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CPG # T0: OFFICE OF REVENGE AND RECOVERY � � py <br /> ' ACCOUNT TRANSMITTAL <br /> 11 ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> B.V.O.S. INC <br /> C/O NAME GUARANTOR SSN <br /> ROBERT JIMENEZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> B.V.O.S. INC P.O. BOX 30366 STOCKTON CA 95213 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBMd IN MONTHLY PAY AMT <br /> 14232 HAZMAT 1 3/15/12 <br /> UkiPLKQiBb <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> TART STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 042000.0 2012 Hazmat Fee $285.00 8P43009.01 <br /> 30 014290010 Hazmat Penalty Fee $28.50 8 1043109.01 <br /> 8 42 00 0 State Surcharge Fee $24.00 8043009.01 <br /> 8 0 2 00 o Electronic Surcharge $25.00 6 1 P4 00 .0 <br /> 80 1 0 2 00 0 I p8q <br /> 80 0 290010 8 P43009.01 <br /> 80 1 0 2qi)O.p 1 P43009.01 <br /> TOTAL $362.50 <br /> GUARANTOR <br /> PRIOR STREET IT ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> B.V.O.S. INC <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1580 REPORT AVE STE1 STOCKTON CA 95213 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> B.V.O.S. INC <br /> EMPLOYER STREET CITY ST 71P r.OnF <br /> 1580 REPORT AVE STE�1 STO TON CA 95213 <br /> I CHECKED BY IDATE COL 20 (3/88) <br />