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Department of <br />Revenue C <br />OA <br />Washington State <br />Form 64 0100 <br />Levy Certification <br />Submit this document, or something similar, to the county 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 Rd EIVE] <br />In accordance with RCW 84.52.020, 1 John Sinclair <br />NUV 16 2023 <br />MIKE HOUGARDY <br />(Name), 1',ITTITAS COUNTY ASSESSOR <br />Fire Chief (Title), for Kittitas County Fire District 2 (District name), <br />do hereby certify to the Kittitas (Name of county) County legislative authority <br />that the Board of Fire Commissioners (Commissioners, Council, Board, etc.) of said district requests <br />that the following levy amounts be collected in 2024 (Year of collection) as provided in the district's <br />budget, which was adopted following a public hearing held on 11/09/2023 (Date of public hearing). <br />Regular levies <br />Levy General levy Otherlevy* <br />Total certified levy request $ 8,200,000.00 <br />amount, which includes the <br />amounts below. <br />Administrative refund amount $7,034.52 <br />Non -voted bond debt amount <br />Other* <br />Excess levies <br />Total certified levy <br />request amount, <br />which includes the <br />amounts below. <br />Administrative refund <br />amount <br />Other* <br />*Examples of one, levy <br />Examples of other imou <br />a description w <br />Signature: <br />$ 47S,000.00 <br />$ 2,365.00 <br />lay include EMS, school district transportation, or construction levies. <br />inclu ,levy error correction or adjudicated refund amount. Please include <br />Date: /< ! r 27,-), <br />To rellues s document in an alternate format, please complete the form dor.wa. ov/Accessibilit Re nest <br />or call 3 05-6705. Teletype (TTY) users please dial 711. <br />REV 64 04tO (8/27/21) Page 1 of 1 <br />