Laserfiche WebLink
Ra**ffit@ <br />Washtngton State <br />hol"nn 64 r$:|CI$ <br />Levy Certification <br />Submit this document, or something similar, to the county legislative <br />authority on or before November l0 of the year preceding th" 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 g4.52"070. <br />ln accordance with Rcw 84.s2.020, I chris Helgeson (Name), <br />Fire chief ffitte), for Kiftitas county Fire Diskict #3 (District name), <br />do hereby certify to the Kittitas (Name of countylcounty legislative authority <br />that the commisioners $ommissioners, council, Board, etc.l of said district requests <br />that the following levy amounts be collected in 2a23 ffear of collectian/ as provided in the district,s <br />budget, which was adopted following a public hearing held on 1111412022 (Date of public hearing). <br />ular levies <br />Excess levies <br />@ Cmsd <br />h&ftrshoo$ffil hd ftffiM@ffi@d[d]@ffiec fo}fikxffisnP <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other* <br />*Examples of other I evy types may include EMS, school district tra nsportation, or construction levies. <br />Examples of other amounts may include levy error correction or adjudicated refund amount. please include <br />a description hen u g he "other"options <br />Date 11t29t2122 <br />@ @@ @h,tf <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />210,000 <br />Administrative refund amount <br />Non-voted bond debt amount <br />Other* <br />To request this document in an alternate format, p]."?lq complete the form dsruya.gg,ylAc(bstibilityRequestor call 360-705-6705. Teletype (TTy) users please bial Z.t t - '- ".-- <br />REV 64 A1!A $/27 lztl page L of t