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Levy Certification <br />Submit this document, or something similar, to the county tegislative <br />authority on or before November 3O 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 />ln accordance with Rcw 84.s2.020, I qb/t t#- G <br />Woshington Stote <br />Form 64 CI100 <br />a descripti <br />Signature: <br />on when usi "other" <br />Sq.,r^*-"t <br />do hereby.urti/y to the a idp,rd ki{fi'tod <br />(ritte),f", k-/fi44 <br />(Name), <br />Frrc*f (District name), <br />(Name of tyl County legislative authority <br />that the C.avnnrurs8,r t rtr,r5 (Commissioners, Council, Boord, efc./ of said district requests <br />that the followin6levy amounts be collected in TiZJ ffear of coJtection) as provided in the district's <br />budget, which was adopted fotlowing a public hearing held on ,r&r/U- @ate of public hearing). <br />lar levies <br />Excess levies <br />*Examples of other 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 />s <br />daret tl-30 -ea- <br />Total certified levy request <br />amounb which includes the <br />amounts below- <br />/)a 44 O2l// I <br />?0 <br />Administrative refund amount <br />Non-voted bond debt amount <br />Other* <br />Levy General levy Other levy* <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other+ <br />Gelrcral <br />(n/a for school <br />districts) <br />Enrichment <br />(school <br />districts only) <br />Other t <br />Levy Bond <br />* <br />Cap. project <br />To reglesJ!ry: qglyment in an alternate format pJe?$ complete the forrn dqr.Wagpv/AccessibilityRegqestorcali36o.7o5.6705.Teletype(TTY}usersplease'oialztt.T <br />REV 64 AL$O l8l27l21l pase 1 of 1