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CPG # TO: VICE OF REVENUE AND RECOVERY ` copoy <br /> ACCOUNT TRANSMITTALACCOUNT NO. DEPT.NO. REFERRA02000.0 L <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> BAY INSULATION OF CALIFORNIA INC <br /> C/O NAME GUARANTOR SSN <br /> BAY INSULATION OF CALIFORNIA INC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> BAY INSULATION OF CALIFORNIA INC 2929 WALKER DR GREEN BAY WI 54311 209-234-1133 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO, <br /> P.O BOX 9229 GREEN BAY WI 54305 209-234-1133 <br /> USER REFERENCE NO. I BILL SjAj CYCLE STATUS DATE BMd CBMC INT I MONTHLY PAY AMT <br /> 12455 HAZMAT I I I I I I I I I I I I I 1 1 12/22/05 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENTOR 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 /> NONO <br /> 230 026000.0 2001 - 2005 limmp <br /> Annual Fee $1200.00 <br /> 1 Chem @ $15.00 r_ <br /> Each Year $75.00 <br /> 10% Late Charge $127.50 <br /> TOTAL $1402.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BAY INSULATION OF CALIFORNIA INC 209-234-1133 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4336 POCK LN#100 STOCKTON CA 95206 <br /> ffeS9H CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BAY INSULATION OF CALIFORNIA INC 209-234-1133 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4336 POCK LN#100 STOCKTON CA 95206 <br /> PREPARED BCWCHEC JDATE coy. zo �yaa <br />