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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 RCH,E€.[?1pE$ <br />iluv lv 2023 <br />Woshington State <br />Form 54 0100 <br />ln accordance with RCW 84.52.020, I (Name), <br />il:KF r"'iCi:G,lFDY <br />ii;riiAS c a ufiry .1.is iss lR-l <br />(Title), for (District name), <br />do hereby certify to the (Name of county)County legislative authority <br />that the (Commissioners, Council, Board, etc.) of said district requests <br />that the following levy amounts be collected in ,2,ta4 (Year of collection)as provided in the district's <br />budget, which was adopted following a public hearing held on (Date of public hearing). <br />lar levies <br />Excess levies <br />*Examples of other levy typ es may includ e EMS, school district transportation, or construction levies. <br />Examples er amounts may include levy error correction or adjudicated refund amount. please include <br />a descri <br />Signature: <br />To request <br />or call360- <br />u options <br />ment ana format, <br />705-6705. Teletype Fry) <br />Date: <br />pLe? se co m p I ete the form do r,wa.E ovlA{ee.Uihr!:tf8egle5t <br />dial 71 1. <br />Page 1 of 1 <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />*Q1-a41 ,Ab{. qq <br />Administrative refund amount <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 />Administrative refund <br />amount <br />Other* <br />General <br />(n/a for school <br />d istricts ) <br />Enrichment <br />(school <br />districts on ly)ffiBondCap. projecttevy <br />REV 64 0!oO (8/23/221 <br />users please