912 N HELENA 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 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 $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
OWNER INFORMATION;
N 14^A 4^'
Name:
Address;2 /I A
Phone Number:Home (Cell(7;\^.}
APPLICANT INFORMATION:
3 Name:cs.
Phone Number:Home (Cell (
PROPERTY INFORMATION:QProjectAddress:n.
Development Type:{)Residential -New (>,^>fCesidential -Room Addition
()Single Family
4 )Commercial:
()Multi-Family Condos/Apartments #of units:
Project Name:
COMMERCIAL:RESIDENTIAL:
/.
H.S.
Total Square Footage:
Multiplied by Current Rate
Elem.
Total Square Footage;
Multipiled by Current Rate
5 =S Elem.S
ft.s =$
Equals Total^eCTS =S Equals Total Fee:$=$
FEE WAIVER:
6 Fees Waived:{)Yes [Y);No If yes,reason:
ACKNOWLEDQEMENyTheaboverespresentationsas to square footage are true,Developer/Appiicant agrees that if it is later determined that such respresentations
are not true.Certificate shall automatically terminate andtjie approjitiataCity/^unty shall be notified.^—'
Developer/Applicant 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.^/>ol8 ^3
Date -Anaheim Union High School DistrictRepniti'
ACTUAL FEES PAID:
/09sCheckNo.
Check No.
9
$Anaheim Union H.S.Dist.
Distribution;Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department