<?xml version="1.0" encoding="UTF-8"?>
<!--
     Electronic Court Filing 4.0 Portable Media Service Interaction Profile Version 2.0
     Committee Specification Draft 02 / Public Review Draft 01
     10 May 2011
     Copyright (c) OASIS Open 2011.  All Rights Reserved.
     Source: http://docs.oasis-open.org/legalxml-courtfiling/specs/ecf/v4.0/ecf-v4.0-portablemedia-spec/v2.0/csprd01/
-->
<PaymentMessage xmlns="urn:oasis:names:tc:legalxml-courtfiling:schema:xsd:PaymentMessage-4.0" xmlns:cac="urn:oasis:names:specification:ubl:schema:xsd:CommonAggregateComponents-2" xmlns:cbc="urn:oasis:names:specification:ubl:schema:xsd:CommonBasicComponents-2" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:oasis:names:tc:legalxml-courtfiling:schema:xsd:PaymentMessage-4.0 ../xsd/message/ECF-4.0-PaymentMessage.xsd">
	<FeeExceptionReasonCode>Inpauperis</FeeExceptionReasonCode>
	<FeeExceptionSupportingText>Filer in pauperis</FeeExceptionSupportingText>
	<PayerName>Mr. John Smith</PayerName>
	<cac:AllowanceCharge>
		<cbc:ID>1</cbc:ID>
		<cbc:ChargeIndicator>true</cbc:ChargeIndicator>
		<cbc:AllowanceChargeReason>Filing fee</cbc:AllowanceChargeReason>
		<cbc:PrepaidIndicator>false</cbc:PrepaidIndicator>
		<cbc:SequenceNumeric>1</cbc:SequenceNumeric>
		<cbc:Amount currencyID="USD">100.00</cbc:Amount>
		<cac:PaymentMeans>
			<cbc:PaymentMeansCode>2</cbc:PaymentMeansCode>
			<cbc:PaymentDueDate>2008-08-01</cbc:PaymentDueDate>
			<cbc:PaymentID>1001</cbc:PaymentID>
			<cac:CardAccount>
				<cbc:PrimaryAccountNumberID>999999999999999</cbc:PrimaryAccountNumberID>
				<cbc:NetworkID>AMEX</cbc:NetworkID>
				<cbc:ExpiryDate>2009-08-01</cbc:ExpiryDate>
				<cbc:CV2ID>9999</cbc:CV2ID>
				<cbc:CardChipCode>Chip</cbc:CardChipCode>
				<cbc:HolderName>Mr. John Smith</cbc:HolderName>
			</cac:CardAccount>
		</cac:PaymentMeans>
	</cac:AllowanceCharge>
	<cac:AllowanceCharge>
		<cbc:ID>1</cbc:ID>
		<cbc:ChargeIndicator>true</cbc:ChargeIndicator>
		<cbc:AllowanceChargeReason>Service fee</cbc:AllowanceChargeReason>
		<cbc:PrepaidIndicator>false</cbc:PrepaidIndicator>
		<cbc:SequenceNumeric>2</cbc:SequenceNumeric>
		<cbc:Amount currencyID="USD">100.00</cbc:Amount>
		<cac:PaymentMeans>
			<cbc:PaymentMeansCode>2</cbc:PaymentMeansCode>
			<cbc:PaymentDueDate>2008-08-01</cbc:PaymentDueDate>
			<cbc:PaymentID>1001</cbc:PaymentID>
			<cac:CardAccount>
				<cbc:PrimaryAccountNumberID>999999999999999</cbc:PrimaryAccountNumberID>
				<cbc:NetworkID>AMEX</cbc:NetworkID>
				<cbc:ExpiryDate>2009-08-01</cbc:ExpiryDate>
				<cbc:CV2ID>9999</cbc:CV2ID>
				<cbc:CardChipCode>Chip</cbc:CardChipCode>
				<cbc:HolderName>Mr. John Smith</cbc:HolderName>
			</cac:CardAccount>
		</cac:PaymentMeans>
	</cac:AllowanceCharge>
	<cac:Address>
		<cbc:ID>500</cbc:ID>
		<cbc:StreetName>Main St.</cbc:StreetName>
		<cbc:CityName>Seattle</cbc:CityName>
		<cbc:PostalZone>98101</cbc:PostalZone>
		<cbc:CountrySubentityCode>WA</cbc:CountrySubentityCode>
		<cac:AddressLine>
			<cbc:Line>500 Main St.</cbc:Line>
		</cac:AddressLine>
		<cac:Country>
			<cbc:IdentificationCode>US</cbc:IdentificationCode>
			<cbc:Name>United States</cbc:Name>
		</cac:Country>
	</cac:Address>
	<cac:Payment>
		<cbc:ID>1001</cbc:ID>
		<cbc:PaidAmount currencyID="USD">200.00</cbc:PaidAmount>
		<cbc:ReceivedDate>2008-08-01</cbc:ReceivedDate>
	</cac:Payment>
</PaymentMessage>
