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Confirmation & Receipt <br />What You Paid <br />Successl 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 Filelocall 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 KUBRA service fee for processing the transaction has <br />been 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 />LReturn to FileLocal]. You will be able to view and print each form from the FileLocal website, if needed. <br />Form <br />Na rnv <br />Everett FileLocal User Fee ($4.00 per City Paid) <br />Everett GBL Application "Applied For" <br />KUBRA-Everett Convenience Fee <br />FileLocal <br />FileLocal User Fee ($4.00 per City Paid) <br />Amount Due <br />Filing Period Amount Due Payment Cont. it <br />Jun 2022 $90.00 03137G <br />non-refundable s2.24 00932G <br />non-refundable $4.00 02305G <br />.•.t, . 1 <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: <br />Payment Amount: <br />Card Number: <br />Cardholder Name: <br />Expiration Date: <br />Billing Zip Code: <br />$2.24 non-refundable <br />$96.24 <br />Visa #**********'9140 <br />Bryan K Vanden Bos <br />0327 <br />98027 <br />