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Rel?tffiliEr? <br />Washington Stote <br />Form 64 0100 <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 94.s2.070.l!0v 23 <br />ln accordance,with RCW 84,52 .A2O,l JAY MCGOWAN {Name),MAYoR {Titte),1o, crry oF c[E ELUM (District name], <br />do hereby certify to the KlrrlrAs @ome of caunty) County legislative authority <br />that the ctE ELUM clrY couNclt {commissioners, council, Board, etc.} af said district requests <br />that the following levy amounts be collecls6 1n 2022 ffear of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on L0l25l2o2t @atu of pubtic hearing). <br />ular levies <br />Excess levies <br />*Examples of other levy types may include EMS,I district transportation, or construction levies. <br />Exarnples of other amounts include levy error correction or adjudicated refund arnount. Please include <br />a description usrng "other" options, <br />Date: <br />To req <br />or call <br />REV 64 <br />in an alternate format, please com pIete the form dor.wp.gEvlAccff_r djtyFegllgsl36A-745-6705. Teletype (TTY) users please dial 7t t. <br />Total certified levy request <br />amount, which includes the <br />amounts helow. <br />$ 925,ooo.oo <br />Administrative refund a mount <br />Non-voted bond debt amount <br />Otherr <br />General levy Other levy*Levy <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other* <br />6eneral <br />(n/a for schciol <br />districts) <br />Enrichment <br />(school <br />districts only)ffLevyBondCap. project <br />0too (8/27llLl,Page 1 of 1