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CtGT# TO: OFFICE OF REVENUE AND RECOVERY <br /> 3 <br /> ACCOUNT TRANSMITTAL Co [py ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ROCKITE CO <br /> CIO NAME I GUARANTOR SSN <br /> NEIL DAVIS <br /> MAILING STREET CITY ST ZIP.CODE AREA PHONE NO. <br /> 1550 SHAW RD #DSTOCKTON CA 95215 209-918-0815 <br /> RESIDENCE STREET CITY ST ZIP;CODE AREA PHONE NO. <br /> 4212 ELDENBERRY CT MODESTO CA. 95356 209-918-0815 <br /> USER REFERENCE NO, BILL TAT CYCLE STATUS DATE BMd CBMCI INTIMONTHLY PAY AMT <br /> 13907 HAZMAT 3115112 <br /> 3. <br /> LAST RECIPIENT FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> DOB <br /> SERVICE DATE OF <br /> TART STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NR <br /> 230 042000.0 2012 Hazmat Fee $255.00 p8q P4300P.0 <br /> 301 1 014290010 1 Hazmat Penalty Fee $25.50 p1q p4300?.0 <br /> �8q 1 942900,0 Skate Surcharge Fee $24.00 Bq P44009.01 <br /> p8q I 0 2 0D 0 I Electronic Surcharge $25.00 P84 <br /> ?8q I 02000 I p8q400 .0 <br /> 1 1 <br /> 8 02000 11 p8q400 .0 <br /> 8 0200. 13q P43009.0, <br /> TOTAL $329.50 <br /> GUARANTOR <br /> PRIOR STREET rITY ZIP CODE <br /> j. <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ROCKITE CO 209-918-0815 <br /> EMPLOYER STREET CITY !.ST ZIP CODE <br /> 1550 SHAW RD#D STOCKTON CA 95215 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I 1 ! <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ROCKITE CO 209-918-0815 <br /> EMPLOYER STREET rITY 'RT ZIP r,0QF <br /> 1550 SHAW RD#D SCA 95215 <br /> PRFPARFn BYC E D TE COL. 20{3188} <br />