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Re"ffifitii@ <br />Woshington Stote <br />Form 64 0100 <br />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 lrear 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 />ons <br />ln accordance with Rcw 84.52.020, I Tracey Finch @ame), <br />clerk ffitle), for Kittitas county cemetery Dist#1 (District name), <br />do hereby certify to the Kittitas fiame of county) County legislative authority <br />that the Commissioners (Commissioners, Council, Board, etc.) of said district requests <br />that the following levy amounts be collected in 2025 ffear of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on Nov'14' 2024 paft of pubtic heoring). <br />ular levies <br />Excess levies <br />*Examples of other levy types may include EMS, school district transportation, or co nstruction levies <br />Examples of other amounts may include levy error correction or adjudicated refund amount. Please include <br />a description en using the gr" o <br />ll-/L/- 2YSignature:Date: <br />To request this document in an alternate format, please complete the <br />or call 360-705-6705. Teletype (TTY) users please dial 71 1. <br />form dor.wa.gov/Accessibil ityReq uest <br />Total certified levy request <br />amount, which includes the <br />amounts below. <br />$18,000.00 <br />Ad ministrative refund amount <br />Non-voted bond debt amount <br />Other* <br />General levy Other levy*Levy <br />L-,,l <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below, <br />Administrative refund <br />amount <br />Other* <br />General <br />(nla f or school <br />d i stri cts) <br />Enrichment <br />{school <br />districts only) <br />Other I <br />Cap. projectBond <br />* <br />Levy <br />REV 64 OtOo (8/27/2!l Page 1 of 1