RES 2023-210 - Laserfiche WebLink

Home Browse Search

Raiilfftit€a Woshlngton State Form 54 0100 ln accordance with RCW 84.52.020, I Chief Financial Officer Levy Certification Submit this document, or something similar; to the county legislative authority on or before November 30 of the year preceding the year in which the levy amounts are to be collected. Courtesy copy may be provided to the county assessor. This form is not designed for the certification of levies under RCW 94.52.07CI. lason Adler (Name), (Title), for Kittitas County Public Hospital Dist. No. 1 (District name), do hereby certify to the that the Kittitas Board of Commissioners (Name of county)County legislative authority (Commissioners, Council, Board, etc.) of said district requests 2424that the following levy amounts be collected in (Year of collection) as provided in the district's budget, which was adopted following a public hearing held on LOl26l2023 (Date of public hearing). r levies Excess levies *Examples of other levy types may include EMS, school district transportation, or construction levies Examples of other amounts may include levy error correction or adjudicated refund amount. Please include a desription wh si options. este; 10/2612023Signature: To request or call 360- this in an alternate format, please com plete the form dor.wa.gov/Accessi bi I ityReq uest 705-6705. Teletype (TTY) users please dial 71 1. Total certified levy request amount, which includes the amounts below. 20,000.00 Administrative refund amount Non-voted bond debt amount Other* General levy Other levy*Levy Totalcertified levy request amount, which includes the amounts below. L-J Administrative refund amount Other* General (n/a for school districts) Enrichment (school districts only) Other I Cap. projectBondLevy REV54 0L0O (8/23/221 Page 1 of 1