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Ra'*ffilt@ <br />Woshington Stote <br />Fors'* 64 S3.** <br />LeW 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 Olive (Nome), <br />(District name), <br />(Name of county) County legislative authority <br />(Commissioners, Council, Baard, etc.) of said district requests <br />(Title),for <br />do hereby certify to the Kittitas County <br />Commissioners <br />Fire District #1 <br />that the <br />2025that the following levy amounts be collected in (Yeor af callectionJ as provided in the district's <br />budget, which was adopted following a public hearing held on tolztl2oz4 (Date of public hearing) <br />ar levies <br />Excess levies <br />*Examples of types may i EMS, school district transportation, or construction levies. <br />Examples of other amounts may include levy error correction or adjudicated refund amount. Please include <br />ad when usi the'bther" options <br />Signature:Date:L <br />To requestthis document in an alternate format, please complete the form dor,r.q'a.coylAcEessibilityFe-Eue-st <br />or call 360-705-6705.Teletype {TTY) users please dial 71 1. <br />ITTTE <br />Total cedified levy request <br />amount, which includes the <br />amounts below. <br />682,$10.00 <br />Administrative refund amount tt97t.46 <br />Non-voted bond debt amount <br />Other* <br />L-J <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other*