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72823, 10:03 AM KUBRA i-Doxs VBS <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- <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 />[Return to FileLocal]. You will be able to view and print each form from the FileLocal website, if needed. <br />Form Name <br />Everett FileLocal User Fee ($4.00 per City Paid) <br />Everett GEL Application "Applied For" <br />KUBRA-Everett Service Fee <br />FileLocal <br />FileLocal User Fee ($4.00 per City Paid) <br />Amount Due <br />Filing Period Amount Due Payment Conf. # <br />Jul 2023 $50.00 028102 <br />non-refundable $1.25 028590 <br />non-refundable $4.00 028352 <br />$55.24 <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 />$1.24 non-refundable <br />$55.24 <br />Visa ************6269 <br />Kumar Koneru <br />1123 <br />91730 <br />https://secure8.i-doxs.net/FILELOCAL/0neTimeAdd.aspx 1/1 <br />