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Confirmation . Receol <br />Nhat 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 />(hank you for using FileLocal! The total payment will appear as multiple transactions paid to the appropriate Cities and FileLocal on <br />tour bank or credit card statement. The Amount Due for each form will be deposited to the appropriate City, and the non- <br />•efundabl.e User Fee(s) will be deposited to FileLocal. The non-refundable KUBRA service fee for processing the transaction has <br />)een added as 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 />iF <br />Filing Period Amount Due ftymwt Conf. <br />vote: The Payment Confirmation Number indicates that your payment was successfully authorized. Note that you may have more <br />:han one Payment Confirmation Number per City if that City separates funds into different receiving accounts. <br />NOTMUT-rEMPI <br />KLIBRA Service Fee: $1.24 non-refundable <br />Payment Amount: $46.74 <br />Card Number: Visa ************9972 <br />Cardholder Name: Melody Fosmore <br />Expiration Date: 0521 <br />Billing Zip Code: 98133 <br />NO <br />