HomeMy WebLinkAboutFire District 1Department of
R&enue
Washington state
Levy Certification
Submit this document to the county legislative authority on or before November 30 of the year preceding
the year in which the levy amounts are to be collected and forward a copy to the assessor.
Qt'�n� �
In accordance with RCW 84.52.020 I J 1^ f✓ �^ 1�1
L1 (Name)
`Q- C k' e � , for 0 � �HS �+�1n.�, � �� c C Nd l'i't f I do hereby certify to
(Title) (Distric Name)
the K11 +I 'f 1 �y%s County legislative authority that the F ire 6M/A 1 5� 5 i r5
(Name of County) (Commissioners, Council, Board, etc.)
of said district requests that the following levy amounts be collected in 01 provided in the district's
II (Year ofCollccyvn)
budget, which was adopted following a public hearing held on I — 17 .
(Date of Public Hearing)
Regular Levy:
Excess Levy:
Refund Levy:
(State the totral dollar amount to be levied)
(State the total dollar amount to be levied)
(State the total dollar amount to be levied)
Signature: �.
Date:Tp� —1,5 — / 7
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REV 64 0100e (w) (2/21/12)