1343 N. Minot St.
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Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803.3520
(714) 999-2188
(714) 520-5741 FAX
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CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
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NOTICE: The gO-day period in which you may protest the fee des ibed her. 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 gO-day protest period began at the time your project was approved.
Receipt No:
Elementary District:
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Owner Information:
Name: md (\O-~,i, AJ
Address: 13<J 3, ",1 M,~o~ I
phone Number: ( "((( ) ,?:,O<;?;- G~b2:,
High School District:
Anaheim Union High School District
Ann h.""",
Applicant Information:
Name:
Phone Number: (
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)
Property Information:
Address of Project:
Development Type: [
Pnoject Name:
Type:
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[ ] Commercial
] Residential - New
Single Family
MUlti-Family Condos/Apartments - # of units:
Commercial:
Total Square Footage:
Multiplied by Current Rate: Elem.
$
-$
-$
-$
Residential:
[ ] Levell [ ] Level 2 - ACSO oolv [ ] Level 3- ACSD Oolv
Total Square Footage: 5~
Multiplied by Current Rate: Elem. $ (/.2,.. - $$<{ (,.<./
H.S.$ /.i::>... - $5?fi.1,<-(
Equals Total Fee: $ 62. ,~ Y = $ /1 (.,9 ?Lli
Fee Waiver:
Fees Waived:
Yes
[~
If yes, reason:
Acknowledgement:
The above representations as to square footage are tr e. Developer/Applicant agr
representations are not true, Certificate shall automa terminate a e appropriate 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.
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Representative - Anaheim Union High School District
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Date
Actual Fees Paid:
. Y\{' <' D
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Anaheim Union H.S. District
$
$
5"6<1.4<"1
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Check No.
Check No.
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uuo
Distribution: City/County - Developer ~ Accounting - Elementary District
,
~
Anaheim Union High School District
501 Crescent Way, P.O. BOl< 3520, Anaheim, CA 92803-3520
(714) 999-2188
(714) 520-5741 FAX
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE: The gO-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 gO-day protest period began at the time your project was approved.
Receipt No:
Elementary District:
High School District:
Anaheim Union High School District
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Owner Information:
Name: mcJ (\0- ~,,:,-Q
Address: 13<-19> f.j, Mi'~~ I ftN.d'V\<\A
Phone Number: ( <J(4 ) __"\O'?;- G~b~
Commercial:
Total Square Footage:
Multiplied by Current Rate: Elem,
,5, $
Applicant Information:
Name:
Phone Number: (
Property Information:
Address of Project:
Development Type:
Project Name:
Type:
Fee Waiver:
Fees Waived:
] Yes
~'E:.
)
....
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[ ] Commercial
Residential - Room Addition
Single Family
Multi-Family Condos/Apartments - # of units:
$
-$
-$
-$
esidential:
[ ] Level 1 [ ] Level 2 - ACSD Only [ ] Level 3- ACSD Only
Total Square Footage: 5'~
Multiplied by Current Rate: Elem, $ /. /.:2. - $$<f.t,<-(
H,S. $ /(;).. -$5'64.~<'(
Equals Total Fee: $ cQ < ~ Y - $" L;, il~
[~
If yes, reason:
Acknowledgement:
The above representations as to square footage are tr e. Developer/Applicant agr at if it is later determined that such
representations are not true, Certificate shall automa e appropriate 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,
I d-/ ( 10<;'
Date
Actual Fees Paid:
A-~D
Anaheim Union H.S. District
\_~ ~p
Representative - Anaheim Union High School District
$
$
S'8Y ,~<"I
::;<g~.lo'l
Check No.
Check No,
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Distribution: City/County. Developer - Accounting . Elementary District