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:. <br />ln accordance with RCW 84.52'020, I <br />do hereby certify to the <br />that the <br />(Name of county)County legislative authority <br />(Commissioners, Council, Board, etc.) of said district requests <br />(Name), <br />(Title), for (District name), <br />that the following levy amounts be collected in ffi ffear of cotlection)as provided in the district's <br />budget, which was adopted following a public hearing held on (Dote of public hearing). <br />lar levies <br />Excess levies <br />*Examples of other levy types may include EMS, schoo I district transportation, or construction levies. <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />Admi nistrative refund amount <br />#$S"ff#W,,.i "''' j'-'l'l'.:" ' 'Non-voted bond debt amount <br />Other* <br />General levy Other levy*Levy <br />l *-irffiTotalcertified levy <br />request amount, <br />which includes the <br />amounts below. <br />il;.*;ii': ., "...:'," '; <br />$#Administrative refund <br />amount <br />L:"r:[a .'-1 ':]::: ' j -. " <br />':-i:1- ":2...-:)\-; :.-; ir: . "r^.1:.t:,",. r " .1' <br />,-r:.r-''l!:,:rL-]. - ..1i',. ::,.&$.'i.'f *ffi "iqi <br />t$:!f,AtA , ,Ja! i{ ;ij;-.jiplt{qf,i <br />ffiffi#?*b-ffiOther* <br />General <br />(n/a for school <br />disiricts) <br />Enrichment <br />(school <br />d istricts only)ffiffiCap. projectBondLevy <br />Examples amounts may include levy eror correction or adjudicated refund amount. Please include <br />ade <br />Signatu <br />REV 64 otoo (8/23/221 <br />her" <br />Date: <br />Page L of 1