2101 S ANCHOR ST, BAnaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES tea,-UD �6�
NOTICE: The SIG -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:
I
HIGH SCHOOL DISTRICT:
Anaheim Union High School District KA
OWNER INFORMATION:
Name: J01Q A-M&(Q Ly
Address: ;-I o 1 SUU+�\ r nGhol- 5 ry't e_;(n ('_A ':5)2 &U Z
Phone Number: Home (%/y) —3Rg- 12 7 3 Cell ( )
APPLICANT INFORMATION:
Name:
Phone Number: Home ( ) Cell (7/4 / z 73
PROPERTY INFORMATION:
Project Address: L) r
Development Type: ( Residential - New ( ) Residential - Room Addition ( ) Commercial:
( )Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name: AA::X_ h
COMMERCIAL:
Square Footage:
RESIDENTIAL: / A
��
Total
Total Square Footage:
Multipiled by Current Rate
Elem.
Muhipiled by Current Rate a39 / Al %2 4
7 $
$ _ $
Elem. $
�_
= 5
H.S. $ $
Equals To = $
Equals Total Fee: $ _ $
FEE WAIVER:
Fees Waived: ( ) Yes No If yes, reason:
e above respresentations as to square footage are truADeve/cant grew that if it is later determined that such respresentations
are nottrue, Certificate shall automati Ily terminate anity County shall be notified.
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school faci fees in compliance with Government Code Sections 53080 and
65995.
� g� z
Date R esen ive - Anaheim Union High School District
ACTUAL FEES PAID:
A F S !::�t— $ -14 �o? • / Check No.
17,
Anaheim Union H.S. Dist. $ J, 7; ��Z. 9 Check No.
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department