1910 W BROADWAY (5)Anaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
n
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 $30.00 administrative fee.
RECEIPT NO.;ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
OWNER INFORMATION:
\t(K VIKT1 r p I^Q W -Phone Number:Home ^^12.CellQji/)
Name:
Address:2
APPLICANT INFORMATION:
Phone Number:Home HlH)M 1 ^I 2^
3 Name:
Cell
PROPERTY INFORMATION:
Project Address:
Development Type:()Residential -New ()Resj
()Single Family k
4 ;ial -Room Addlti^{f)Cbrnmerdal:
IbsTApartments^f of units:)Mul
Project Name:
COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
RESIDENTIAL:
Total Square Footage:
Multiplied by Current RateElem.$=$h=sV.
5 =$EJ
H.S.$=$H.S.
EqualstetSlFee:$=$Equals Total Fee:$=S -1
FEE WAIVER:
Fees Waived:()Yes6 No If yes,reason:
ACKNOWLEDGEMENT:
The above respresentations as to square footage are true,Developer/Applicant agrees that if it is later determined that such respresentations
are not true,Certificate shall automaticallv/^rmj^ate and the appro^nate City/County shall be notified.
Developer/Applicant Signature:
7
2
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.b>l \8 {jCZ.’Z.aC
fltativey Anaheim Union High School DistrictDateRepra
ACTUAL FEES PAID:
4A 3^1$Check No.
Check No.
9
Anaheim Union H.S.DIst.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department