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Credit CardReceipt TRANSACTION SUMMARY PAYMENT ITEM NPS Convenience Fee Building Dept TOTAL: TOWN OF WAPPINGER 20 Middlebush Rd Wappingers FaIIs,NY 12590 845-297-4158 LUCIEN CICIGLINE REFERENCE NUMBER Page 1 of 1 TRANSACTION TYPE: SALE AMOUNT $3.68 $150.00 $153.68 Transaction Number: 333253 Date Processed: 12/13/2012 10:01:42 EST Transaction Type: Credit Cazd MASTERCARD -Swiped CazdNumber. ************8221 Authorisation: 04328B Reference Number: ,~ 00819290 Building Dept $150.00 Total: t $150.00 t jJ I agree to pay ove totaGamotu~t according to th~card isspdr agreement. i J' r / q / Signature i. . ~.. `_ Y .. t NPS MUNICIPAY CONY FEE -TOWN OF WAPPINGER,~fVY 400 Technology Way // Scarborough,ME 04074 877-564-5656 LUCIEN CICIGLINE Transaction Number: 333253 Date Processed: 12/13/2012 10:01:42 EST Transaction Type: Credit Card MASTERCARD -Swiped CardNumber: * * * * * * * * * * * *8221 Authorization: 04330B Reference Number: ~ 00819291 Convenience Fee r 1 $3.68 Total: 1 ~ $3.68 I agree to pay ab ve total am unt ac ording to the c issuer agree t~ enders d this convenience fee will be char ed to allow m /~/ ,;il ~ ~ ~ 8 Y Payment via credit card. ' ~ ~ ° ~ ~ ~ ` ~ $ignatur - ~... ~ ~~G i ` 1... Printed: 12/13/2012 10:02:03 https://trx.npspos. com/payapp/app?component=%24DirectLink&page=Receipt&service=... 12/13 /2012