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CPG # TO: DICE OF REVENUE AND RECOVERYtopy ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> TONY'S AUTO SERVICE <br /> C/O NAME GUARANTOR SSN <br /> JOE M FRANCO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1951 S EL DORADO ST STOCKTON CA 95206 209-688-2255 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1951 S EL DORADO ST STOCKTON CA 95206 209-688-2255 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT PYMT PROS <br /> 5505 HAZMAT 11/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOMARRATIVE <br /> SERVICE DATE: DATE OF <br /> R233O <br /> STOP MED REC NO CHARGE <br /> DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 026000.0 2005 - 2009 Hmmp <br /> Annual Fee $350.00 <br /> 1 Chem @ $15.00 <br /> Each Year $75.00 <br /> 10% Late Charge $42.50 <br /> TOTAL $467.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> TONY'S AUTO SERVICE 209-688-2255 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1951 S ELDORADO ST STOCKTON CA 95206 <br /> &PAUSE- 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 /> TONY'S AUTO SERVICE 209-688-2255 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1951 S EL DORADOST STOC pN CA 95206 <br /> PREPARED BY CHECKED BY DATE ` / p COL. 20 (3188) <br />