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Reithltit@ LeW Certification <br />submit this document, or something similar, to the county leglslatlve <br />authority on or before November 3o of the year preceding the year in which <br />the levy arnounts are to be collected. <br />courtesy copy may be provided to the county assessor. <br />This form is not destgned for the certificafion of levies under Rcw g4.s2.070, <br />ln accordance with RCW 84.52 .070,1 (Nome), <br />(Title), far (District name), <br />do hereby certify to the (Name of county) County legislative authority <br />that the (Co m m issioners, Council,Board, etc.) of said district requests <br />that the following levy amounts be collected in (Yeor of callection) as2024 <br />Woshington Stotc <br />Form 64 0L00 <br />budget, which was adopted following a public hearing held on <br />r levies <br />Excess levies <br />11t21t2023 <br />provided in the district's <br />(Dote of public hearing). <br />*of other types may include EMS,ool district tra nsportation,or constructlon levies. <br />Examples of r amounts may include levy error correction or adjudicated refund amount. please incl ude <br />a ons. <br />Signature:Date: <br />To req <br />or call <br />uest ument in an alternate format, please the form dor.wa.Sov/AccessibilityReguest <br />James L. DeVere <br />the Town of South Cle Elum <br />Kittitas <br />Town Council <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />136,000.00 <br />Administrative refund amount <br />Non-voted bond debt amount <br />Other* <br />LevV Ceneral levy 0thcr lcvy* <br />Totalcertffied levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other* <br />General <br />lri,i; inr ':i.ttlril <br />11r::1rtlr j <br />ln rie hrrre nt <br />i:; lr'lol <br />r:l:il t ir:.i', Only)ruLrvyEonrlC;rir. pro.lcct <br />REV54OtgJ (8123/221 <br />Teletype (TW)users please dial 71 1, <br />et <br />Page 1 of I