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Department of <br />Revenue <br />Washington State <br />Levy Certification <br />DEC 2 2 , `lk? <br />Submit this document to the county legislative authority on or before November 30 of the year preceding <br />the year in which the levy amounts are to be collected and forward a copy to the assessor. <br />In accordance with RCW 84.52.020, I, Chris Cudip _ <br />(Name) <br />Secretary for Kittitas Cvurlty Fire Dist #4 , do hereby certify to <br />(Title) (District Name) <br />the Kittitas <br />(Name of County) <br />County legislative authority that the Cllitlimss)(MaI:s <br />(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 12/11/17 <br />(Date of Public Hearing) <br />Regular Levy: $28,000.00 <br />(State the total dollar amount to be levied) <br />Excess Levy: <br />(State the total dollar amount to be levied) <br />Refund Levy: <br />(State the total dollar amount to be levied) <br />Signature: _ Date: <br />is -1611( <br />To ask about the availability of this publication in an alternate format for the visually impaired, please call (360) 705- <br />6715. Teletype (TTY) users, please call (360) 705-6718. For tax assistance, call (360) 534-1400. <br />REV 64 0100e (w) (2/21/12) <br />