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CPG # TO: 'ICE OF REVENUE AND RECOVERY , <br /> 4 ACCOUNT TRANSMITTAL Copy <br /> ACCOUNT NO. DEPT.NO. DATE REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> RELIANCE EXPRESS INC <br /> C/O NAME GUARANTOR SSN <br /> AVTAR S DEOL <br /> MAILING STREET CITY ST ZIPCODE AREA PHONE NO. <br /> RELIANCE EXPRESS INC 793 S TRACY BLVD TRACY CA 95376 209-321-6140 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1333 GRAY FOX PL STOCKTON CA 95215 209-469-5011 <br /> USER REFERENCE NO. I BILL S11 CYCLE STATUS DATE BMI CBMC INT I MONTHLY PAY AMTQUF DATE TERM DATE <br /> 10669 HAZMAT 2/23/05 <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 /> NONO <br /> 230 026000.0 2005 Hmmp Annual Fee $70.00 <br /> 1 Chem @ $15.00 $15.00 <br /> 10% Late Charge $8.50 <br /> State Service Fee $24.00 <br /> TOTAL $117.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RELIANCE EXPRESS INC 209-321-6140 <br /> EMPLOYER STREET CITY ST ZIPCODE <br /> 1919 E CHARTER WAY STE B STOCKTON CA 1 95205 <br /> SPe8SH CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RELIANCE EXPRESS INC 209-321-6140 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1919 E CHARTER WAY STE B STOCKTON CA 95205 <br /> PREPARED BY I CHECKED BY DATE �/ d9 n_5-.- COL 20 Iare8 <br />