Laserfiche WebLink
Reftffilt(e <br />Woshington State <br />Form 54 0X.00 <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 84.52.070, <br />Date: t / <br />NOl/ 22 ",''1 <br />ln accordance with RCW 94.52 .O2O,l James L DeVere (Nome), <br />Mayor ffitte),1or Town of South cle EIum (District name), <br />do hereby certify to the Kittitas (Name of county)County legislative authority <br />that the TownCouncil (Commissioners, Council, Board, etc.) of said district requests <br />that the following levy amounts be colleclg6 1n 2022 (Year of collection)as provided in the district's <br />budget, which was adopted following a public hearing held on LL/L6l2o2L (Date of pubtic heoring). <br />ular levies <br />Excess levies <br />*Examples of other levy types may include EMS, school district transportation, or construction levies. <br />Examples of her amounts may include levy error correction or adjudicated refund amount. Please include <br />a descripti <br />Signature: <br />u ob <br />,ro er" options <br />To req <br />or call <br />this document in an alternate format, please complete the form dor.wa.gov/AccessibilityRequest <br />360-7A5-6705.Teletype (TTY) users please dial 711 <br />Total certifi ed levy request <br />amount, which includes the <br />amounts below. <br />$ 130,000.00 <br />Administrative refund amou nt <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 />Administrative refund <br />amount <br />Other* <br />General <br />(n/a for school <br />d istricts) <br />Enrichment <br />(school <br />districts only) <br />Other levyxrBondCap. projectLevy <br />REV 64 0700 (8/27/2t)Page 1 of 1