2235 W MIDWOOD LN (3)Anaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
n
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 $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRia:
Anaheim Union High School District1(fo o /7
oQ-'T)\A^S-i
W 7 -
OWNER INFORMATION:
Name
Address
Phone Number:Home (CellfyiL^)
APPLICANT INFORMATION:
t>AW)Name:
iqjLjPhoneNumber:Home (Cell
PROPERTY INFORMATION:
I—.r\Project Address:
4 Development Type:{)Residential -New {
{)Single Family
}Residential -Room Addition
()Multi-Family Condos/Apartments #of units;
}Commercial;
Project Name:
COMMERCIAL:RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
Total Square Footage:
Multiplied by Current Rate
5 Elem.$_
H.S.$
=S Elem.$
=$H.S.
EqualsTotal Fee:$=$Equals Total Fee:$=S
FEE WAIVER:
6 Fees Waived:()Yes No If yes,reason:
ACKNOWLEDGEMENT^
The above respresentations as to square footage are true,Developer/Applicant agrees that if it is later determined that such respresentations
are not true.Certificate shall automatically terminate ar^the ^pfopriate^ffly/Couiity'sl'iall be notified.
Developer/Applicant Signature:
7
z9CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8
;sent^ve -Anaheim Union ^igh School DistrictDateRe
ACTUAL FEES PAID:/s Check No.
Check No.
9 S ;2_3 ■yAnaheimUnionH.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department