HomeMy WebLinkAboutHospital District 2 Levy Certification CorrectionDepartment of
Revenue c
Washington State
Fora 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 RCW 84.52.070.
In accordance with RCW 84.52.020, I Dale Scott Olander (Name),
Treasurer (Title), for Fittitas County Public Hospital Dist. No. 2 (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 10-16-2023 (Date of public hearing).
Regular levies
Levy
General levy
Other levy* EMS
Total certified levy request
$2,000,000.00
$2,000,000.00
amount, which includes the
amounts below.
Administrative refund amount
$1 29
$ .39
Non -voted bond debt amount
Other*
Excess levies
Ttxamples 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 —when usjrg the ;'other ps.
Signature: t--'c,�`�/��( c,f,�-/{� (vdh Date: It 0& Z v z
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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