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DEPARTMENT <br />OF REVENUE 2 9 <br />WASiWWWON SWE Levy Certification <br />Submit this document to the county legislative authority on or before November 30 of the year precedingtheyearinwhichthelevyamountsaretobecollectedandforwardacopytotheassessor. <br />In accordance with RCW 84.52.020,I,Debbie L.Lee , <br />(Name) <br />Clerk/Treasurer ,for City of Kittitas ,do hereby certify to(Title)(District Name) <br />the Kittitas County legislative authority that the City Council <br />(Name of County)(Commissioners,Council,Board,etc.) <br />of said district requests that the following levy amounts be collected in 2018 as provided in the district's <br />(Year of Collection) <br />budget,which was adopted following a public hearing held on 11/28/17 : <br />(Dute of Public Hearing) <br />Regular Levy:$180,000,00 <br />(State the total dollar amount to be levied) <br />Excess Levy: <br />(State the total dolinr amount to be levied) <br />Signature:Date:I 1/28/2017 <br />For tax assistance,visit hup://dor.wa.nov or call 1-800-647-7706.To inquire about the availability of this document in analternateformatforthevisuallyimpaired,please call (360)705-6715.Teletype (TTY)users may call 1-800-451-7985. <br />REV 64 0 i00c (w)(10/26/05)