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RAfrHilTcz <br />Woshington Stote <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 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 />ln accordance with RCW 84.52.020, I <br />Finance Director <br />lerica Pascoe (Name), <br />(Title), for City of Ellensburg (District name), <br />do hereby certify to the <br />that the Council <br />Kittitas (Name of county)County legislative authority <br />(Commissioners, Council, \oard, etc.) of said district requests <br />2025that the following levy amounts be collected in (Year of collection)as provided in the district's <br />Date: <br />please complete the form <br />dial 71 1. <br />budget, which was adopted following a public hearing held on tt11812024 (Date of public heoring) <br />lar levies <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 desc <br />Signat <br />To req <br />or call <br />REV 64 <br />np tio when using the r" options. <br />uest th ment in an alternate format,dor.wa.gov/Accessi bilitvRequest <br />360-7 O54V05. Teletype (TTY) users please <br />oToo (8/23/221 <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />s3,900,000.00 <br />Administrative refund amount <br />Non-voted bond debt amount <br />Other* <br />General levy Other levy*Levy <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />t-J <br />Administrative refund <br />amount <br />Other* <br />General <br />(n/a for school <br />d istricts) <br />Enrichment <br />(school <br />districts only) <br />Other <br />Bond Cap. proiectLevy <br />Page 1 of 1