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Reildfftit@ levy Certification <br />Submit this document, or something similar, to the county leglslative <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 rnay be provided to the county assessor, <br />This form is not designed for the certification of levies under RCW 84.52.070, <br />705.Teletype (TTY) users please <br />please complete the form dor.wa.gov/Accessibil8yRequest <br />dial711, <br />Page 1 of 1 <br />Woshlngeon Secte <br />Form 64 0100 <br />or ca <br />ln accordance with RCW 94,52 .A2A, I James L DeVere (Name), <br />Mayor ffi*e),6s'- TheTown of South Cle Elum (District name), <br />do hereby certify to the Kittitas (Name af caunty) County legislative authority <br />that the Town councll (Commissioners, Councii, Baard, etc.) af said district requests <br />that the following levy amounts be collec1"6 in 2023 {Year of collection}as provided in the district's <br />budget, which was adopted following a public hearing held on LUL5|2A22 (Aate of public hearing). <br />lar levies <br />Excess levies <br />*Examples of other levy types may include EMS, school district transportation, ar construction levies. <br />Examples of er amounts may include levy error correction or adjudicated refund amount. Please include <br />a descriptio hen g "othg o <br />Signature:Date: , t <br />To g document in an alternate format, <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$ 134000.00 <br />Adrn in istrative refund amount <br />Non-voted bond debt amount <br />Other* <br />Levy General levy Other levy* <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below' <br />L- <br />Administrative refund <br />amount <br />Other* <br />General <br />(n/.r lor rchool <br />dr:tnt t-.,) <br />Enrichment <br />{i,,-hool <br />drst ri11., unly) <br />Other <br />Eond Cap. projectLevy <br />REV 54 ATOA $/27/271