Laserfiche WebLink
CPG # , TO: ICE OF REVENUE AND RECOVERY . COPY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> DAVID'S PIZZA INC <br /> C/O NAME GUARANTOR SSN <br /> DAVID CALDER <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> DAVID'S PIZZA INC 900 W BEN HOLT DR STOCKTON CA. 95207 209-957-2850 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1717 PORTOLA AVE. STOCKTON CA. 95207 209-475-0277 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMCBM INT MONTHLY PAY AMT PYMT PROB <br /> 13900 HAZMAT 7/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT, NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Annual Hmmp Fee $240.00 <br /> 1 Chem @ $15.00 $15.00 <br /> 10% Late Charge $25.50 <br /> State Surcharge Fee $24.00 <br /> TOTAL $304.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DAVID'S PIZZA INC 209-957-2850 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 900 W BEN HOLT DR STOCKTON CA 95207 <br /> SI OU" CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DAVID'S PIZZA INC 209-957-2850 <br /> EMPLOYER STREET CITY y ST ZIP CODE <br /> 900 W BEN HOLT DR STOCKTON, �� �fJ Q CA 95207 <br /> REPARED BY I CHECKED BY JDATE coy. zo Israel <br />