733 N. Pauline 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
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 gO-day protest period began at the time your project was approved.
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High School District:
Anaheim Union High School District
Receipt No:
Owner Information:
Name:
Address:
Phone Number:
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Property Information:
Address of Project:
Development Type:
Project Name:
Type:
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Applicant Information:
Name:
Phone Number: (
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)
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] Residential - New
~] Residential - Room.Addition
] Commercial
] Single Family
Multi-Family Condos/Apartments - # of units:
Commercial:
Total Square Footage:
Multiplied by Current Rate: Elem. $
H.S. $
Equais Total Fee: $
=$
=$
-$
Residential:
[ ] Level 1 [ ] Level 2 - ACSD Only [ J Level 3- ACSO Only
Total Square Footage: $'Z </
Multiplied by Current Rate: Eiem. $ //:2-:- $ fo.3f. I( 1
H.S. $ / /'2. - $ (;;$/. to '8'
Equals Total Fee: $ ,.;{..z~ - $!'~~.o.
Fee Waiver:
Fees Waived:
J Yes
[It] No
If yes, reason:
Acknowledgement:
The above representations as to square footage are true. Deve
representations are not true, Certificate shall automatically
Developer/Applicant Signature:
plicant agrees that if it is later determined that such
nd the appropriate City/County shall be notified.
Certification:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code
Sections 53080 and 65995.
'7 ~ A{)-<J:;;
Date
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Representative - A elm Union High School Dlstnct
ActuafjJ S~ .
Anaheim Union H.S. District
$
$
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Check No.
Check No.
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Distribution: City/County. Developer. AccountIng - Elementary District