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Raidffi,i{@ <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 />Date: ll-1-gZ <br />Wcshington Stote <br />Fcrrn 64 CIX0CI <br />ln accordance with RCW 84.52 .OZA,l Tracey Finch (Name),clerk <br />ffitle), for Kittitas county cemetery Dist #1 pistrict name), <br />do hereby certify to the Kittitas fiame of county) County legislative authority <br />that the commissioners ftommissioners, Council, Boord, etc.) of said district requests <br />that the following levy amounts be collected in 2a24 ftear of collection)as provided in the district's <br />budget, which was adopted following a public hearing held on Nov 9, 2023 @atu of pubtic hearing). <br />lar levies <br />Excess levies <br />*Examples 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 descripti <br />Signature: <br />on n usrng "other" options <br />To requqsl this document in an alternate format, please complete the form dor.wa.gov/AccessibilityRequest <br />or call 360-705-6705. Teletype (TTY) users please dial 71 1. <br />REV 64 otOo (8127/2Ll page 1 of 1 <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$18,000.00 <br />Administrative refund amount <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 />L-J <br />Administrative refund <br />amount <br />Other* <br />General <br />(nla f or school <br />d istricts) <br />Enrichment <br />(school <br />districts only) <br />Other I <br />Levy Bond Cap. project <br />*