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Reffilitii@ <br />Woshington 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 84.52.070. <br />ln accordance with RCW 94.52.020, I John Sinclair (Name), <br />Fire chief ffiile),1or Kiftitas county Fire District z lDistrict name), <br />do hereby certify to the Kittitas (Name of county)County legislative authority <br />that the Board of Fire commissioners $ommissioners, council, Board, etc.) of said district requests <br />that the following levy amounts be collecls6 i6 2024 (ear of cottection) as provided in the district's <br />budget, which was adopted following a public hearing held on tUo9l2o23 (Date of public hearing). <br />lar levies <br />Excess levies <br />*Examples of other levy y incl ude EMS, school district transportation, or construction levies <br />Examp les of other amo ay include levy error correction or adjudicated refund amount. Please include <br />a description er" options <br />p <br />Signature: <br />To d <br />or ca <br />o"r", //'-?-27 <br />ocument in an alternate format, p.lease complete the form dor.wa.gov/AccessibilityRequest <br />705. Teletype (TTY) users please dial 71 t. <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />s &200,000.00 <br />Administrative refund amount 57,034.52 <br />Non-voted bond debt amount <br />Other* <br />General levy Other levy*Levy <br />Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />$ 47s,ooo.oo <br />L-J <br />Administrative refund <br />amount <br />s 2,365.00 <br />Other* <br />General <br />(nla for school <br />d i stri cts) <br />Enrichment <br />(school <br />districts only) <br />Other I <br />Bond Cap. projectLevy <br />REV 64 100 (8/27/21)Page 1 of 1