Laserfiche WebLink
R[.ffi;lii@ 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.s2. oza,t CA"f lrrl" GnZ"l"S (Name), <br />%rvuii1ioi.u' (ritte),ror f<i/d'{* F-vc frfr,& +r1 pistrictname), <br />do hereby certify to the ftf #*aS ftame of county)County legislative authority <br />that the CaVX"n\Stt'One;i (Commissioners, Council, Boord, etc.) of said district requests <br />that the following levy amounts be collected in ?OZ5 ffeor of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on tt rt, /Zf @ate of public hearing)' <br />; descripti <br />--Signature:Date: I <br />Woshington Stote <br />brm 64 0100 <br />To uest this document <br />lar levies <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />Administrative refund amount <br />Excess levies <br />Examples of other evy types may include EMS, scho ol district transportation, or construction levies <br />Examples of other amounts may include levy error correction or adjudicated refund amount. Please include <br />on when usin the "other" options. <br />an alternate format, please complete the form ds$rua@ <br />or 360-705-6705.Teletype (fiY) users please dial 711. <br />req <br />call <br />to,ooo <br />e <br />eNon-voted bond debt amount <br />IOther* <br />Other levy*Levy General levy <br />-JlvA <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount MX <br />MAOther* <br />General <br />ln/a f or school <br />districts) <br />Enrichment <br />(school <br />districts only) <br />Other <br />Cap. projectBondLevy <br />REV 64 OrAo 18/27/2Il Page 1 of L