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RafffffiE@ <br />Washington Stote <br />Ferre 6r$ SlCICI <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 tevies under RCW 84.52.070. <br />that the C{)fnfnlgslgn9re {commissioners, cauncil, Eoard, etc.} ofsaid district requests <br />that the following levy amounts be collected in 2D23 ftear of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on tl ltUlZryZ @ate of pubtic hearins). <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 descripti <br />Signature: <br />"other" options. <br />To request this document in an alternate for_mat, please complete the form dor.wa.gov/Aceessiloilityfteques!call ?6O-7fi\-67n\ Tplpfrrne {TTY) r r<Arq nlee<c-diel 711 <br />ln accordance with Rcw 84.s2.020, I lkhg- Cn\Ue-(Name), <br />do hereby ce <br />(ritte), for $;\\{as Cnin\y F're- b;At.+L (District nome), <br />to the K\++i{as (Name of caunty)county legislative authority <br />o en using <br />Date: <br />Total certified levy request <br />amount, which includes the <br />amounts below <br />$ qro,UJ)'DD <br />Administrative refund amount <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 />Lr--l <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 />Cap. projectBondLevy <br />frr