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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL '44 c O py ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> EXEL(FRONTIER) <br /> C/O NAME GUARANTOR SSN <br /> EXELINC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> EXEL(FRONTIER)4512 FRONTIER WAY STOCKTON CA 95215 209-518-1226 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 570 POLARIS PARKWAY WESTERVILLE OH 43082 614-865-8500 <br /> USER REFERENCE NO. I BILL TAT ICYCLE STATUS DATE BMd CBMd IN MONTHLY PAY AMT 1 01 IE DATE I TERM OATZ, <br /> 12036 HAZMAT I 1 11 11 1 1 1 1 1 1 1 1 1 1 1 1. 3/15/12 <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 /> 230 042000.0 2012 Hazmat Fee $300.00 8 4 00 .0 <br /> 30 1 042 00 0 I Hazmat Penalty Fee $30.00 P891043009.01 <br /> p8q q429OOrO State Surcharge Fee $24.00 13q 1 P43009.01 <br /> p8q 0 2 00 0 Electronic Surcharge Fee $25.00 p8q <br /> 1 1 <br /> 80 1 01,1290010 BP43009-01 <br /> Bo 1 o 290010 6P43009.01 <br /> ao o 2qOO-p p8q <br /> TOTAL $379.00 <br /> GUARANTOR <br /> PRIOR STREET CITY sT ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> EXEL(FRONTIER) 209-518-1226 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4512 FRONTIER WAY STOCKTON CA 95215 <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 /> EXEL(FRONTIER) 209-518-1226 <br /> EMPLOYER STREET CITY QQDF <br /> 4512 FRONTIER WAY ST C T N CA 95215 <br /> CHECKED BY IDATE coL m 16/66I <br />