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4/4/2019 KUBRA i-Doxs VBS \9 0(4 <br /> Confirmation & Receipt <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-refundable <br /> User Fee(s)will be deposited to FileLocal.The non-refundable KUBRA service fee for processing the transaction has been added as <br /> shown below and will be retained by the payment processor, KUBRA. <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 Cant <br /> Name <br /> Everett FileLocal User Fee($4.00 per City Paid) <br /> Everett GBL Application "Applied For" Apr 2019 $83.00 07711G <br /> KUBRA-Everett Convenience Fee non-refundable $2.49 00846G <br /> FileLocal <br /> FileLocal User Fee($4.00 per City Paid) non-refundable $4.00 09141G <br /> Amount Due $89.49 <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 /> KU BRA Service Fee: $2.49 non-refundable <br /> Payment Amount: $89.49 <br /> Card Number: Visa ************5046 <br /> Cardholder Name: Jeremy H Wilson <br /> Expiration Date: 0623 <br /> Billing Zip Code: 98402 <br /> https://secure8.i-doxs.net/FILELOCAUOneTimeAdd.aspx 1/1 <br />