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Wttshington Stote Form 64 0100 Levy Certification Submit this document, or something similar, to the county leglslative authority on or before November 30 of the year preceding the year in which the levy amounts are to be collected. Courtesy copy may be provided to the county assessor. This form is not designed for the certification of levies under RCW B4.SZ.O7O. ln accordance with RCW 84.52.020, I of Commissioners Chairman iam Powers (Title), for lmie Pass Fire & Rescue (Name), (District name), do he that t certify to the and Kittitas (Name of county)County legislative authority (Commissioners, Council, Boord, etc.) of said district requestshe 2025that the following levy amounts be collected in (Year of collection) as provided in the district's budget, which was adopted following a public hearing held on Ltl0612024 (Date of public hearing), ar levies Excess levies *Examples of other levy types may incl ude EMS, school district transportation, or construction levies. Examples of other amounts may include levy error correction or adjudicated refund amount. please include a description ust t r" opti Signature:- 2-O To request or call 360- this docume in an alternate format,complete the form a, g o v I A c qesslbjilyBequCEt 705-6705.Teletype (TTY) users please Date: please dial 7'l 1 Commissioners Total certified levy request amount, which includes the amounts below. 1,400,000.00 Administrative refund amount Non-voted bond debt amount 86,539.00 Other* General levy Other levy*Ievy Totalcertified levy request amount, which includes the amounts below. tG3,7oz.w Fb $: $'qf,tog.stP t-,J Administrative refund amount Other* General {n/a for school d istricts) Enrichment {school districts only) Levy Bond Cap. project Other lev REv 64 0100 18123/22'l Page 1 of 1