3349 W ARIEL PL, BAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
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
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 $30.00 administrative fee.
was
RECEIPT NO.:ELEMENTARY DISTRICT:.HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
ptyNER INFORMATION:
Name;
Address:y Phone Number:Home (Cell
ICANT INFORMATION:
Name:OA 9dc?^JL^
Phone Number:Home(Cell(
PROPERTY INFORMATION:
Project Address;
Development Type:()Residential {
()Single Family
«c-C_C4)Residential -Room Addition
()Multi-Family Condos/Apartments #of units:
()Commercial:
.Aipps.Project Name:
COMMERCIAL:RESIDENTIAL:n 99TotalSquareFootage:
Multiplied by Current Rate
Total Square Footage:
Multiplied by Current Rate
5 =$Elej Elem.$
H.S.$=$H.S.
Equals TQtafPee:$=$Equals Total Fee:$=$_
FEE WAIVER:
Fees Waived:()Yes6 If yes,reason:No
ACKNOWLEDGEMENT:
Tne above respresentations as to square footage are true,Developer/Applicant agrees that if it is later determined that such respresentations
5re not true.Certificate shall automatically terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:
7
VCERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8
^ ilTtatlv^Anaheim Union High School DistrictDateRepre:
ACTUAL FEES PAID:,
Check No.
Check No.
9 /Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department