1108 N OUTRIGGER WAYAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520UNLIMITED
(714)999-5454
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 wasimposedbytheCityorCountyasaconditionofapprovalforyourproject,and you have received the requisite notice,the 90-day protest periodbeganatthetimeyourprojectwasapproved.Returned checks (NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1 AqOWNERINFORMATION:
Name:
Address;2
Phone Number:Home{
APPLICANT INFORMATION:
3 Name:
Phone Number:Home(
PROPERTY INFORMATION:
Development Type:()Residential -New (X)Residential -Room Addition,,
{)Single Family
Project Address:
4 ()Commercial;
()Multi-Family Condos/Apartments#of units:
Project Name:r<i-.^
COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
^^H.S.$
RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
5 =$Elem.S
=$H.S.a
EqualsJefSlFee:$=$Equals Total Fee:$=$_
FEE WAIVER:
Fees Waived:()Yes6 No If yes,reason:
ACKNOWLEDGEMENT:
The above respresentations as to square footage are true,Oeveloper/Applicant agrees that if it is later determined that such respresentations
are not true.Certificate shall automatically terminate and the apprppri^City/County shall be notified.
Developer/Applicant Signature:
7
Z
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8
Date -Anaheim Union High School District
ACTUAL FEES PAID:
Check No._
Check No.
9
$Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department