Laserfiche WebLink
CPG # TO: ^PFICE OF REVENUE AND RECOVERY � 0 py <br /> ACCOUNT TRANSMITTAL '' V <br /> ACCOUNT NO. nATP <br /> NMI <br /> EFERRAL <br /> LAST - GUARANTOR - FIRSTLE LAST - AKA - FIRST MI TITLE <br /> BR EN ICK MECHANICAL <br /> C/O NAME GUARANTOR SSN <br /> RICK ABRAHAMSON <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> BRENICK MECHANICAL 1040 W KETTLEMAN LN 1B-142 LODI CA 95240 209-334-1960 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1040 W. KETTLEMAN LN. 1B-142 LODI CA 95240 209-334-1960 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE M CBMC INT MONTHLY PAY AMT <br /> PYMT PR B <br /> B <br /> 14644 HAZMAT 11/15/11 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENTUSER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGEKDEPT DESCRIPTION AMOUNT <br /> 230 042000.0 Hazmat Penalty Fee $51.00 380230 0420000 ( 380380 042000.0 380 <br /> 380 042000.0 380 042000.0 <br /> 380 042000.0 380 042000.0 - <br /> 380 042000.0 1 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> TOTAL $51.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BRENICK MECHANICAL 209-334-1960 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1040 W KETTLEMAN LN 1 B#142 LODI CA 95240 <br /> 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 /> BRENICK MECHANICAL 209-334-1960 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1040 W KETTLEMAN LN 1B#14 LODI CA 95240 <br /> PREPARED BY CHECKED BY JDATE COL. 20 (3/M) <br />