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RaTeffltt@ <br />Washingtan State <br />Form 64 0100 <br />Levy Certification <br />submit this document, or something similar, to the county legislative <br />authority on or before November 30 of the year precedirtg 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 g4.52.070. <br />n an alternate format,please complete the form d o r'.we. govi Ascess-ib i I i tl8 eq u es! <br />ln accordance with Rcw 84.52.020, I william Powers (Name), <br />chairman of the Board ffitle),;s; King and Kittitas counties Fire District sl (District name), <br />do hereby certify to the Kingand Kittitas Name of county) county legislative authority <br />that the Fire commissioners (commissianers, cauncil, gaard, etc.) afsaid district requests <br />that the following levy amounts be colleclg6 ;n 2023 {Year of coltection) as provided in the district,s <br />budget, which was adopted following a public hearing held on tllag/2azz (Date of public hearing). <br />lar levies <br />Excess levies <br />*Examples of oth er levy types may include EMS, s chool district transp ortation, or construction levies <br />Examples of other amounts m include levy error correction or adjudicated refund amount. please inclu dea description ust th r" <br />Signature Date: <br />To request this docu <br />or call 360-705-6205 <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$ Tso,ooo.oo <br />Administrative refund amou nt <br />Non-voted bond debt amount $ gz,goo.oo <br />Other* <br />General levy Other levy*Levy <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />$ s9,t13.50 <br />leona FKA#8 lb <br />$ 41,s92.50 <br />Administrative refund <br />amaunt <br />0ther* <br />General <br />{rr/a for school <br />d istricts) <br />Enrichment <br />(school <br />districts onlyi <br />Bond Cap. projectLevy Other lev *( <br />REV 64 ATOA gl27l2U <br />. Teletype (TrV1 users please dial 71 1. <br />Page 1 of 1