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R.iruffilt@ 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. Woshington Stote Form 64 0100 ln accordance with RCW 94.52 .OZO, a Tracey Epenesa (Name), Clerk ffiile),1ey KittitasCountycemeteryDist#l pistrict nome), do hereby certify to the Kittitas fiame of county) County legislative authority that the Commissioners (Commissioners, Council, Boord, etc.) of said district requests that the following levy amounts be colleclg6 1n 2023 ffeor of cottection) as provided in the district's budget, which was adopted following a public hearing held on Lllt0l2022 poft of pubtic heoring). lar levies Excess levies *Examples of other levy types may in de EMS, school district transportation, or construction levies Examples of other amounts may include levy error correction or adjudicated refund amount. Please include a description en using the "other" o ptions Signature:Date: I t- to - a* Total certified levy request amount, which includes the amounts below. s 17,000.00 Administrative refu nd a mount S o.or Non-voted bond debt amount Other* General levy Other levy*Levy Total certified levy request amount, which includes the amounts below. L-.J Administrative refund amount Other* General (nla f or school d ist ri cts ) En rich ment (school d istricts on ly) Other lev Levy Bond Cap. project To reques-t this document in an alternate format, please complete the form dor.wa.gov/AccessibilityRequest or call 360-705-6705.Teletype (TTY) users please dial 7t t. REV64ot0o (8/27l2Ll pagelofl