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CPG # TO: ICE OF REVENUE AND RECOVERY <br /> a ACCOUNT TRANSMITTALCom y <br /> ACCOUNT NO. DEPT. NO. REFERRALil <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> RONALD E MCNAIR HIGH SCHOOL <br /> C/O NAME GUARANTOR SSN <br /> LODI UNIFIED HIGH SCHOOL <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO, <br /> RONALD E MCNAIR HIGH SCHOOL 1305 E VINE ST LODI CA 95240-3145 (209) 331-7213 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1305 EAST VINE STREET LODI CA 95240-3148 (209) 331-7000 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PYMT PR B <br /> n,1F n ATF TERM nATF: <br /> 13492 HAZMAT 1.3/15/09 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Nn <br /> 230 026000.0 2009 Annual Fee $240.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $28.50 <br /> State Surcharge Fee $24.00 <br /> TOTAL $337.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RONALD E MCNAIR HIGH SCHOOL (209)331-7213 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 9550 E MCNAIR WAY STOCKTON CA 95210 <br /> SPOUSE- CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RONALD E MCNAIR HIGH SCHOOL (209) 331-7213 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 9550 E MCNAIR WAY STOCKTON CA 95210 <br /> PREPARED BYI CHECKED BY IDATE2 <br /> � COL. 20 (3M6) <br />