1600 S DISNEYLAND DR (155)Anaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
„4WiJMITED
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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 $30.00 administrative fee.
ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District
RECEIPT NO.:
1
OWNER INFORMATION:
Name'T 'E.StVnxAfi
Address:2 ^OQ uO>
Phone Number:HomefT^^)Cell (
APPLICANT INFORMATION:
Name:3
Cell (Phone Number:Home (
PROPERTY INFORMATION:
Project Address:IfoOQ S n~^-v<^rgy\ftnr\
Development Type:()Residential -New ()Residential -Room Addition
()Single Family
Project Name:Alotba N\t.2^rNv'(\e
(Xc4 ommerciai:
()Multi-Family Condos/Apartments #of units:
RESIDENTIAL:COMMERCIAL:
Total Square Footage:Total Square Footage:
Multiplied by Current RateMultipliedbyCurrentRate
Elem.$M A’
H.S.
MAi =$5 =$Eiertv,$C
$=$=$
●oo//7 =$Equals Tot^LPe^$Equals Total Fee:$=$
FEE WAIVER:
6 {)No If yes,reason;Fees Waived:Yes
ACKNOWLEDGEMENT:
The above respresentations as to square footage are true,Deveioper/Applicant agrees that if it is later determined that such respresentations
are not true,Certificate shall automatically terminatg.aDcU^e aoprooriatp rity/rrmntv shall be notified.
Developer/Applicant Signature:
7
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8
Representative -Anaheim Onion/fligraSchool DistrictDate
ACTUAL FEES PAID:
$Check No.
Check No.
9
$Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department