1241 E CRESTBROOK PL BAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
{714}999-5454
UNLIMITED
r\
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 $30.00 administrative fee.
RECEIPT NO.;ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
OWNER INFORMATtON;
Name:Dg ?>eS>jS C.yJ,7
\X4\b C\e^\X)rr,r>\C-2
PH)Phone Number:Home(Cell
APPUCANT INFORMATION:
Name:
Phone Number:Home(
3
PROPERTY INFORMATION:
Project Address:^^(jf b)TOo\C~P4DevelopmentType:(VfResidential -New ()Residential -Room Addition
()Single Family
()Commercial:
()Multi-Family Condos/Apartments #of units:
Project Name:
COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
ESIDENTIAL:923_Total Square Footage:
Multiplied by Current Rate
5 Elem.$=$Eiem.
=S H.S.
=$Equals Totaigper Equals Total Fee:$=$_
FEE WAIVER:
Fees Waived:()Yes6 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 termiryite and the appropriate City/County shall be notified.
Developer/Applicant Signature:
7
.CY\f7.t
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8
t-
Represeojawe -Anaheim Union High School DistrictDate
AaUAL FEES PAID:
S 3:2.
Check No.
Check
9
Anaheim Union H.S.DIst.
Distribution:Deveioper/Applicant,AUHSD Accounting Department,Elementary School District Accounting DepajJinent<7sC:p