Laserfiche WebLink
CPG # I TO: r ,-ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL � C <br /> O Fly <br /> ACCOUNT NO. DEPT. NO, REFERRA <br /> 026000.0 L <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> COPE MFG CO <br /> C/O NAME GUARANTOR SSN <br /> DAN MILLS& MIKE VALDEZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 20400 N KENNEFICK RD ACAMPO CA 95220 209-334-1999 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> P.O. DRAWER 2660 LODI CA 95241-2660 209-334-1999 <br /> PYMT USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMTnATF P B <br /> 8700 HAZMAT 1.3/1.5/09 <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 /> mn <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 Service Fee $24.00 IR <br /> AM <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 /> COPE MFG CO 209-334-1999 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 20400 N KENNEFICK RD ACAMPO CA 95220 <br /> SPANS& CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> 1 I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COPE MFG CO 209-334-1999 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 20400 N KENNEFICK RD ACAMPO CA 1 95220 <br /> REPARED BY CHECKED BY IRATE / aQ COL. 20 (3M) <br />