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cpi # TO: C 'ICE OF REVENUE AND RECOVERY <br /> .... ACCOUNT TRANSMITTAL *./ COPY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ARMOR FIRE EXTINGUISHER CO <br /> C/O NAME GUARANTOR SSN <br /> ARMOR FIRE EXTINGUISHER CO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1321 W OAK ST STOCKTON CA 95203 209-547-1937 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> SAME 209-649-4430 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMTR S <br /> 13915 HAZMAT 7/15/09 <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 CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2005-2009 Annual <br /> Hmmp Fee $1200.00 <br /> Imum <br /> 1 Chem @ $15.00 1 VA M law <br /> Each Year $75.00 . low, <br /> 10% Late Charge $127.50 <br /> State Surcharge Fee $24.00 <br /> TOTAL $1426.50 <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 /> ARMOR FIRE EXTINGUISHER CO 209-547-1937 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1321 W OAK ST STOCKTON CA 95203 <br /> SPOUS& CO–OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB I DR LIC NO I AUTO LIC NO <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ARMOR FIRE EXTINGUISHER CO 209-547-1937 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1321 W OAK ST STOCKTON — -C Z1O CA 95203 <br /> REPARED 8 1 CHECKED BY JDATE COL. 20 (3/BB) <br /> i <br />