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Raiiiffti:;@ <br />Woshington Stote <br />Form 64 0100 <br />To request this document in an alternate format, please <br />or call 360-705-6705.Teletype (TTY) users please dial71 <br />REV 64 OI.OO (8/27/2rl <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 />Date:l\ /lal uratt <br />coln pl ete the form dor.wa govlAccessi bi I ityRequ est <br />1. <br />Page 1 of 1 <br />tn accordance with RCW 84.52 .O2O, tBrent Hals NoV 3 0 <br />(Name), <br />Mayor ffiile), for, cltY of Roslyn ,, r.. (District nome), <br />do hereby certify to the Kittitas : i; '',r' lrlorii'i| ci;ounty)County legislative authority <br />that the City Council (Commissioners, Council, Board, etc.) of said district requests <br />that the following levy amounts be collecls6 in 2022 (Year of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on Ll"l0gl202r' @ate of public hearing). <br />ar 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 descripti <br />Signature: <br />on hen using r" options <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$ 239,0(l0.oo <br />Ad ministrative refund amount <br />Non-voted bond debt amount <br />Other* <br />General levy Other levy*Levy <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />$ 30,649.77 <br />L-J <br />Administrative refund <br />amount <br />Other* <br />General <br />(n/a for school <br />d i stricts) <br />Enrichment <br />(school <br />districts only) <br />Other <br />Bond Cap. projectLevy