HomeMy WebLinkAboutHospital Dist 1 Levy CertificationDepartment of Q
Revenuele
Washington State
,U:0 r, fu 54 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 RCW 84.52.070.
In accordance with RCW 84.52.020, I ason Adler (Name),
Chief Financial Officer (Title), for Kittitas County Public Hospital Dist. No. 1 (District name),
do hereby certify to the Kittitas (Name of county) County legislative authority
that the Board of Commissioners
(Commissioners, Council, Board, etc.) of said district requests
that the following levy amounts be collected in 2024 (Year of collection) as provided in the district's
budget, which was adopted following a public hearing held on 10/26/2023 (Date of public hearing).
Regular levies
Levy
General levy
Otherlevy*
Total certified levy request
20,000.00
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 of other amounts may include levy error correction or adjudicated refund amount. Please include
a description wh sin the other" options.
Signature: �"` Date: 10/26/2023
To request this ocument in an alternate format, please complete the form dor.wa.gov/AccessibilityRequest
or call 360-705-6705. Teletype (TTY) users please dial 711.
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