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CPG'# TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL c ��� ^y <br /> ACCOUNT NO. DEPT. f <br /> REFERRAL \1 /,(`v,\//\j 't`j�rJ) <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> HIGH SPEED TRANSMISSION <br /> C/O NAME GUARANTOR SSN <br /> SUSAN HANMORE <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 901 W FREMONT ST STOCKTON CA 95203 209-943_1590&209 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 935 JORANOLLO DRIVE TRACY CA 95376 209-943-1590 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PYM PRO11 <br /> 10233 HAZMAT 1. <br /> 3/20/10 <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 HARGE DEPT. NO. CRIPTION OUNT <br /> 230 026000.0 Sm Hw Gen <5tons/yr $213.00 <br /> 2010 Hazmat Fee $100.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee 1 $25.00 <br /> Hazmat Penalty Fee $10.00 <br /> 1 f <br /> TOTAL $372.00 <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 /> HIGH SPEED TRANSMISSION 209_943.1590&209 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 901 W FREMONT ST STOCKTON CA 95203 <br /> SPAUSS 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 /> HIGH SPEED TRANSMISSION 209-943-1590&209 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 901 W FREMONT ST ST TO I, ✓ CA 95203 <br /> PREPARED BY CHECKED BY ATE ,:�re d I COL. M (M.) <br />