Laserfiche WebLink
CPG '# TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL O1�1. 14-C p <br /> n /JACCOUNT NO. DEPT. N�. REFERRAL V <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> GARLIC BROTHERS RESTAURANT& <br /> C/O NAME GUARANTOR SSN <br /> GREGORY RISSO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 6629 EMBARCADERO STOCKTON CA 95219 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> USER REFERENCE NO. IBILL TAT CYCLE STATUS DATEI BM CBM INT MONTHLY PAY AMT PYMT I PRIOR <br /> 13848 HAZMAT 3/20/10 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOMARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Kin I 230 026000.0 2010 Hazmat Fee $255.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $25.50 <br /> TOTAL $329.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I I I I I I I I I I I I I T, <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GARLIC BROTHERS RESTAURANT& BAR <br /> EMPLOYER STREET CITY ST �Zlp <br /> 6629 EMBARCADERO STOCKTON CA 95219 <br /> SPAS&To- CO—OWNER <br /> I.AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO I AUTO LIC NO <br /> I 1 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GARLIC BROTHERS RESTAURANT& BAR <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 6629 EMBARCADERO STOCK O I CA 95219 <br /> REPARED BY CHECKED BY ATE 0 COL. <br />