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RaTdHtit@ Woshington State Fsrnn 64 01.00 Levy 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 RCW 84.52.070. ln accordance with Rcw 84.52.020, I Tracey Finch fiame),clerk ffitte), for Kittitas county cemetery Dist #1 pistrict nome), do hereby certify to the Kittitas (Nome of county) County legislative authority that the commissioners $ommissioners, Council, Board, etc.) of said district requests that the following levy amounts be collected in 2a24 ffear of collection)as provided in the district's budget, which was adopted following a public hearing held on Nov 9, 2023 @ate of public hearing). lar levies Excess levies *Examples of other levy types may include EM5, school district transportation, or construction levies. Examples of other amounts may include levy error correction or adjudicated refund amount. Please include a description en usrng "other" options Signature:Date: ll-1-gZ To request this document in an alternate format, please complete the form dor.wa.gov/AccessibilityRequest or call 360-7A5-6705. Teletype (TTY) users please dial 71 1. REV 64 a$o $l27l2Ll page L of 1 Total certified levy request amount, which includes the arnounts below. $18,000.00 Administrative refund amount Non-voted bond debt amount Other* General levy Other levy*Levy Total certified levy request amount, which includes the amounts below. L-.J Administrative refund amount Other* General (nla f or school d istricts) Enrichment (school districts only) Other I Bond Cap. project * Levy