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RafrffilE(e <br />Woshngtan Staie <br />Forrn 64 0100 <br />Levy Certification <br />submit this document, or something 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 g4.52.070. <br />ln accordance with Rcw 84.52 .azo,l william Powers (Name), <br />chairrnan of the Eoard ffitle),;or King and Kittitas counties Fire District 51 (District nome), <br />do hereby certify to the King and Kittitas (Name af countylcounty legislative authority <br />that the Fire commissioners ftommissioners, cauncil, Baard, etc.) of said district requests <br />that the following levy amounts be collecls6 ;p 2023 {Year of cotlection)as provided in the district,s <br />budget, which was adopted following a public hearing held on ltlCI9l2a22 (Dote of pubtic hearing). <br />lar levies <br />Excess levies <br />*Exarnples of other I evy types may include FMS <br />Examples of other amounts m include levy er <br />a description ust th r" optio <br />Signature <br />To feq <br />call <br />uest tl'lis <br />360-705-6705,or <br />an alternate form at, please com p I ete t h e fo r m .d_o-r,vg4.g o v/ A cge s s i b i I i t y fi e q u.qs t <br />, school district tran <br />ror correction or adj <br />Date: <br />sportation, or construction levies. <br />udicated refund amount. please include <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$ z5o,ooo.oo <br />Administrative refund amount <br />Non-voted bond debt amount $ gl,seo.oo <br />Other* <br />Levy 6enerallevy Other levy* <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below <br />$ sg,ru.so <br />lsona FKA#a I <br />- <br />$ 41,532.50 <br />Administrative refund <br />amount <br />Other* <br />General <br />(n/a for school <br />d istricts) <br />Enrichment <br />(school <br />districts only) <br />Other IBondCap. project <br />*Levy <br />REV 64 AfiO g127l2r) <br />Teletype (TTY)users please dial 71 1. <br />Page 1 of 1