1303 S COURTRIGHT ST BAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
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
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 $30.00 administrative fee.
was
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
OWNER INFORMATION:
Name:
Address;2
Cell (?■(/)Phone Number:Home(7/V^)
APPLICANT INFORMATION:
Phone Number:Homef^yY)^
3
cell(7-V)21??-r
PROPERTY INFORMATION;
Ce>urViT\^\AfDevelopmentType:(}Residential -New (y")Residential -Rooni Addition ^
{)Single Family
Project Address:
4 )Commercial:
()Multi-Family Condos/Apartments U of units:
-ftDU oDiUProjectName:Jel
COMMERCIAL:RESIDENTIAL:>9/?Total Square Footage:
Muitipiled by Current Rate
Total Square Footage:
Muitipiled by Current Rate
5 Elem.$Elem.$
H.S.
Equals TotaLPe^$Equals Total Fee:$=S
FEE WAIVER:
Fees Waived:()Yes6 If yes,reason:lo
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 terminate and the appropriate City/County shall be notified.7
Deveioper/Appiicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
6S995.
8
Re^rese^^ative -Anaheim Union High School DistrictDate
ACTUAL FEES PAID:
S /■
/o^Check No.
Check No.
9 /OLoAnaheimUnionH.S.Dist.
Distribution:Deveioper/Appiicant,AUHSD Accounting Department,Elementary School District Accounting Department