Case Number Name Amount ($) 4.5% Convenience Fee($) Total to be charged($)

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Card Holder: Card Number: Card Exp Date: Receipt Email:
Person Name Cuxum, Sebastian Manuel
Drivers License
Drivers License #
Date Of Birth 01171979
Case Number MC19-0000282
Issue Date 06262019
Court Date 10212019
Offense Description 13A-6-132; DOMESTIC VIOLENCE 3RD
Total Fine 536.28
Date Paid
Auth Num