206 S EMERALD ST, BAnaheim Union High School District �y���//��� /ll
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520 b LonU 2�_�� I D
(714) 999-5454
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 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. Retumed checks (NSF) are subject to a $30.00 admidishative fee.
RECEIPT NO.:
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
Anaheim Union High School District S
S�
A S
OWNER INFORMATION:
Name: SAZ KUMA? C(-}TTT-IcELA
Address: lob S EmF-RrAu) ST, ANAI-IF_�G _ A,�iZ$Olf
Phone Number. Home(68`� Sg3 - 3 3 Z6 Cell(6VZ) 573 33Z6
APPLICANT INFORMATION:
Name: 5 t<UMAYL C HTTT-K�L/q
Phone Number: Home (6 Pf) 593 331 G Cell { )
PROPERTY INFORMATION:
Project Address: a 06 /S C M IFIZIA L D sT/ A /J A 0 9-XM, C A ir �L
Development Type: (✓j Residential -New ( ) Residential - Room Addition ( ) Commercial:
I
( ) Single Family ( ) Mufti -Family Condos/Apartments # of units:
Project Name: G
COMMERCIAL:
RESIDENTIAL:
�3
Total Square Footage:
Total Square Footage:
Multiplied. by Current Rate
Multiplied by Current Rate
Elem.$ _$
,— l
Elem. $��y�j�,�=$ �U'ylo. Ca Z
Equals Tot = $
Equals Total Fee: $ _ $
FEE WAIVER:
Fees Waived:( ) Yes ) No If yes, reason:
ACKNOWLEDGEMENT:
he above respresentations as to square footage are true, Developer/Applicant agmesthat if it is later determined that such respresentations
are not true, Certificate shall automatically terminate and the appropriate City/9ty§iall be notified.
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
Date es tative -Anaheim Union High School District
ACTUAL FEES PAID: _
A E- ^l- 6 $ �. /} �/ • 6D7q' Check No. / LolL & �;'2y
�Z�
Anaheim Union H.S. Dist. $ CO2 Check No.
Distribution: Develooer/Aoolicant. AUHSD Accountine Deoartment. Elementary School District Accountine Department