Laserfiche WebLink
CPG # TO: *CE OF REVENUE AND RECOVERY • <br /> ACCOUNT TRANSMITTAL REFERRATF-1 C <br /> © ��/] <br /> ACCOUNT NO. DEPT.NO. nATFV <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> APRIA HEALTHCARE <br /> C/O NAME GUARANTOR SSN <br /> APRIA HEALTHCARE <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 7514 MURRAY DR STOCKTON CA 95210 209-475-6860 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 26220 ENTERPRISE CT. REST CA. 92630 209-475-6860 <br /> USER REFERENCE NO. BILL STA CYCLES S M B INT MO LY PAY AMT <br /> 12119 HAZMAT 3/15/07 <br /> 4kysG <br /> LAST - RECIPIENT - FIRST MI'TITLE CI IE USER REFERENCE NO/NARRATIVE <br /> DO <br /> SERVICE DATE: DATE OF <br /> NO <br /> E23 <br /> STOP MED REC NO CHARGE \' <br /> DEPT.NO. DESCRIPTION AMOUNT CHARGE D PT O. DESCRIPTION AMOUNT <br /> 026000.0 2007 Hmmp Annual Fee $240.00 <br /> 1 Chem @ $15.00 Each $15.00 <br /> 10% Late Charge $25.50 <br /> State Service Fee $24.00 <br /> TOTAL $304.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> APRIA HEALTHCARE 209-475-6860 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 7514 MURRAY DR STOCKTON CA 95210 <br /> OFeffM CO—OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> APRIA HEALTHCARE 209-475-6860 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 7514 MURRAY DR STOCKTON CA 95210 <br /> PREPARED BY CHECKED BY JDATE COL. 20 tares <br /> 61 O 7 <br />