300 W CARL KARCHER WAYAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
^1202^22-023L.2
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 $30.00 administrative fee.
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RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
OWNER INFORMATION:
Name:
Address:
Phone Number:HomeC^-f^)q.M
2
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APPLICANT INFORMATION:
Name:
Phone Number:Home(Vt^)^\\'7 C*m-)(7
1QdIAciC<,<i3
Cell (^)
PROPERTY INFORMATION:
Project Address:',10 0 C 1 ^‘'Wt^n''
Development Type:()Residential -New ()Residential -Room Addition
()Single Family
4 Commercial:
()Multi-Family Condos/Apartments#of units:
Project Name:
COMMERCIAL:^Total Square Footage:/\L.P
Multiplied by Current Rate
RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
Elem.$
H.s.=s
5 EI^.$_
H.S.S
=$
=S
Equals Total Fee:$=$(a\s Total Fee:$=$_
FEE WAIVER:
Fees Waived:()Yes6 If yes,reason:No
ACKNOWLEDGEMENT:f
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 terminaYgi^^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.
Re^esent^ve^AnaheimUnionHigh SchoolDistrirt
8
Date
ACTUAL FEES PAID:
o.$Co ^
Check No.
Check No.
9
Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department