700 N HAMPTON ST, B3>U^2C'2.]-0‘5^^UAnaheimUnionHighSchoolDistrict
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520UNLIMITED
(714)999-5454
AWl u aCKjCn.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 wasimposedbytheCityorCountyasaconditionofapprovalforyourproject,and you have received the requisite notice,the 90-day protest periodbeganatthetimeyourprojectwasapproved.Returned checks (NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
OWNER INFORMATION:
Name:
Address:2 '7C^C>a//~o
Cell(7IH]?/qf -OPhoneNumber:Home(
APPLICANT INFORMATION:
3 Name:
Cell 17/^)7/°t-toPhoneNumber:Home(
PROPERTY INFORMATION:
Project Address:Q Q /\/on y>i jt?^0 K)C/f ^<37^1
Development Type:()Residential -New {
('Y')Single Family
4 )Residential -Room Addition ()Commercial:
()Multi-Family Condos/Apartments#of units:
Project Name:
COMMERCIAL:
Total Square Footage:-M3-
Multiplied by Current Rate
RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate3ASI /99a
=%^/l£>2.9TO
5 Fie«rs =$Elem.$
H.S.H.S.
Equa’'...ee:$=s Equals Total Fee:$=S
FEE WAIVER:
Fees Waived:()Yes6 }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 and the appropriate City/County 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
3
^3.
Re'^c^sentaYi^e -Anaheim Union High School DistrictDate
ACTUAL FEES PAID:
$/.aQ
Check No.
Check No.
5
Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department