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Ra*filt@ Woshrngton Stote Farm 64 $i.S0 Levy Certification Submit this document, or something similat to the county legislative authority on or before November 30 of the year preceding the year in which the levy amounts are to be collected. Courtesy copy may be provided to the county. assessor. This form is not designed for the certification of levies under RCW 84.52.070. ll0l, J0 ,ril:il ln accordance with RCW 94.52 .02A, I Chris Helgeson (Name), Fire chief (Titte), tor Ki$i!,ll pountv Firq Difrict t llistrict name), do hereby certify to the Kittitas '' i':iil'ji';r'r twatdid'b!''dtluntylcounty legislative authority that the Commissioners (Commissioners, Council, Board, etc.) of said district requests that the following tevy amounts be collecls6in 2422 (Year of collectian) as provided in the district's budget, which was adopted following a public hearing held on 11-08-2021 Pote of public hearing). lar levies Excess levies *Examples of other levy types may include EMS, school district transportation, or construction levies. Examples of other amounts may'include levy error correction or adjudicated refund amount. Please include a descripti on "other" options. Signature:Date: I l-;8 -Joa t To request this document in an alternate format, please complete the form do-r.wa.govlAccessibilityRequest or call 360-7A5-6705. Teletype (TTY) users please dial 71 1. REV 64 01AA lS/27l2tl Page 1of 1 Total certified levy request amount, which includes the amounts below. $ 209,990.00 Administrative refund amount Non-voted bond debt amount Other* General levy Other levy+Levy Totalcertified levy request amount, which includes the amounts below. Administrative refund amount Other* General lnla f or school districts) Enrichment (school districts only) Other levy*I€ap. projectBondLevy