1220 N KENWOOD PL, B1
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Anaheim Union High School District _ U 5Z
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(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. Returned checks (NSF) are subject to a $30.00 administrative fee.
RECEIPT NO.:
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
!P l 00Y
1 ,DES �
Anaheim Union High School District
OWNER INFORMATION:
Name: SMoA �_(IIY�fGI
Address: I -77 b
Phone Number: Home7l -p (,� (i .�� Z 08 Cell ( )
APPLICANT INFORMATION: \-
j4/ Name: °�v-2 e � O o-UJ
Phone Number: Home ( ) Cell ( )
PROPERTY INFORMATION:
Project Address:
Development Type: ( ) Residential -New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name:
COMMERCIAL:
RESIDENTIAL:
Square Footage:
Total Square Footage:
Total
Multipiled by Current Rate
Elem. $ -
Multipiled by Current Rate C7-�7• a
Elem. �,,___$
H.S. _$
H.S. 5r-1,L� $
Equals Total =$
Equals Total Fee:$ _$
FEE WAIVER:
Fees Waived: ( ) Yes �o If yes, reason:
ACKNOWLEDGEMENT:
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 terminate and the appropriate City/County shall 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. --
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Date resen ive - Anaheim Union High School District
ACTUAL FEES PAID: t�
E. s• i� 2 O D/3
. $ • Check No.
Anaheim Union H.S. Dist. $ e-"O.2- --2-0 Check No.
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department E