909 S ROANNE ST BAnaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454 j c
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:
IHIGH SCHOOL DISTRICT:
1 �i✓`
o.az�_•
Anaheim Union High School District
Q_ 1lVNER INFORMATION:
.
/ Name:_ t�
Address: CIl9a S jet L i r, !'k C4
Phone Number: Home (i (rf) 'T 4 /f () ( I Cell (-I tq) Si i- L{ el i 1
APPET INF6RMATIONi
Ap7Phone
I Name: f4 ��. " 1 -Ca it
Number: Home (? 14t) 9 - AU 1 1 Cell (' 7 i y) 0—r �R- LE i i
P ROPE RTY INFORMATION:
ProjectAddress:
Development Type: ( Residential -New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name: ocyam- 'L DU �� /•cj
COMMERCIAL:
RESIDENTIAL:
Total Square Footage:
Total Square Footage: J
Multiplied by Current Rate
Multiplied by Current Rate
Elem. $ _ $
=/o✓
Elem. $ a�" $ Co
$ =S
H.S.
Equals Total Fe _ $
Equals Total Fee: $ _ $
FEE WAIVER:
Fees Waived: ( ) Yes ( No If yes, reason:
OEM OE(1N7 w "
The above respresentations as to square foota are true, Developer/Applicant agrees that if it is later determined that such respresentations
are not true, Certificate shall automatically minate and the ap priate City/County shall be notified.
Developer/Applicant Signature
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school fac" egs in compliance with Government Code Sections 53080 and
65995.
2 -aL
Date rese ative -An heim Union Hlgh School District
ACTUAL FEES PAID; J
p
�p o ITS. Bia $ Check No. i� -a Jr0 A'71.
Anaheim Union H.S. Dist. $ /, Q 9z. / z Check No.
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department