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Rai.fftil(g <br />Wcishington Stote <br />Form 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 84.s2.070, <br />ln accordance with RCW B4,52.020, I <br />Finance Director <br />Jerica Pascoe (Name), <br />do hereby certify to the Kittitas County <br />that the Council <br />(Title), for City of Ellensburg (District name), <br />(Name of countylCounty legislative authority <br />(Commissioners, Council, Board, etc,) of said district requests <br />Date: <br />2AZ3that the following levy amounts be collected in (Year of collection)as provided in the district's <br />budget, which was adopted following a public hearing held on LLlA712A22 (Date of public hearing) <br />ular levies <br />Excess levies <br />*Examples of other levy types may incl ude 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 when using the ther" options, <br />Signature: <br />To request this document in an alternate format, plea <br />or call 36A-705-6705. Teletype (TTY) users please dial <br />se cornplete the form dor.wa.gov/Accessibi lityReq uest <br />711. <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />3,650,000.00 <br />Adm inistrative refund amou nt <br />Non-voted bond debt amount <br />Other* <br />General levy Other levy*Levy <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <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 />Cap. project <br />Other <br />BondLevy <br />REV 64 A]l,O $/23/22\Page 1 of 1