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CPG # TO: ''ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL *./ c O rj- y <br /> ACCOUNT NO. DEPT. NO. REFERRAL IL�11� ►L!1 <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ROOF RANGERS <br /> C/O NAME GUARANTOR SSN <br /> PATRICK W MAPLE <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> ROOF RANGERS P.O. BOX 5114 GALT CA 95632 209-745-5753 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> PO BOX 5114 GALT CA 95632 209-745-5753 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT PYMT PR <br /> OBI13547 HAZMAT 12/15/08 <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. DESCRIPTION AMOUNT <br /> mn <br /> 230 026000.0 2006- 2008 Hmmp <br /> Annual Fee $720.00 <br /> 3 Chems Co) $15.00 I <br /> Each Year $135.00 <br /> 10% Late Charge $85.50 (, <br /> TOTAL $940.50 <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 /> ROOF RANGERS 209-745-5753 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 129 HOOPER DR STOCKTON CA 95203 <br /> SPOUS& CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO I DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ROOF RANGERS 209-745-5753 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 129 HOOPER DR STOCKTON CA 95203 <br /> REPARED BY CHECKER BY DATE Coy. 20 (3,88) <br />