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'?G ! TO: O"" CE OF REVENUE AND RECOVERY • <br /> Of ACCOUNT TRANSMITTAL /�(�\\�\� Pf <br /> ACCOUNT NO. DEPT.NO. REnATF FERRAL \.`1 <br /> 026000.0 9/10/02 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> RAMIREZ AUTOMOTIVE <br /> C/O NAME GUARANTOR SSN <br /> JUAN RAMIREZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 811 N SACRAMENTO ST LODI CA 95240 209-367-4332 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 315 S STOCKTON ST LODI CA 95240 209-367-4385 <br /> USER REFERENCE NO. BILL STAA CYCLE STATUS DATE BMd CBMC INT MONTHLY PAY AMTnt IF DATE I TERM DATE <br /> 6584 HAZMAT 6/24/02 <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 /> NONo <br /> 230 026000.0 2002 Hmmp Annual Fee $240.00 1 1 1 1 1 1 1 Business Owner: <br /> 3 Chems @ $15.00 Each $45.00 Juan Harnirez <br /> 10% Late Charge $28.50 <br /> TOTAL $313.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RAMIREZ AUTOMOTIVE 209-367-4332 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 811 N SACRAMENTO ST LODI CA 95240 <br /> SpotTSE CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB OR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RAMIREZ AUTOMOTIVE 209-367-4332 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 811 N SACRAMENTO ST LODI CA 95240 <br /> PREPARED BY. , �/ CHECK ^Y� DATE 9/1 n/09 <br />