527 S RESH ST, BAnaheim Union High School District
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 wasimposedbytheCityorCountyasaconditionofapprovalforyourproject,and you have received the requisite notice,the 90-day protest periodbeganatthetimeyourprojectwasapproved.Returned checks (NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1 KA
OWNER INFORMATION:
Name:Druni j aH.
Address:
Phone Number;Home(^i S)1}
2
Cell ()
APPLICANT INFORMATION:
3 Name:
Phone Number:Home (51^)?S \●'1 Celi(
PROPERTY INFORMATION:
Project Address:'^''2'^^
Development Type:()Residential -New ()Residential -Room Addition
()Single Family
Sf.Ar\f.Ko-.4
{)Commercial:
()Multi-Family Condos/Apartments#of units:
Project Name:
COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
/..3S.S;.an
=$'
5 Elei =$Elem.$
H.S.$=$H.S.
Equals TotaLFd^$=S Equals Total Fee:$
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 respresentationsarenottrue.Certificate shall automatically terminate
Developer/Applicant Signatun
7 le appropriate City/G shall be notified.
CERTIFICATION:
This certifies that the above named Developer/Appiicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995 I
R^pc^ntb^ive -Anaheim Union High School District
8
Date
ACTUAL FEES PAID:
/,xc>
$/
3>o^1$Check No.
Check No.
9
Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department