2173 W. NIOBE AVE, BAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
E)L'PZ0 22--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 $30.00 administrative fee.
HIGH SCHOOL DISTRICT:
Anaheim Union High School District
ELEMENTARY DISTRICT:RECEIPT NO.:
1
OWNER INFORMATION:
Name:
Address:K ;\0 ;K/(nP><A~\/CL■^2
(7(4)CellPhoneNumber:Home (
APPUCANT INFORMATION:1/^.f i/.ALName:3
CellPhoneNumber:Home (
PROPERTY INFORMATION:
.g\>2>Project Address:
Development Type:()Residential -J^
()Single Family
{}Commercial:4 {}Residential -Room Addition
{)Multi-Family Condos/Apartments #of units:
■LLProjectName:
RESIDENTIAL:COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
Elem.S^
Total Square Footage:
Muitipiled by Current Rate
Elem.
H.S.$
=S5
"i.$=$
=$Equals Total Fee:$=SEqualsTolaffee:$
FEE WAIVER:
Fees Waived:()Yes (6 If yes,reason:No
ACKNOWLEDGEMENT:
The above respresentations as to square footage are true,Dev^loper/Applicant agrees that if it is later determined that such respresentationsarepottrue,Certificate shall automatically te|/ninate and \inappropriate City/County shall be notified.Developer/Applicant Signature://K —
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
-Anaheim Union High School DistrictDate
ACT^^L FEES
Anaheim Union H.S.Dist.
/'/Check No.
Check No.
$9
$
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department