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.:PG # TO: ICE OF REVENUE AND RECOVERY <br /> � ACCOUNT TRANSMITTAL �0 n�/] <br /> ACCOUNT NO. DEPT.NO. REFERRAL LLL+fffrJ U <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST <br /> MI TITLE <br /> TOKAY HIGH SCHOOL <br /> C/O NAME GUARANTOR SSN <br /> LODI UNIFIED SCHOOL DISTR7CA <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1111 W CENTURY BLVD LODI !952!40 209-331-7935 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1305 E VINE ST LODI CA 95240 209-331-7000 <br /> 11 PROS <br /> USER REFERENCE NO. I BILLI STA CYCLEI STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> TERM DATE <br /> 1403 t{gZMAT 3/15/07 <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 <br /> NO — NQ DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2007 Hmmp Fee $240.00 <br /> 4 Chems @ $15.00 Each $60.00 <br /> 10% Late Charge $30.00 <br /> State Service Fee $24.00 <br /> Sm Hw Gen <5 Tons/yr $206.00 <br /> Permit Fee Penalty $206.00 <br /> TOTAL $766.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE <br /> TOKAY HIGH SCHOOL 209-331-7935 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1111 W CENTURY BLVD LODI CA 95240 <br /> OF898H CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> TOKAY HIGH SCHOOL 209-331-7935 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1111 W CENTURY BLVD LODI CA 95240 <br /> PREPARED BCf� // CHECKED B IDATE ' v <br /> COL. 20 (MR- <br />