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Reiilffli're <br />Wasl'ungton State <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 g4.s2.070. <br />ln accordance with Rcw 84.52.020, I william Powers (Name), 4 ichairman of the Board ffitre),tor snoqualmie pass Fire & Resscue fi,'ur,n name), <br />do hereby certify to the King and Kittitas (Name of county) county legislative authority <br />that the Fire commissioners {commissioners, council, Board, etc.) ofsaid district reguests <br />that the following levy amounts be collected in 2024 ffear of coilection)as provided in the district,s <br />budget, which was adopted following a public hearing held on 11/A8/2A23 (Date of pubtp hearing). <br />ular levies <br />Excess levies <br />*Examples of ot her levy types may include EMS, school district transportation, or co nstruction levies.Examples of other amounts may include levy error correction or adjudicated refund amount. please includea description when using t ,rot <br />s.ert' o <br />Signature:Date: <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$1,200,000.00 <br />Administrative refund amount <br />Non-voted bond debt amount $87,119 <br />Other* <br />General levy Other levy*Levy <br />Totalcertified levy <br />reguest amount, <br />which includes the <br />amounts below. <br />FD 51: <br />$64,044.00 <br />FD8: <br />$41,336.50 <br />L-J <br />Administrative refund <br />amount <br />Other* <br />General <br />{rr/a for school <br />districts) <br />€nrichment <br />(sclrool <br />districts only) <br />tevy Cap. project <br />*OtherBond <br />To request this document in an alternate format, p.legse complete the form dqtwa,gsylAggesiibilj-tyfieq_uestor call 360-70s-6705. Tetetype (TTy) users pteaie ii;t ;1 i. "'' <br />REV 64 }TAA $127 /ztt Page 1 of 1