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CPG -# ' TO: OFFICE OF REVENUE AND RECOVERY - <br /> ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> FIREWORKS & STAGE FX AMERICA INC <br /> C/O NAME GUARANTOR SSN <br /> JOSEPH BARTOLOTTA <br /> MAILING STREET CITY ST ZIP DE AREA PHONE NO. <br /> FIREWORKS & STAGE FX AMERICA INC P.O. BOX 488 LAKESIDE CA 92040 619-938-8377 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> PO BOX 488 LAKESIDE CA 92040 619-938-8277 <br /> USER REFERENCE NO. 113ILL TAT ICYCLE ISTATUS DATEI BMd CBMd INTI MONTHLY PAY AMT <br /> 14330 HAZMAT 1. 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> r <br /> R ICE DATE: DATE OF <br /> STOP MED REC NO CHARGE <br /> DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> NR 042000.0 2012 Hazmat Fee $270.00 8 4 00 .0 042 000 Hazmat Penalty Fee $27.00 6 4 00 .01 1 <br /> 42 00o State Surcharge Fee $24.00 8 4 00 .00 2 00 o Electronic Surcharge $25.00 sP43009.01 <br /> 60 0 290010 8P43009.0 <br /> 8 014290010 8P43009.01 <br /> 8 0200 8 400 .0 <br /> TOTAL $346.00 <br /> GUARANTOR <br /> PRIOR STREET ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FIREWORKS & STAGE FX AMERICA INC 619-938-8377 <br /> EMPLOYER STREET CITY ST ZIP CODE - <br /> 32727 S CORRAL HOLLOW RD TRACY CA 95376 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FIREWORKS & STAGE FX AMERICA INC 619-938-8377 <br /> EMPLOYER STREET <br /> 32727 S CORRAL HOLO D T ACY CA 95376 <br /> C B COL. 20 (3188) <br />