HomeMy WebLinkAboutFire District 3 Levy Certification (2)Department of
Revenue F
Washington State
Forrei 64. GI Goa
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, 1
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H���F�Sa
(Name),
�lQk
(Title), for
I�,i���AS
Nky iC� oi�� 1 (Districtname),
do hereby certify to the K144,\s
(Name of county) County legislative authority
that the QoeiD a� Con�miSidNE� (Commissioners, Council, Board, etc.) of said district requests
that the following levy amounts be collected in c�0al4 (Year of collection) as provided in the district's
budget, which was adopted following a public hearing held on [ t- 13'a3 (Date of public hearing).
Raaular Ipvies
h9'
OiOP
Total certified levy request
amount, which includes the
amounts below.
3CJO��O�
Administrative refund amount
Non -voted bond debt amount
Other*
Excess levies
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Q
uom
Maw oo
�
oo
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Total certified levy
request amount,
which includes the
amounts below.
Administrative refund
amount
Other*
*Examples of other levy types may tncluae tivl5, scnooi aistrici iransporiauon, or cunsuucuun ieviet'.
Examples of other amounts may include levy error correction or adjudicated refund amount. Please include
a descriptio�he���he us'";ner." options.
Signature.E� Date:
To request this document 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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