Laserfiche WebLink
CPG # TO: -'FICE OF REVENUE AND RECOVERY <br /> 4 ACCOUNT TRANSMITTAL y COPY <br /> ACCOUNT NO. DEPT. NO. QATC REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ALL TUNE&LUBE <br /> C/O NAME GUARANTOR SSN <br /> ALL TUNE& LUBE <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 543W GRANT LINE RD #213TRACY CA 95376 <br /> RESIDENCE STREET CITY ST ZIPCODE AREA PHONE NO. <br /> USER REFERENCE NO. BILL kTAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT I DI FPYnATFM TPAMQATP <br /> PROS <br /> 14087 HAZMAT 11/15/09 <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 /> wn <br /> 230 026000.0 2009 Hmmp Annual Fee $70.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $11.50 <br /> wp <br /> TOTAL $126.50 <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 /> ALL TUNE & LUBE <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 543 W GRANT LINE RD#213 TRACY CA 95376 <br /> SPOUS& CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ALL TUNE & LUBE <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 543 W GRANT LINE RD#213 TRACY 7 CA 95376 <br /> REPARED BY I 1 11 DATE �/� /15 coL. zo lareel <br /> .tel <br />