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CP"G # TO: WCE OF REVENUE AND RECOVERY r <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. REFERRALnATF c (opy <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> DAN'S AUTO REPAIR <br /> CIO NAME GUARANTOR 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 STAA CYCLE STATUS DATE BM CBMC INT I MONTHLY PAY AMT <br /> 9131 HAZMAT 1 . 3115107 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOINARRATIVE <br /> DOS <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 2007 Hmmp Annual Fee $70.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $10.00 MR <br /> State Surcharge Fee $24.00 <br /> b <br /> VOW <br /> b TOTAL 4.00 <br /> GUARANTOR V <br /> �1 <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP COD <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DAN'S AUTO REPAIR 209-334-2969 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1533 S STOCKTON ST LODI CA 95240 <br /> opeom CO—OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC 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 /> 1533 S STOCKTON ST LODI CA 95240 <br /> PREPARED B I CHECKED BY IDATE ' 0 7 coL. zo we <br />