705 N BUSH STC
/3
Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714) 999-5454
t�1D2-2 - b351 l
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. Retumed checks (NSF) are subject to a $30.00 administrative fee.
RECEIPT NO.:
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ELEMENTARY DISTRICT:
Q
HIGH SCHOOL DISTRICT:
JAnaheim Union High School District
'-A-CS
OWNER INFORMATION:
Name: X—
Address:
Phone Number: Home (7/ y Cell (`J1
APPLICANT INFORMATION:
Name:
Phone Number: Home ( ) Cell ( j
PROPERTY INFORMATION:
Project Address: > f\
Development Type: ( ) Residential -New ( ) Residential - Room Addition ( j Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name:
COMMERCIAL:
Total Square
RESIDENTIAL:
Footage:
Total Square Footage:
Multiplied by Current Rate
Ele
Multiplied by Current Rate 22 /� U
=$
H.S. $ = $
Elem.$ ��J1�-57
H.S. _ $�L0.S
Equals Tot ee: $ _ $
Equals Total Fee: $ _ $
FEE WAIVER:
Fees Waived: ( ) Yes ( o if yes, reason:
ACKNOWLEDGEMENT:: ,`'
e above respresentations as to square footage are true, Developer/Applicant agrees that if it is later determined that such respresemations
are not true, Certificate shall automatically terminat and thee ppropnate City/Cou shall be notified.
Developer/Applicant Signature: -1Otf�11
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53050 and
65995.
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Date Represents " a�hei\m Union High School District
ACTUAL FEES PAID: /���
S $ 3 d X// [! Check No.
Anaheim Union H.S. Dist. $ 3� 0-41/, LczS Check No. /, 5
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department