State of Washington
(State the . total. dollar amount to be levied) Refund Levy: (State the . total. dollar amount to be levied) Signature: Date: To ask about the availability of this publication in an alternate format for the visually impaired, please call (360) 705-6715. Teletype (TTY) users, please call (360) 705-6718. For tax assistance, call (360) 534-1400. ................
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