712 N PAULINE ST B, CAnaheim 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 DISTRia:
Anaheim Union High School District An1A
OWNER INFORMATION:
Name:
Address:11 \)■^1
Phone Number:Home (7 M)
2
tsHP )
APPUCANT INFORMATION:
Name:3
Phone Number;Home(Cell(
PROPERTY INFORMATION:
l\^-(^xA\n'pProjectAddress:~1 (
Development Type:()Residential -New {
()Single Family
4 {)Commercial:)Residential -Room Addition
{)Multi-Family Condos/Apartments#of units:
A^uArouProjectName:
COMMERCIAL:RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
Total Square Footage:
Multiplied by Current Rate 3,/3^^L p
.s 3.)3S-0(^
5 Elem.S Elem.$
.B.5r H.S.
Equals TotalTeeT$Equals Total Fee:$=S
FEE WAIVER:
Fees Waived:{)Yes6 If yes,reason:
ACKNOWLiESSgi^ENt:^
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 automaticaii^^terminate and the ^propriate^City/County shall be notified.
Developer/Applicant Signature:Vv
7
CERTIFICATION:
This certifies that the above named Deveioper/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8 ¥Representafn^Anaheim Union High School DistrictDate
AaUALFEES PAID:
3?,/3-g.$Check No.
Check No.
9.
$Anaheim Union H.S.Dist.■VA.
Distribution:Devetoper/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department