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Re'"ffilt@ 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 84.52.070. <br />Date: tlllD lUzt <br />Woshington Stote <br />ln accordance with RCW 94.S2.O20,I Eryn A Micallef (Nome), <br />District Secretary Fiile),1or Kittitas County Fire Protection District No.7 pistrict name), <br />do hereby certify to the Kittitas (Name of county) County tegislative authority <br />that the commissioners $ommissioners, Council, Boord, etc.) of said district requests <br />that the following levy amounts be colleclgd ;n 2022 (Year of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on LVtol20zt @aft of pubtic hearing). <br />lar levies <br />Excess levies <br />*Examples of other levy types may include EMS, school district transportation, or construction levies <br />Examples of amounts may include levy error correction or adjudicated refund amount. Please include <br />a descripti gr" o <br />Signature: <br />To request this <br />or call 360-705 <br />ument in a ternate <br />-6705.Teletype (TTY) users please <br />please complete the form clor.wa.covrAceessi hi I itirRea uest <br />dial 71 1. <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$ 3,25o,ooo.oo <br />Administrative refund a mount <br />Non-voted bond debt amount <br />Other* <br />Levy General levy Other levyx <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other* <br />General <br />(nla for school <br />d istricts) <br />Enrichment <br />(school <br />districts only) <br />Other levy*IBondCap. projectLevy <br />REV 64 Or00 (8/27/27)Page 1 of 1