refund amount. please include <br />a descri the er" options. <br />Signature:Date:1[-13-2t <br />Re'"ffi{e <br />Washington Store <br />Form 64 0100 <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$ tSg,ooo.oo <br />Administrative refund amount <br />Non-voted bond debt amount <br />Other* <br />Levy General levy Other levy* <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />l-J <br />Administrative refund <br />amount <br />Other* <br />Ge nera I <br />(n/a for school <br />d ist rr cts ) <br />Enrichment <br />(sch ool <br />clistricts only) <br />Other IIevyBond <br />i( <br />Cap. project <br />To request thls document in an alternate folmat, F.legry complete the form dor:.wa.gov/AccessibilityRequestor call 36A-7os-O705. Tetetype (TTy) users pteaii liiiTi i. <br />REV640'.00 lglzzlatl pagetofl