Annexation Certificate
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State ofWashmgton
ANNEXATION CERTIFICATE
Office of Financial Management, Forecasting Division, 450 Insurance Buildmg, PO Box 43113, Olympia, W A 98504-3113
IMPORTANT: The following documents must be attached with this certificate (RCW 35 13.260 and 35A.14 700)'
I Three copies of the final ordinance containing the legal description of the annexed area;
2. Three copies of a map clearly showing annexed area and existing city limits on an 8W'x II" or an 8W'x 14" size paper Outline the
annexation boundaries in red, outline former city limits in green. Maps should conform to acceptable engineering standards, including
directional arrow, scale, street designations, rivers, and other relevant physical characteristics; and,
3 The original, handwritten Special Population Census Sheets used to enumerate the population and housing of the annexed area and
all census summary sheets. Census procedures and definitions must follow the Office of Financial Management's (OFM) Enumerator's
Manual. Duplicate copies of the census are not needed. Please contact OFM for census manuals and forms at (360) 902-0597
CityITown V~/m County -rhf1f~fof)
Name of the Annexation (if any) f o.fltJ.-/ / /.. he)!of) R..d.. - AN X 0/8 ?? 22fcJ Y L
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Ordinance Number -MB Amending Ordinance Number (if applicable)
Date Passed 14 p r; J 14 I I~ Date Passed
Date Published -B-p (I' 2.. ~ J I q q tj Date Published
Ordinance Effective Date rtpr I I 2-6, /1 q '1 Ordinance Effective Date
Annexation Effective Date /f-pft I 7..,g I (q ~ '1 Annexation Effective Date
Statute(s) Authorizing Annexation. RCW < i5' A, /4. L W
Was a Boundary or Annexation Review Board Hearing Required? Yes _ No L lfyes. date ofhearing
Annexation Area (in acres)
/2 I 5'[)
Population and Housing Census.
Occupied Housing Units
2-
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_3
Housing Units
Population
CERTIFICATION I hereby certify that, to effect the above annexation, aI/legal requirements have been satisfied, and that the data set
forth in this certificate, including the attached documents, are true and correct.
[CITY SEAL]
(Mayo') ~ Jr;, cd4
Attest: (CityITown Clerk) a ../ ~ /.~
Date 1/ ~'I /, ()
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Date /111'1 / (fv
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(White) Office of FinanCial Management
(Canary)Department of Transportation
(Pink) Return to City/Town
No Carbon Paper Needed
Do Not Separate Form
Return All Three Copies