Laserfiche WebLink
CPG # TO: FICE OF REVENUE AND RECOVERY <br /> 40 ACCOUNT TRANSMITTAL ! COPY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> JASON'S WHOLESALE <br /> C/O NAME GUARANTOR SSN <br /> JASON MATECKI <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2444 STATION DR STE DSTOCKTON CA 95215 209-345-4371 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1369 SANTONA ST. MANTECA CA 95337 209-345-4371 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT P M PROS <br /> 14594 HAZMAT 11/15/11 <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 /> 230 042000.0 2011 Hazmat Fee $285.00 380 042000.0 <br /> 230 042000.0 Hazmat Penalty Fee $28.50 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> TOTAL $313.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JASON'S WHOLESALE 209-345-4371 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2444 STATION DR STE D STOCKTON CA 95215 <br /> CO-OWNER <br /> I.AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JASON'S WHOLESALE 209-345.4371 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2444 STATION DR STE DST KTON CA 95215 <br /> REPARED BY CHECKED BY JDATE COL. M (sre8) <br />