215 E WILHELMINA ST, UNIT BAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
tINLIMITED
ANMfftM Moon HgH aCMOOL MTTCCT CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES 3 n
N
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 $30.00 administrative fee.
RECEIPT NO.:J\aELEMENTARYDISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1b2d/:l.
OWNER INFORMATION:
Name:If
Address:
a €.St.ArvAVvi\^t rA-.
)Cell niq)
2
Phone Number:Home (
APPLICANT INFORMATION:
'^Y\CO\pLMnJirL I V\^ncii3Name:
-
ceiii^S)Phone Number;Home (
PROPERTY INFORMATION:
Project Address:S-I\V~\Lg.1 Cdj
4 Development Type;(_X)Residential -New ()Residential -Room Addition
()Multi-Family Condos/Apartments #of units:
()Commercial:
()Single Family
Project Name:
COMMERCIAL:RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
Total Square Footage:
Multiplied by Current Rate
5 =$Elei Elem.$
H.S.^3-H.S.S =s
Equals TotahFee:S =S Equals Total Fee:$=S
FEE WAIVER:
Fees Waived:()Yes6 if yes,reason:No
ACKNOWLEDGEMENT:
The above respresentations as to square footage are true,Developer/Applicant agrees that if it is later determined that such respresentations
are not true.Certificate shall automatically terminate
Developer/Applicant Signature:
7 i8-aftpropriate City/County shall be notified.
7=^
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8 \o\t-\
Y
RepreseTTtatjJ^-Anaheim Union High School DistrictDate
ACTUAL FEES PAID:
/,3 /$Check No.
Check No.
9
$Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department