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CPGl # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSNYITTAL » COPY <br /> ACCOUNT NO. DEPT.NO. REFERRAL - <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> BOYD'S DRIVE LINE SVC OF STKN <br /> C/O NAME GUARANTOR SSN <br /> KEN & CINDY BOYD <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> BOYD'S DRIVE LINE SVC OF STKN 1900 HERNDON RD CERES CA 95307 209-944-9966 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1421 CLINTON RD HUGHSON CA 95326 209-944-9966 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT <br /> WE 04TP TERM n"F- <br /> 13812 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE DATE OF <br /> START STOP EMED NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> NA <br /> 230 042000.0 2012 Hazmat Fee $270.00 8P43009.01 <br /> 30 1 014290010 1 Hazmat Penalty Fee $27.00219__ 04 00 .0 <br /> 8q42900,0 State Surcharge Fee $24.00 p8q , P43009.01 <br /> p8q 1 04290010 Electronic Surcharge Fee $25.00 p8qP43009.01 <br /> 801 110 2 90010 1 p8q4 00 .0 <br /> 80 0 2 00 0 8P43009.0,_, <br /> 80 0 2 00. 8q P43009.0,_, <br /> TOTAL $346.00 <br /> GUARANTOR <br /> PRIOR STREET CITY qT ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BOYD'S DRIVE LINE SVC OF STKN 209-944-9966 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 679E MINER AVE STOCKTON CA 95202 <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BOYD'S DRIVE LINE SVC OF STKN 209-944-9966 <br /> EMPLOYER STREET <br /> 679 E MINER AVE STO KTCA 95202 <br /> CHECKED <br /> BY T COL 20 (WBB) <br />