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ln accordance with RCW 84.52.020, I (Nome),
<br />(Title), tor (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 ffi (Year of collection)as provided in the district's
<br />budget, which was adopted following a public hearing held on ffi (Date of public hearing).
<br />lar levies
<br />Excess levies
<br />*Examples of other levy types may include EMS,school district transportation, or construction levies-
<br />Total certified levy request
<br />amount, which includes the
<br />amounts below.
<br />j.:!i:-,,'li,-;.-, 1.,':' ... ,'-!tlil'ir.: ji.- ..:"':'- . .. ,
<br />Adm inistrative refund a mount
<br />Non-voted bond debt amount
<br />Other*
<br />Other levy*Levy General levy
<br />ffir$ft\i.'::._ :
<br />,:. r:..i-ri',-;r:,r- !:::,.:: t.:. :
<br />il:. -a . .. ; -. " r..,' .:. ..
<br />Total certified levy
<br />request amount,
<br />which includes the
<br />amounts below.
<br />bfi:it'i'rj'i.j:. .,..1''i .;^:r':..-!,:::." IAdministrative refund
<br />amount
<br />l:!;t'A-?-":;i ' jr l
<br />it.i ..f-" -::,:;r,., :,. . ,,
<br />;.,,.1-"i,i,-:, .l.i:: ..r: ',
<br />l r, j:rt ') ii,,.i .;I.- -rr,j:t-,..)l
<br />!i.....':,',7,-'ii I 'l:.I :','.r..''i.'1,.:-..r.. r 'ffi #.* ]$fOther*
<br />General
<br />(n/a for school
<br />d i stri cts)
<br />Enrichment
<br />(school
<br />districts only)mW*.Cap. projectBondLevy
<br />Examples amounts may include levy erro r correction or adjudicated refund amount. Please include
<br />a descri
<br />REV 64 oLOo (8/23122)
<br />her"
<br />Date:
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