HomeMy WebLinkAboutFire Dist 7 Levy Certification onlyDepartment of
Revenue @
Washington State
Form 64 0100
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 RCM164.Lq'9ffb
In accordance with RCW 84.52.020,
NUV 17 2023
r MIKE HOUGARDY
I e " A iCa -C (Name), KITTITAS COUNTY ASSESSOR
(Title), for ��lt CD.ivC ��] �i11`r1�]i5{` (District name),
do hereby certify to thei �'IS
(Name of county) County legislative authority
that the tS�ll1rL.1 (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 — -a0213 (Date of public hearing).
Regular levies
Levy
General levy
Otherlevy*
Total certified levy request
51 L14-1) m)'K- I fq
amount, which includes the
amounts below.
Administrative refund amount
Non -voted bond debt amount
Other*
Excess levies
*Examples of other levy types may include EMS, school district transportation, or construction levies.
Examples o her amounts may include levy error correction or adjudicated refund amount. Please include
a descrip on v+hen u i g t e" then" options.
Signature• L Date: 1 °l 2 2L
To request thiDdocument in an al nate format, please complete the form dor.wa. ov/Accessibilit Re nest
or call 360-705-6705. Teletype (TTY) users please dial 711.
REV 64 0100 (8/23/22) Page 1 of 1