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Reff;ilt(e <br />Washington Stote <br />Fj*rm ffi4 S1$S <br />Levy Certification <br />Submit this document, or something similar, to the county legislative <br />authority on or before November 30 of the year p,receding 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 cerfification of levies under Rcw g4.s2.070. <br />ln accordance with RCW S4,S2.020, I Debbie Lee (Name), <br />clerurreasurer ffitte), for city of Kittitas (District nome), <br />do hereby certify to the Kittitas (Name of county)County legislative authority <br />that the city of Kittitas council (ommissioners, council, Board, etc.) of said district requests <br />that the following levy amounts be collected in 2023 (Year of collection)as provided in the district's <br />budget, which was adopted following a public hearing held on 1110812022 (Date of pubtic hearing). <br />Regular levies <br />Excess levies <br />*Examp es of other levy types may incl ude EMS, school district transportation, or construction lev <br />Examples of other amounts may include levy error correction or adjudicated refund amount. please include <br />a descri when usin the "er" options <br />Signature:Date <br />Total certified levy request <br />amount, which includes the <br />amounts below.198,000.00 <br />Administrative refr.in d amount 568.00 <br />Non-voted bond debt amount <br />Other* <br />Generallevy Other levy*Levy <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />r] <br />Administrative refund <br />amount <br />Other* <br />General <br />(n/a for school <br />districts) <br />Enrichment <br />(school <br />districts only) <br />Bond Cap. projectLevy <br />To reque-s_t this document in an alternate format, pLe?lq complete the form dor.wa.govlAccessibilityRequest <br />or call 360-705-6705. Teletype (TTy) users please htal Zt t . <br />REV 54 01,00 18/27 /2L) page 1 of 1