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Credit Card Kecelpt t'age 1 or 1 TRANSACTION SUMMARY TRANSACTION TYPE: SALE PAYMENT ITEM Building Dept NPS Convenience Fee TOTAL: REFERENCE NUMBER cas 8-30-10 AMOUNT $175.00 $4.29 $179.29 .............................................................................................................................................................................................................................................. TOWN OF WAPPINGER 20 Middlebush Rd Wappingers Falls,NY 12590 845-297-4158 MESBAHUDDIN FORKAN MASTERCARD - Swiped Auth #: 030251 Building Dept TOTAL CardNumber: ............3065 Ref#: 00424227 Timestamp: 08/30/2010 10:48:27 EDT $175.00 5175.00 I agree to pay above total amount according to the card issuer agreement. Sign: NPS MUNICIPA Y CONY FEE - TOWN OF WAPPINGER, NY 400 Technology Way Scarborough,ME 04074 877-564-5656 MESBAHUDDIN FORKAN MASTERCARD - Swiped Auth #: 030247 CardNumber: ............3065 Ref#: 00424228 Timestamp: 08/30/201010:48:27 EDT $4.29 54.29 Convenience Fee TOTAL I agree to pay abo~e otal oa;;~t.. ording to; the card is 6r a~pent & understand this convenience fee will be charged to allow my payment via credit card. . / . , ..~ -;:::'-,d .-?7"- Sign: .J ':'d/ ~ k'?? -1. " ~- ...... Printed: 08/30/201010:48:42 https://trx.npspos.comlpayapp/app? component=%24 DirectLink&page= Receipt&service=d... 8/30/2010