Laserfiche WebLink
CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> a` 0 <br /> ACCOUNTNO. DEPT. N�. REFERRAL <br /> 026000.0 O ipy <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> AD FORCE PRIVATE SECURITY <br /> C/O NAME GUARANTOR SSN <br /> GEORGE GARCIA <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> AD FORCE PRIVATE SECURITY P.O. BOX 55331 STOCKTON CA 95205 209-465-8420 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO, <br /> 209-465-8420 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT <br /> 8665 HAZMAT 3/15/12 <br /> CHAvGz <br /> zi <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERV CE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO, DESCRIPTION AMOUNT CHARGE DEPT.NO, DESCRIPTION AMOUNT <br /> 230 042000.0 2012 Hazmat Fee $85.00 8P43009.01 <br /> 30 1 014290010 1 Hazmat Penalty Fee $8.50 219 P4300P.0 <br /> p8q I q429OOrO State Surcharge Fee $24.00 p8q <br /> 1 1 <br /> 8 0 2 0010 1 Electronic Surcharge Fee $25.00 Bq 1 P43009.01 <br /> 80 1 014290010 8q P437009.01 <br /> 80 0 2 000 1 p8q P4300P0 <br /> 80 0 2 00. 8 4 00 .0 <br /> GUARANTOR TOTAL $142.50 <br /> PRIOR STREET CITY ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> AD FORCE PRIVATE SECURITY 209-465-8420 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3108 CHERRYLAND AVE STOCKTON CA 95215 <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> AD FORCE PRIVATE SECURITY 209-465-8420 <br /> EMPLOYER STREET <br /> 3108 CHERRYLA V ST KTON CA 95215 <br /> CHECKED BY IDATE <br /> COL. 20 ca/eal <br />