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Rai*filit@ <br />Washington State <br />Fornn 64 010CI <br />Levy Certification <br />Submit this document, or something similat 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 84.52.070. <br />(Nome), <br />(District name), <br />ln accordance with RCW 84.52.020, I Jerica Pascoe <br />Finance Director (Title), for City of Ellensburg <br />do hereby certify to the <br />that the <br />Kittitas <br />Council <br />(Name af county)County legislative authority <br />(Commissioners, Council, Board, etc.) of said district requests <br />p I ease com plete the form dor.wa.govlAccessi bil ityReq uest <br />dial 71 1. <br />Page 1 of 1 <br />that the following levy amounts be collected in 2024 (Year of collection)as provided in the district's <br />budget, which was adopted following a public hearing held on 1112012023 (Date of public hearing). <br />lar levies <br />Excess levies <br />*Exampl es 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 descri n usrng the "other" o ptions, <br />Signat Date: <br />To requ <br />or call 3 <br />est ocument in an alternate format, <br />60-705-6705. Teletype (TTY) users please <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$3,800,000.00 <br />Administrative refund amount <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 />L-J <br />Administrative refund <br />amount <br />0therx <br />General <br />(rr/a for school <br />districts) <br />Enrichment <br />(school <br />districts only) <br />Other <br />Cap. projectBondLevy <br />REV 64 0100 (8/23/22)