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RATTHIiiJ@ <br />Woshington 5cote <br />f;::*ir lrirl 6,li *,.ri"Lltilt <br />Levy Certification <br />Submit this document, or something similat 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.A7A. <br />ln accordance with RCW 94.52.020, I Chris Helgeson (Nome), <br />Fire chief (Titte), f or Kittitas county Fire District #3 (District name), <br />do hereby certify to the Kittitas (Name of county) County legislative authority <br />that the commisioners (Commissioners, Council, Board, efc.l of said district requests <br />that the following levy amounts be collected in ?A23 (Year of callectionl as provided in the district's <br />budget, which was adopted following a public hearing held on 1111412022 pak of public hearing). <br />ular levies <br />Excess levies <br />*Examples of other levy types rnay 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 description he "other" options <br />11t29t2022Date: <br />To request this document in an alternate format, please complete the form de1.wa.gq1v-4l&Xrbd:ty$eggesl <br />or call 350-7A5-6705. Teletype (TTY) users please dial 71 1. <br />REV 64 O]fA $127 /2Ll Page 1 of L <br />@ Cmdfisry ffiffiW <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />210,000 <br />Admin istrative refund amount <br />Non-voted bond debt amount <br />Other* <br />w Mffi&ffidMdMM) <br />Fffi HnffidffiEM@d*@Smilnffi <br />e{h.uf*uP <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other*