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Ra,0"fiilt@ <br />Woshlngton Stote <br />Form 54 0100 <br />Levy Certification <br />Submit this document, or something similat to the Gounty 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 <br />Mayor <br />Adams (Name), <br />(Title), for <br />Kittitas <br />of Roslyn (District name), <br />do hereby certify to the <br />Council <br />(Name of county) County legislative authority <br />(Commissioners, Council, Boord, etc.) of said district requeststhat the <br />2025that the following levy amounts be collected in (Year of collection) as <br />uest <br />budget, which was adopted following a public hearing held on <br />provided in the district's <br />(Date of public hearing). <br />ar levies <br />Excess levies <br />*Examples of other levy types may include EMS, sc hool distr ict transportation, or construction levies. <br />Examples of oth mounts may include levy error correction or adjudicated refund amount. Please include <br />a description "other" options. <br />Signature Date: <br />To req <br />or call <br />in an alternate format, please form dor.wa.gov/AccessibilitvRequest <br />705. Teletype (TTY) users please dial 71 I . <br />500,000.00Total certified levy request <br />amount, which includes the <br />amounts below. <br />Administrative refund amount <br />Non-voted bond debt amount <br />Other* <br />Other levy*General levyLevy <br />l-l <br />31,715.00Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other* <br />General <br />(nla for school <br />d i st ri cts) <br />Enrichment <br />( schoo I <br />districts only) <br />Cap. projectBondLevy <br />Other lev <br />REV 54 OLOO (8123/22l,Page 1 of 1