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RffiilIiT@ Levy Certification <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 />Woshington 5tore <br />Form 64 0100 <br />do hereby certify to the <br />ris M. Scaccoln accordance with RCW 84.52.02O,1 <br />ate Superintendent for Dlstrict Op (Title), for ah School District <br />(Name), <br />(District name), <br />ma and Kittitas Counties (Name of county)County legislative authority <br />{Commissioners, Council, Board, etc.) of said district requeststhat the School Board <br />that the following levy amounts be collected in <br />To request this <br />or call 360-705 <br />cument in an alternate format, <br />-6705.Teletype (TTY) users please <br />(Year of collection)as provided in the district'st025 <br />budget, which was adopted following a public hearing held on 7125124 (Date of public hearing). <br />lar levies <br />Excess levies <br />*Examples of other levy types may include EMS, schoo I district transpo rtation, or construction levies. <br />Examples of other amo may include levy error correction or adjudicated refund amount. Please include <br />a description w h u the "other" o ptions. <br />Date: I I ls 7Signature: <br />please complete the form dor.wa.gov/AccessibilitvRequest <br />dial 71 1. <br />Page 1 of 1 <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />Ad ministrative refund amount <br />Non-voted bond debt amount <br />Other* <br />6eneral levy Other levy*Levy <br />L-l <br />4,075,000.00 5,352,292.O0Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrafive refund <br />amount <br />Other* <br />General <br />(nla f or school <br />d istricts) <br />Enrichment <br />(school <br />districts only) <br />Other <br />Cap. projectBond <br />rf <br />Levy <br />REV 64 AL00 18/23/22l,