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Levy Certification Department of~ <br />Revenue~ <br />Washi ngton St ate <br />Form 640100 <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, 1 I James L Devere J (Name), <br />j Mayor j (Title), for j the Town of South Cle Elum l (District name), <br />do hereby certify to the I Kittitas I {Name of county) County legislative authority <br />that the I Town Council I (Commissioners, Council, Board, etc.) of said district requests <br />that the following levy amounts be collected in I lOZS I (Year of collection) as provided in the distri ct's <br />budget, which was adopted following a public hearing held on I 11/19/l024 J (Date of public hearing). <br />Regular levies <br />-- <br />Levy Gen eral levy Othe r levy* I <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 />--- <br />General <br />136,000.00 <br />levy (n/a t o r schoo l Bond <br />d i st 'icts ) ---· ·----- <br />Total certified levy ! <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other* <br />- <br />Enrichment <br />(sc hool Cap. project <br />d i str icts o nly) --· ------ <br />- <br />lliiiiil <br />---- <br />I <br />REV 64 0100 (8/23/22) Page 1 of 1