HomeMy WebLinkAboutFire Dist 1 Levy Certification onlyDepartment of
Revenue c-
Washington State
Form 64 0100
Leery Certification
Submit this document, or something similar; 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.
Courtesy copy may be provided to the county assessor.
This form is not designed for the certification of levies under 1R$f($FWVZp,
OCT 3 12023
� Kliillf�g CHOTYASSESS OR
In accordance with RCW 84.52.020, 1 �I VV�� (Name),
'( Y (Title), for(District name),
do hereby certify to the[El v-i o
(Name of county) County legislative authority
that the i (Commissioners, Council, Board, etc.) of said district requests
that the following levy amounts be collected in (Year of collection) as provided in the district's
budget, which was adopted following a public hearing held on hOl V? I (Date of public hearing).
Regular levies
Levy
Total certified levy request���
amount, which includes the
amounts below.
General levy
Otherlevy*
Administrative refund amount
Non -voted bond debt amount
Other*
Excess levies
-txampies oT other levy types may include EMS, school district transportation, or construction levies.
Examples of other amounts may include levy error correction or adjudicated refund amount. Please include
a description when using the "other" options.
Signature: H _��L Date:
To request this document in an alternate format, please complete the form dor.wa. ovlAccessibilit Re uest
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