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CPG TO: --FICE OF REVENUE AND RECOVERY i <br /> ACCOUNT TRANSMITTAL L. f <br /> ACCOUNT NO. DEPT.NO. REFERRALD <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> MOONLIGHT AUTO <br /> C/O NAME GUARANTOR SSN <br /> JOSE ROMERO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2560 S EL DORADO ST STOCKTON CA 95206 . 209-688.3247 <br /> RESIDENCE STREET CITY ST` ZIP CODE AREA PHONE NO. <br /> STOCKTON CA 95206 209-547-8996 <br /> USER REFERENCE NO, BILL STAT CYCLE STATUS DATE BMC CBMC INT MONTHLY PAY AMT hjjpnAT= <br /> T PROS <br /> 13464 HAZMAT 3/15109 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE: RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: <br /> DATE 01= <br /> E START STOP MED REG NO CHARGE <br /> l <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION -AMOUNT <br /> plin <br /> 230 026000.0 2009 Hmmp Annual Fee $70.00 <br /> 4 1 Chem @ $15.00 $15.00 <br /> 10% Late Charge $8.50 <br />` State Surcharge Fee $24.00 <br /> TOTAL $117.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST 71P CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHOJEN <br /> MOONLIGHT AUTO 209-688-3247 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2560 S ELDORADO ST STOCKTON CA 95206 <br /> SPAUS& 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 /> MOONLIGHT AUTO 209-688-3247 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2560 S EL DORADO ST STOCKTON <br /> CA 9 06 <br /> PREPARED BY 1 CHECKED BY JiWTE / COL. 20 (3188) <br /> �- C7L <br />