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Rai6ff1i.'re Levy Certification Submit this document, or something similar, to the county legislative authority on or before November 30 of the year preceding the year in which the levy amounts are to be collected. Courtesy copy may be provided to the county assessor. This form is not designed for the certification of levies under RCW 84.52.070. Washington Stote Forrvl 64,#:3.0S ln accordance with RCW 94.52 .O2O,l John Sinclai, (Nome), Fire chief ffitle),;o, Kittitas county Fire District z lDistrict name), do hereby certify to the Kittitas (Nome of county)county legislative authority that the Board of Fire commissioners (commissioners, council, Board, etc,) of said district requests that the following levy amounts be collec1"6 ;n 2023 (Year of cotlection)as provided in the district's budget, which was adopted following a public hearing held on Lrlrcl2022 (Date of pubtic heoring). lar levies Excess levies *Examples of other I evy types may include EMS, school district transportation, or construction levies Examples of other amounts may i n de levy error correction or adjudicated refund amount. Please include a description when usin e"r"ons.e Signature:Date: l/- la * 2aZ7 To requ or call 3 5 705 document in an alternate format, p.lease complete the form dor.wa.govlAccessibilityRequest -6705.Teletype (TTY) users please dial 71 1. Total certified levy request amount, which includes the amounts below. S 8,ooo,ooo.oo Administrative refund a mou nt Non-voted bond debt amount Other* General levy Other levy*Levy Total certified levy request amount, which includes the amounts below. S 47o,ooo.oo l-J Administrative refund amount Othert General (nla for school districts) Enrichment (school districts only) Other Bond Cap. project * Levy REV 64 0L0O (8/27lzrj Page L of 1