2152 S. VERN ST, B&CAnaheim 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 $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT;HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
OWNER INFORMATION:
UM-vt B
Address:^^
Phone Number:Home 1 ~'7,
Name
2 r,A ^7.^0^
Cell (
APPLICANT INFORMATION:
3 Name:
(~7ifPhoneNumber;Home Ceil (
Project Address;^^
Development Type:()Residential -New (Residential -Room Addition
PROPERTY INFORMATION:
4 )Commercial:
()Multi-Family Condos/Apartments #of units:)Single Family
Project Name:
COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
Elem^S,^
RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
5 =S Elem.S
=S H.S.
Equals Tot^i»P€e:$=S=$Equals Total Fee:S
FEE WAIVER:
Fees Waived:()Yes6 If yes,reason:
ACKNOWLEDGEMENT:,
The above respresentations as to square footage are true,Developer/Appficant agrees that if it is later determined that such respresentations
are not true.Certificate shall automaticaiiwtfiimicate and the appropriate City/County shali be notified.7
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in cgmpiiance with Government Code Sections 53080 and
65995 j ^^8
R e p r e s e eim Union High School DistrictDate
ACTUAL FEES PAID:
$Check No.
Check No.
9
$Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department