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Ra*ffil're 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 />Washington Stote <br />Form 64 0100 <br />ln accordance with RCW g4.52.020, I TraceyEpenesa (Name), <br />clerk ffiile),16p Kittitas county cemetery Dist 1 pistrict nome), <br />do hereby certify to the Kittitas (Name of county) County legislative authority <br />that the commissioners pommissioners, Council, Boord, etc.) of said district requests <br />that the following levy amounts be collecls6 ;n 2022 (Year of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on L2l09l2o2l @ote 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 other amounts may include levy error correction or adjudicated refund amount. Please include <br />a description w en using the 'bther" options. <br />Signature:Date: <br />To request this document in an alternate format, please complete the form dol.wa.govlAccessibilityRequest <br />or call 36A-705-6705. Teletype (TTY) users please dial 71 1. <br />REV 64 0Lo0 (8/27/2Ll Page 1 of 1 <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$17000.00 <br />"l I <br />Administrative refu nd amount sx0.8e <br />ltAl r <br />Non-voted bond debt amount lluv J u <br />Otherx <br />General levy Other levy*Levy <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />l-J <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 le <br />Bond Cap. projectLevy