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CPG r TO: ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> FIVE STAR EXPEDITERS INC <br /> C/O NAME GUARANTOR SSN <br /> ARCHIE R MEND 11 <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> FIVE STAR EXPEDITERS INC P.O.BOX 30158 STOCKTON CA 95213 209-938-0117 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3661 WOOD DUCK CIRCLE STOCKTON CA 95207 209-938-0117 <br /> USER REFERENCE NO. BILL STA CYCLE STATUS DATE BMd CBMC INT MONTHLY PAY AMT <br /> 11245 HAZMIAT 3/15/06 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF U <br /> `''\/ <br /> START STOP MED REC NO CHARGE D �� <br /> CHARGE <br /> NO DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> Nn <br /> 230 026000.0 2003 - 2006 Hmmp <br /> Annual Fee $960.00 <br /> 9 Chems @ $15.00 <br /> Each Year $540.00 <br /> 10% Late Charge150 $150.00 <br /> State Surcharge Fee $24.00 <br /> TOTAL 1 $1674.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FIVE STAR EXPEDITERS INC 209-938-0117 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1617E MAIN ST STOCKTON CA 95205 <br /> SRASSi} CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FIVE STAR EXPEDITERS INC 209-938-0117 <br /> EMPLOYER STREET CITY ST ZIPCODE <br /> 1617 E MAIN ST STOCKTON CA 95205 <br /> PREPARED BY CHECK,?—Na,, <br /> _ - DATE Coy. 20 fa8e' <br /> ✓/9s�a�/o� <br />