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nep,rrmenr of <br />Revenue(e <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 RCW 84.52.070. <br />In accordance with RCW 84.52.020, 1 IlBrent Hals <br />(Name), <br />Mayor I (Title), for JCitY of Roslyn I (District name), <br />do hereby certify to the Kittitas I (Nameof county) County legislative authority <br />that the Council (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 11/14/2023 (Date of public hearing). <br />Regular levies <br />Levy <br />General levy <br />Otherlevy* <br />Total certified levy request <br />$246,354.24 <br />amount, which includes the <br />amounts below. <br />Administrative refund amount <br />Non -voted bond debt amount <br />Other* <br />Excess levies <br />*Examples of other levy types may include EMS, school district transportation, or construction levies. <br />Examples of other amounts may include levy error correction or adjudicated refund amount. Please include <br />a description when using the "other" options. <br />Signature: Date: 11/28/2023 <br />