1862 S MARGIE LN 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 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 $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1O^D^O
OWNER INFORiyiATiON:SiA//Co CjlX)Name:
Address:
CC
2 (X.r^:((i hJPhoneNumber:Home (Cell
APiPLIG^T INFORMATION:
3 Name:
Phone Number:Home (Cell(
PROPERTY INFORMATION:
Project Address:Ua.ADevelopmentType:()Residential -New (}Residential
(t--^Single Family
4 ()Commercial:
{)Multi-Family Condos/Apartments #of units:
I -Room Addition
Project Name:
COMMERCIAL:RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
Total Square Footage:
Muitipiled by Current Rate
5 Elem.$
$
=$Elem.$
=$H.S.
Equals Tqtj =S Equals Total Fee;$=$
FEE WAIVER:
Fees Waived:()Yes6 (If yes,reason:0
-ri
The above respresentations as to square footage are true,Developer/Applicant agrees that if it Is later determined that such respresentatlons
are not true.Certificate shall automatically terminate and the appropriate City/County shall be notified.
Developer/Appiicant Signature:
7
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995^y ;^//6/p38
X
fepr^e^tive -Anaheim Union High School DistrictDate
ACTUAL FEES PAID:
_A $Check No.
Check No.
9
$Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department