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Department of <br />Revenue t- <br />Washington State <br />Form 64 0100 <br />Levy Certification <br />Submit this document, or something similar, to the county legislative <br />authority on or before November 30 of the year prececRiFil� &ie1i,n Mich <br />the levy amounts are to be collected. OJARD O COf.s;"` <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 Jeannine Lavande 1, (Name), <br />;Secretary -Financial Mgr. (Title), for Kittitas Co. Fire Protection District 6 (District name), <br />do hereby certify to the Kittitas (Name of county) County legislative authority <br />that the Board of Fire Commissioners (Commissioners, Council, Board, etc.) of said district requests <br />that the following levy amounts be collected in 2025 (Year of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on 11/12/2024 (Date of public hearing). <br />Regular levies <br />Levy <br />General levy <br />Otherlevy* <br />Total certified levy request <br />1,000,000.00 <br />amount, which includes the <br />amounts below. <br />Administrative refund amount <br />1,487.02 <br />Non -voted bond debt amount <br />0.00 <br />Other* <br />0.00 <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 description hen using the 'o er" options. <br />Signature: AIL, A-r>-�- , V �crn Date: I I /(a/,) <br />To reques t is document in an alternate format, please complete the form dor.wa.gov/AccessibilityRequest <br />or call 360- 05-6705. Teletype (TTY) users please dial 711. <br />REV 64 0100 (8/23/22) Page 1 of 1 <br />