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RarufriliE@ <br />M/oshington 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 94.52.070. <br />ln accordance with RCW 84.52.020, I Brent Hals (Name), <br />Mayor [itre), tor city of Rosryn @istrict name), <br />do hereby certify to the Kittitas fiame of county) county legislative authority <br />that the City Council (Commissioners, cauncil, 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 1112912022 @ote of pubtic heoring). <br />levies <br />Excess levies <br />*Examples of other levy 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 />a description using e options. <br />Signature:Date: 1112912022 <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$ 242,177.42 <br />Administrative refund a mount <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 />$ 30,431.59 <br />Administrative refund <br />amount <br />Other* <br />General <br />{n/a tor schorrl <br />drstricts) <br />Enrichment <br />ischool <br />dr.strrcts only) <br />Other levy*ILevyBondCap. project <br />To request this document in an alternate format, p.legs*e complete the form dor.wa.gov/4ccessibllityRequeltor call 360-705-6705.Teletype (TTy) users pleasebiat Zt t. <br />REV 64 0100 (8/27/2Il pase r. of 1