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CPG # T0: l ICE OF REVENUE AND RECOVERY COPY <br /> ACCOUNT TRANSMITTAL v <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> PIZZA FACTORY <br /> C/O NAME GUARANTOR SSN <br /> DANIEL NEHER <br /> 11 <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> PIZZA FACTORY P.O.BOX 1700IONE CA 95640 209-607-7787 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 14088 E HWY 88 LOCKEFORD CA 95237 209-607-7787 <br /> USER REFERENCE NO. I BILL STA CYCLE STATUS DATE BlAd CBMC INT MONTHLY PAY AMT I Dt IF DATE TERM DATE <br /> 13089 HAZMAT 12/15/07 <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 2006 Hmmp Annual Fee $240.00 <br /> 1 Chem @ $15.00 Each $15.00 ddk <br /> 10% Late Charge $25.50 <br /> Restaurant/bar Seats $240.00 <br /> TOTAL $520.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PIZZA FACTORY 209-607-7787 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 14088 E HWY 88 LOCKEFORD CA 95209 <br /> 9F8USB CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PIZZA FACTORY 209-607-7787 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 14088 E HWY 88 LOCKEFORD CA 95209 <br /> PREPARED BY I CHECKED IS Y '7t..te DATE $' DO coy. 20 was <br />