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Cp(r y TO: WICE OF REVENUE AND RECOVERY • <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. REFERRALCOPY <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> DAN'S AUTO REPAIR <br /> CIO NAMEGUARANTOR SSN <br /> DAN HOUSTON <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1533 S STOCKTON ST LODI CA 95240 209-334-2969 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-334-2969 <br /> USER REFERENCE NO. BILL STAI CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT "y IIHOB <br /> DUE DATE TFRM D&IF <br /> 9131 HAZMAT till , it I I 1 3115108 <br /> CHARGES <br /> LAST - RECIPIENT FIRST MI TITLE RECIPIENTDOR USER REFERENCE NOMARRATIVE <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 2008 Hmmp Annual Fee $70.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $10.00 in Ift <br /> State Surcharge Fee $24.00 min <br /> TOTAL $134.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST I ZIP CODE <br /> 1 .1 -1 -1--1 1 1 11 1111 tillil 11 IIIII . Lil Id <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DAN'S AUTO REPAIR 209-334-2969 <br /> EMPLOYER STREET CITY ST I ZIP CODE <br /> 1533 S STOCKTON ST LODE CA 95240 <br /> &PeBOB CO-OWNER <br /> LAST FIRST MI TITLE1 SOC SEC NO. DOS DR LIC NO AUTO LIG NO <br /> HOUSTON PAULA <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DAN'S AUTO REPAIR 209-334-2969 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1633 S STOCKTON ST LODI CA 1 95240 <br /> PREPARED BY CHECKED BYDATE COL 20 13/88 <br />