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10/24/2017 KUBRA i-Doxs VBS <br /> Confirmation & Recallit <br /> What You Paid <br /> Success! You have paid for all the items listed below. Your forms have been filed with the corresponding City/Cities shown. <br /> Thank you for using FileLocal! The total payment will appear as multiple transactions paid to the appropriate Cities and FileLocal on <br /> your bank or credit card statement. The Amount Due for each form will be deposited to the appropriate City, and the non- <br /> refundable User Fee(s) will be deposited to FileLocal. The non-refundable convenience fee for processing the transaction has been <br /> added as shown below and will be retained by the payment processor, KUBRA. <br /> • <br /> An email confirmation will be sent to you by FileLocal. You may print this screen as your receipt, if desired. When finished, click <br /> [Return to FileLocal]. You will be able to view and print each form from the FileLocal website, if needed. <br /> Form Filing Period Amount Due Payment Conf # <br /> Name <br /> Everett FileLocal User Fee ($4.00 per City Paid) <br /> Everett GBL Application "Applied For" <br /> Oct 2017 $39.00 061946 <br /> KUBRA-Everett Convenience Fee non-refundable $1.17 061947 <br /> FileLocal <br /> FileLocal User Fee ($4.00 per City Paid) <br /> non-refundable $4.00 M ^mvµ061945 <br /> Amount Due $4417 <br /> Note:The Payment Confirmation Number indicates that your payment was successfully authorized. Note that you may have more <br /> than one Payment Confirmation Number per City if that City separates funds into different receiving accounts. <br /> How You Paid <br /> KUBRA Service Fee: $1.17 non-refundable <br /> Payment Amount: $44.17 <br /> • <br /> Card Number: Visa ************7104 <br /> Cardholder Name: Thomas Jordan <br /> Expiration Date: 1221 <br /> Billing Zip Code: 98103 <br /> https://secure8.i-doxs.net/FILELOCAUOneTimeAdd.aspx 1/1 <br />