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Receipt Page 1 of 1 TRANSACTION SUMMARY TRANSACTION TYPE: SALE PAYMENT ITEM NPS Convenience Fee Mise Cash TOTAL: REFERENCE NUMBER AMOUNT $1.50 $30.00 $31.50 ..................................................................................11............................'11........................................................................................................................... TOWN OF WAPPINGER 20 Middlebush Rd Wappingers Falls,NY 12590 845-297-4158 CONNIE DERASMO .............................................................................................................................................................................................................................................. Transaction Nwnber: Date Processed: Transaction Type: MASTERCARD - Swiped Authorization: Rererenee Nwnber: Mise Cash Total: 224474 0311412012 14:35: II EDT Credit Card CardNwnber: ............9632 451389 00813985 $30.00 $30.00 I ~gree to pay ~Ording 6'e card issuer agreement. SIgnature: f. #. ----?-___ NPS MUNICIPA Y CONY FEE - TOWN OF WAPPINGER, NY 400 T eebnology Way Scarborough,ME 04074 877-564-5656 CONNIE DERASMO ..........................................................................................................11.................................................................................................................................. Transaction Nwnber: Date Processed: Transaction Type: MASTERCARD - Swiped Authorization: Reference Nwnber: Convenience Fee Total: 224474 031141201214:35:11 EDT Credit Card CardNwnber: ............9632 451388 00813981 $1.50 $1.50 I agree to pay above total amount according to card issuer agreement & understand this convenience fee will be charged to allow my payment via credit card. Signature: Printed: 031141201214:35:15 https:/ /trx.npspos.com/payapp/app?component=%24 DirectLink&page=Receipt&service=d... 3/14/2012