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RATJfiIIi@ <br />Woshrngton Stote <br />Form 64 0100 <br />Levy Certification <br />Submit this document, or something similar, to the county lcgislative <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 />Iim laGrange (Nome),ln accordance with RCW 84.52.020, I <br />do hereby certify to the <br />Kittitas School District <br />Board of Directors <br />this <br />(Title), for (District nome), <br />(Name af county) County legislative authority <br />(Cammissioners, Cauncil, Board, etc.) of said district requests <br />Date: irlrr irrltq <br />format, please complete the form dor.wa.gov/AccessibilityRequest <br />that the <br />1025that the following levy amounts be collected in (Year of collection)as provided in the district's <br />budget, which was adopted following a public hearing held on .uzol2024 (Dote of public heoring). <br />ar 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 i ude levy error correction or adjudicated refund amount. Please include <br />a description r" options <br />Signature: <br />To request <br />or call 360- <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 />General levy Other levy*Levy <br />t,87r.,15?,67 4t3,908.77Totalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />866,011.23 <br />30,691.23 67,125.67 t3,907.77Administrative refund <br />amount <br />Other* Corrcction 50,841.00 <br />General <br />(n/a tor school <br />d istricts) <br />Enrichment <br />(school <br />districts only)ffBondLevyCap. project <br />REV 64 070A $123122l. <br />usi <br />e <br />etype users please dial 711. <br />Page 1 of 1