Annexation Certificate
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No Carbon Paper Needed - Do Not Separate Form
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ANNEXATION CERTIFICATE
STATE OF WASHINGTON ~
OFFICE OF FINANCIAL MANAGEMENT
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* * See Attached Instructions * *
, Ye 1m 'II hurs ton
City or Town County
(If Applicable)
Ordinance Number ,;/' 5 2 8 I Amending Ordinance Number
Date Passed 1 0 - 1 2 ,.".. 9 4 I Date Passed
Date Published 1 0 - 2 0 .., 9 4 i Date Published
Ordinance Effective Date 1 0 - 2 5 - 9 4 I I Ordinance Effective Date
Annexation Effective Date 1 0 - 2 5- 9 4 ~. Annexation Effective Date
Statute( s) Authorizing Annexation 3 5 A . 1 4 0 1 2 0 I
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Was a Boundary or Annexation Review Board Hearing Required? Yes No X
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If yes, date of heanng
Annexation Area (in acres) 9 0 7 6 ('
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Population and Housing Census: Housing Units 1 I
Occupied Housing Vmts 1 \
Population :2
I hereby certify that, to effect the above annexation, all legal requirements have been satisfied, and that the data set forth
in this certificate, including the attached documents, are tme and correct.
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" , ; .. ) " - Attest: I fJ ..' ,i .' "".1, J~
(Mayor) (Date) (Cityffown Clerk) (Date)
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Form 170.1 (4/88) Forecastmg DIVIsion
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