2011/01/01 Menifee Union School District Disbursement Request Form Sequence No. _
City SA# _.
EXHIBIT C
DISBURSEMENT REQUEST FORM
1. Menifee Union School District Community Facilities District No.2011-1
("CFD") is hereby requested to pay from Bond Proceeds to the City of Menifee ("City"), as
Payee,the sum set forth in 3 below.
2. The undersigned certifies that the amount requested for City Fee Facilities is due
and payable, has not formed the basis of prior request or payment, and is being made with
respect to the property described in Exhibit A to the Joint Community Facilities Agreement by
and among the Menifee Union School District, City of Menifee, Sutter Mitland 01,LLC et al
dated as of January 1,2011 (the"JCFA ).
3. Amount requested: $ GZ 1 ZW
For Tractllmprovement Area Lot Nos:
4. The amount set forth in 3 above is authorized and payable pursuant to the terms of
the JCFA. Capitalized terms not defined herein shall have the meaning set forth in the JCFA.
PROPERTY OWNER
By:
Name: ho
Title: J 5. Cr P
;;t=L Joc 05`b;Lp
ATTEST: CITY OF MENIF
/y By:
By: Name:
Clerk of the City Title:
cc: City Finance Dept.
12/17/10 9139.2
#%198 v4 C-1
Receipt#
Tract# 31391-F
Lot#s Lots 5.16 (12 lots)
�1
1 '7 - 19
Development Impact Fees
Acct Number Acct Description Fee #of units Total
500 3701 DIF 16-Pub Fac 1,207.00 0,00 0.00
501 3702 DIF 16-Fire 705.00 0.00 0.00
502 3703 DIF 16-Signals 420.00 0.00 0.00
503 3704 DIF 16-Parks 563.00 0.00 OW
504 3705 DIF 16-Trails 316.00 0.00 0.00
505 3706 DIF 16-Library 341.00 0.00 0.00
506 3708 DIF 16-Admin 46.00 0.00 0.00
507 3701 DIF 17-Pub Fac 1,207.00 12.00 14,484.00
508 3702 DIF 17-Fire 705.00 12.00 8,460.00
509 3707 DIF 17-Roads 1,564.00 12.00 18,768.00
510 3703 DIF 17-Signals 420.00 12.00 5,040.00
511 3704 DIF 17-Parks 563.00 12.00 6,756.00
512 3705 DIF 17-Trails 316.00 12.00 3,792.00
513 3706 DIF 17-Library 341.00 12.00 4,092.00
514 3708 DIF 17-Admin 69.00 12.00 828.00
62,220.00
620 3715 Quimby Fee 0.00 0.00
100 2294 Kangaroo Rat Fee 0.00 0.00 0.00
100 2295 Multi Species fee 1,938.00 12.00 23,256.00
Total Fees: $ 85,476.00
Receipt U
Tract# 31391-F
Lot Its Lots 5-16(12 lots)
Ict
Development Impact Fees
Acct Number Acct Description Fee k of units Total
5003701 DIF 16-Pub fat 1,207.00 0.00 0,00
501 3702 DIF 16-Fire 705.00 0.00 0.00
502 3703 DIF 16-Signals 420.00 0.00 0.00
503 3704 DIF 16-Parks 563.00 0.00 0.00
504 3705 DIF 16-Trails 316.00 0.00 0.00
505 3706 DIF 16-Library 341.00 0.00 0.00
506 3708 DIF 16-Admin 46.00 0.00 0.00
507 3701 DIF 17-Pub Fac 1,207,00 12.00 14,484.00
508 3702 DIF 17-Fire 705.00 12,00 8,460,00
509 3707 DIF 17-Roads 1,564.00 12.00 18,768.00
510 3703 DIF 17-Signals 420.00 12.00 5,040.00
511 3704 DIF 17-Parks 563.00 12.00 6,756.00
512 3705 DIF 17-Trails 316.00 12.00 3,792.00
S13 3706 DIF 17-Library 341.00 12.00 4,092.00
514 3708 DIF 17-Admin 69.00 12.00 828.00
62,220.00
620 3715 Quimby Fee 0.00 0100
100 2294 Kangaroo Rat Fee 0.00 0.00 0.00
100 2295 Multi Species Fee 1,938.00 12.00 23,256.00
Total Fees: $ 85,476.00
City of Menifee
Front Counter
29714 Haun Road
Menifee, CA 92586
951-672-6777
Welcome
000344-0004 Vanessa F 01/21/2014 10:16AM
PERMIT RECEIPTS
Payment Tran Code:
Development Impact Fees
(dif)
Description: TR 31391-F
Lots 5-16
Development Impact Fees 62,220.00
Payment Tran Code:
Building Permits
(bldgpermit)
Description: PT13-3137
Building Permits 3,335.04
Payment Tran Code:
Building Permits
(bldgpermit)
Description: PT13-3138
Building Permits 3,519.16
Payment Tran Code:
Building Permits
(bldgpermit)
Description: PT13-3139
Building Permits 679.P1
--------------
69,753.41
Subtotal 69,753.41
Total 69,753.41
CHECK 31,409.82
Check Number 50166165
CHECK 38,343.59
Check Number 50166166
--------------
Change due 0.00
Paid by: ** MULTIPLE
I