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Raiilh:li'Jg <br />M/oshington 5tore <br />Fermr 6l$ SL00 <br />Levy Certification <br />Submit this document, or somethlng similar, to the county legislative <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 may be provided to the county assessor. <br />This form is not designed for the certification of levies under RCW 84.52.070. <br />Date: <br />tn accordance with Rcw 84.s2.020, I 'lkhg SiUe-, (Nome), <br />Secre\or.. I , , ffitte),ror Kj,\gr{as fu:r:nt,F're biet.+f- pistrict nome), <br />I <br />do hereby certify to the K |+i*AS (Name of county)county tegislative authority <br />that the CAfnfnlgsltsnQfg {Commissioners, Council, Board, etc.) ofsaid district requests <br />that the following levy amounts be collected in Z{}23 ffear of cotlection) as provided in the district's <br />budget, which was adopted following a public hearing held on tl $ lf"iZtZZ (Date of pubtic hearing). <br />lar levies <br />Excess levies <br />*Examples of other levy types may include EMS, school district transportation, or construction levies <br />Examples of other amounts may include levy error correction or adjudicated refund amount. Please include <br />a descri <br />Signatu <br />hen using "other" options <br />re: <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />sr{ffi, <br />Administrafive refund amount <br />Non-voted bond debt amount <br />Other* <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />L-l <br />Administrative refund <br />amount <br />Other* <br />General <br />{n/a for schoo,l <br />districts) <br />Emichment <br />(school' <br />di'stricts only) <br />Bo,ndLevy Cap. project <br />To request this document in an alternate format, please complete the form glgr.rrya.Eov/Accessibililyggqu€jfar rall ?6O-7lt\-67O5 Telefvnp fTTY) u<.rrq nk'a<o -diel 71'l