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Credit CardReceipt TRANSACTION SUMMARY Page 1 of 1 TRANSACTION TYPE: SALE PAYMENT ITEM REFERENCE NUMBER AMOUNT NPS Convenience Fee $3.00 Misc Cash $50.00 TOTAL: $53.00 TOWN OF WAPPINGER 20 Middlebush Rd Wappingers Falls,NY 12590 845-297-4158 ANDREA TROSIE Transaction Number: 354035 Date Processed: 01/23/2013 14:47:59 EST Transaction Type: Credit Card VISA -Swiped CazdNumber: * * * * ** * * * *""5019 Authorization: 202513 Reference Number: 00376893 Misc Cash $50.00 Total: $50.00 I agree to pay a veto oust ac ding to the suer agreement. . Signature: NPS MUNICIPAY CONV FEE -TOWN OF WAPPINGER, NY 400 Technology Way Scarborough,ME 04074 877-564-5656 ANDREA TROSIE Transaction Number: 354035 Date Processed: 01/23/2013 14:47:59 EST Transaction Type: Credit Cazd VISA -Swiped CazdNumber: *s*s****-***5019 Authorization: 096678 Reference Number: 00376892 Convenience Fee $3.00 Total: 53.00 I agree to above total oun accordin to the card iss a~eement & understand this convenience fee will be chazged to allow my payment via credit card. 14:48:08 hops://t~.npspos.com/payapp/app?component=%24DirectLink&page=Receipt&service=d... 1 /23/2013