1912 W SLOOP AVE, BeLC72oa)-^>^MmAnaheimUnionHighSchoolDistrict
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
O'
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 $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
OWNER INFORMATION:
Name:
Address;
Phone Number:Home ('7i ^'3"^iSL.
2 'yO S\o<y k.jo
Cell(
APPLICANT INFORMATION:s
Name:3 1 ^irriil
tellPhoneNumber:Home{;^\c)w —"7 ^C
PROPERTY INFORMATION:
A\^12.Co.Project Address:
Development Type:()Residential -New ()Residential -Room Addition4 ()Commercial:
()Multi-Family Condos/Apartments#of units:{)Single Family
Project Name:
COMMERCIAL:RESIDENTIAL:>?s-Total Square Footage:
Multiplied by Current Rate
Total Square Footage:
Multiplied by Current Rate
5 =S Elem.
I.S.$=$H.S.
Equals TofaPfee:$=$Equals Total Fee:$=$_
FEE WAIVER:
Fees Waived:()Yes6 2^No If yes,reason:
ACKNOWLEDGEMENT^
The above respresentations as to square footage are true,Developer/Applicant agrees that if It is later determined that such respresentations
are not true.Certificate shall automatically termir^e and the appropriate City/County shall be notified.
Developer/Applicant Signature:
7
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995’■/1
R^pc^s^tati^-Anaheim Union High School District
8
Date
ACTUAL FEES PAID:
3/>^$Check No.
Check No.
9
$Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department