537 W JULIANA ST BAnaheim Union High School District
501 Crescent Way, R.O. Box 3520, Anaheim, CA92803-3520
(714)999-5454
CERTIFICATE of COMPLIANCE ob-1 ?>O
PAYMENT of SCHOOL FACILITY FEES
NOTICE: The 90-day period in which you may protest the fee described herein will begin on the date :his 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.:
1
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
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�S
Anaheim Union High School District
OWNER INFORMATION:
% y�
Name:
Address:
Phone Number: Home (!il Cell (4:)
ASP€IC'ANTINFORMATION: {1
C(2"
3 Name: o(��vI.�LO
/ c•
Phone Number: Home (9ii
PROPERTY INFORMATION:
Project Address:
Development Type: (�QResidential - New ( ) Resi ial - oom Addition ( ) Commercial:
( (_) Single Family ( ) Multi -Family y Condos/Apartments # of units:
Project
Name: ow
COMMERCIAL:
Total Square Footage:
RESIDENTIAL: y
Total Square Footage:_
Multiplied by Current Rate
Eli
Mukipiled by Current Rate
H.S. $ =$
---=-o-.H.S. $� 9
EqualsT Fee:$ _$
kquals Total Feq:4 =$
FEE WAIVER:
Fees Waived: ( ) Yes No If yes, reason:
The above respresentations as to square footage are true, Developer A plicant agrees that if it is later determined that such respresentatiorts
are not true, Certificate shall automaticall termin and the ao priate City/County shall be notified.
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995. u
1
Date ` ReT s es tati -Anaheim Union High School District
ACTUAL FEES PAID:
S $ 4dJr2. /C eckNo.O!-0�2
Anaheim nion H.S. Dist. $ ���heck .. f
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementa; drool District Accounting Department