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R~;;;;~~(~ <br />Washington State <br />Form 64 0100 <br />Le vy Ce rtifi ca tion <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 />In accordance with RCW 84.52.020, I !Katie Olive j (Name), <br />loistrict Secretary I (Title), for !Kittitas County Fire District #1 I (District name), <br />do hereby certify to the I Kittitas County I (Name of county) County legislative authority <br />that the !commissioners I (Commissioners1 Council, Board1 etc.) of said district requests <br />that the following levy amounts be collected in !202s I (Year of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on 110/23/2024 I (Date of public hearing). <br />Regul ar levies <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />Administrative refund amount <br />Non-voted bond debt amount <br />Other* <br />Excess levies <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other* <br />682,000.00 <br />11,971.46 <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 descri ption when usi n the "other" options. <br />Signature: _,__._.......,::;....;;;;;--=~~~;:::::-=-----Date: ....1:...1..l 1-:Z=-~~--L---1 ~ <br />To request this document in an alternate format, please complete the form dor.wa.qov/ AccessibilityRequest <br />or call 360-705-6705. Teletype (TTY) users please dial 711.