1209 W. KIMBERLY PL5
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Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454
31,D202�
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE: The 9D-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:
HIGH SCHOOL DISTRICT:
Anaheim Union High School District
OWNER INFORMATION:
Name: 1) ()
Address: j n q^�� Y_ 1MINE 2, 1 Y PL /t NA H LI M Ci7 2 9- 2 0
Phone Number: Home ( ) Cell (7f4
APPLICANT INFORMATION:
Name: N C-T /k
Phone Number: Home ( ) Cell 11 1 4
PROPERTY INFORMATION:
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Project Address: 1 `Z n 0) W Y l l/l/14 A A4,- �"�; A-0 a Le. iff1/ Cr- 92 S'Q.
Development Type: ( ) Residential) :. yi. ( ) Residential -1toom Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name:
COMMERCIAL:
Total Square Footage:
RESIDENTIAL:
Total square Footage:
Multiplied by Current Rate
Multiplied by Current Rate
Elem. $ _ $
Elem. $r�3C/.�
H. _$
H.S. $airs $� 87r.10 i
Equals Tota _ $
Equals Total Fee: $ _ $
FEE WAIVER:
Fees Waived: ( ) Yes ( o If yes, reason: -
ACKNOWLEDGEMENT:
e 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 appro n to City/County shall be notified.
Developer/Applicant Signature: D!I
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
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Date ftp&tsenlative -Anaheim Union High School District
ACTU L FEES PAID: p r�
$ Check No. 4�?3 9
Anaheim Union H.S. Dist. $_ 7l I Check No. /ice "10
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department