3434 W BRADY AVE, #B’d^Q20Z2'Anaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE:The 90-day period in which you may protest the fee described herein will begin on the date this fee is paid.However,if the fee was
imposed by the City or County as a condition of approval for your project,and you have received the requisite notice,the 90-day protest period
began at the time your project was approved.Returned checks (NSF)are subject to a $30.00 administrative fee.
HIGH SCHOOL DISTRICT:
jAnaheim Union High S hool District
ELEMENTARY DISTRICT;RECEIPT NO.:
1 Cjp O
OWNER INFORMATION:i/o'3^yiryL'tuJBroicLc^Jr
/Name:
Address:2
CellPhoneNumber:Home(
APPLICANT INFORMATION:
diiAa !AName:3
Cell C7li()-SSPhoneNumber:Home (
PROPERTY INFORMATION:
\aJ Jt B-Project Address:
Development Type:()Residential -New (^Residential -Room Addition
()Single Family
Co
4 ()Commercial;
()Multi-Family Condos/Apartments #of units:
Project Name:
RESIDENTIAL:COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
Total Square Footage:
Multiplied by Current Rate
Elem.S5=$Elem.
$_=S H.S.
=$Equals Total Fee;$=$Equals TotaLFeef $
FEE WAIVER:
Fees Waived;()Yes6 If yes,reason;No
ACKNOWLEDGEMENT:
The above respresentations as to square footage are true.Developer/Applicant agrees that if it ts later determined that such respresentations
are not true,Certificate shall automatically terminate and the Mpropriate
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
7 intyshall be notified.
8
ntative -Anaheim Union High School DistrictDatere:
ACTUAL FEES PAID:to Check No.
Check No.Anaheim Union H.S.Dist.
9
$
Distribution:Developer/Appiicant,AUHSD Accounting Department,Elementary School District Accounting Department