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CPG # TO: ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL (� � )) <br /> ACCOUNT NO. DEPT. NO. REFERRAL colry 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ALL AMERICAN MUFFLER& <br /> -C/O NAME GUARANTOR SSN <br /> CHRIS ORTEGA <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO, <br /> 720 E HAMMER LN STE B-4STOCKTON CA 95210 209-993-6003 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2410 MODOC WAY LODI CA 95242 209-993-6003 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PYMTAT, PROS <br /> TFRMnATr <br /> 12462 HAZMAT I 1 11 11 1 1 1 1 1 1 1 1 1 1 1 1.3/1.5/019 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATQQR <br /> IVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Nn <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $28.50 <br /> State Surcharge Fee $24.00 <br /> TOTAL $337.50 <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 AMERICAN MUFFLER & PERFORMANCE INC 209-993-6003 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 720 E HAMMER LN STE B-4 STOCKTON CA 95210 <br /> SPOU" 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 AMERICAN MUFFLER & PERFORMANCE INC 209-993-6003 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 720 E HAMMER LN STE B-4 STOCKTON CA 95210 <br /> REPARED B G CHECKED BY DATE 2}y O/ COL. 20 (3/88) <br />