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RaiEhlliI(e <br />Woshjngton Stote <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 />Form 64 0100 <br />This form is not designed for the certification of levieTtg{36}$g 84.s2.070. <br />' "': i :; 7jr;1.,t <br />ln accordance with RcW 84.52.020, I ErynA. Micailef 0!d#!i;';,;.,.,:,-,.:,r <br />District Secretary ffiile),go,. Kittitas County Fire Districr No. 7 f Oi"riinti;r"1, <br />do hereby certify to the Kittitas county (Name of county) county legislative authority <br />that the Board of commissioners $ommissiitners, cot)ncil, Boord, etc.) of said district reguests <br />that the following levy amounts be collecls6 ;n 2023 (Year of collection) as provided in the district,s <br />budget, which was adopted following a public hearing held on 1U912022 pote of public hearing). <br />lar levies <br />Excess levies <br />* Examples of other levy types may incl ude EMS, school district transportation, or construction levies <br />Examples r amounts may i ude levy error correction or adjudicated refund amount. please include <br />a descri <br />Signature: <br />To <br />or <br />Iternate t,p <br />Date: <br />lease com plete the form dor.wa.gov/Accessi bi lityRequest <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />S s,soo,ooo.oo <br />Admi nistrative refund amount <br />Non-voted bond debt amount <br />Other* <br />Levy General levy Other levy* <br />Totalcertified 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 school <br />d istricts) <br />Enrichment <br />{school <br />districts only) <br />OtherLevyBondCap. project <br />REV 64 OLOO (8/27/2Ll <br />ffrY)users please d ial711. <br />Page 1 of 1