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CPG # TO: CE OF REVENUE AND RECOVERY <br /> OF^I �� <br /> ' ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. nATr REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CAR QUEST <br /> C/O NAME GUARANTOR SSN <br /> GOLDEN STATE SUPPLY <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1645 E MINER AVE STOCKTON CA 95205 209-943-1000 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 34928 MC MURTREY WAY BAKERSFIELD CA 93305 209-943-1000 <br /> USER REFERENCE NO. BILL ISTAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT I PYMT PROB <br /> 12410 HAZMAT 2/28/09 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 Hmmp 10% Late Charge $25.50 <br /> TOTAL $25.50 <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 /> CAR QUEST 209-943-1000 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1645 E MINER AVE STOCKTON CA 95205 <br /> SPOU59 CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CAR QUEST 209-943-1000 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1645 E MINER AVE STOCKTON CA 1 95205 <br /> REPARED CHECKED 8 DATE -- �� COL. 10 (9re61 <br />