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C?G` # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL + <br /> •s ACCOUNT NO, DEPT. NO " REFERRAL V <br /> 026000.0 C.(Dpy <br /> " <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST . MI TITLE <br /> LEXINGTON PLAZA <br /> CIO NAME GUARANTOR SSN <br /> LEXINGTON HOTELS <br /> MAILING STREET CITY ST ZIP CODE AREA" PHONE NO. <br /> LEXINGTON PLAZA 900 UNIVERSITY AVE SACRAMENTO CA 95825-6737 209-323-3111 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 110 W FREMONT ST STOCKTON CA 95202 209-944-1140 <br /> USE=R REFERENCE NO. SILL TAT CYCLE STATUS DATE BMC CBM INT MONTHLY PAY AMT PYMT PROB <br /> r)1 If=nATE TERRA DATE <br /> 14228 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 AEC NO CHARGE <br /> CHARGE DEPT. NO. - DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> Nfn230 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 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> LEXINGTON PLAZA 209-323-3111 <br /> EMPLOYER STREET CITY ST ZIP CODE " <br /> 110 W FREMONT ST STOCKTON CA 95202 <br /> -9-POWIS& CO=OWNER <br /> AST FIRST' MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> 'LEXINGTON PLAZA 209-323=3111 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 110 W FREMONT ST Z14K CA 95202 <br /> PREPARED BY CHECKED BY JDATE �'/��/� COL. 20(3188) <br />