OP CALIPONNIP

OP CALIPONNIP r~ca DEPARTMENT OF CONSUMER AFFAIRS ERIE Department of Consumer Affairs RECEIPT 23926646 Thank you for using the BreEZe System to submit your application. Name: SHULIAK, KARYNA Transaction Date: 05/09/2019 17:15 Application Number: Complaint Number: License Type: License Number: Payment Description: DDS - Renewal Application Fee Paid: (US $) 650.00 Remaining Balance: (US $) 0.00 Please print and save this receipt for your records. This receipt is provided as a record for the above named licensee/applicant. Illegal use or alteration of this receipt may result in criminal prosecution. EFTA00525485