Laserfiche WebLink
CPG # TO: 04W-E OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL �O Fy <br /> ACCOUNT NO. DEPT.NO. <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> TED'S WELDING&REPAIR <br /> C/O NAME GUARANTOR SSN <br /> BILL(GEORGE)BRAUN <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> TED'S WELDING&REPAIR P.O. BOX 726 VICTOR CA 95253 209-368-9864 OR <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> P.O. BOX 611 VICTOR CA 95253 209-365-9416 <br /> USER REFERENCE NO. I BILL STA CYCLE STATUS DATE BMd CBMC INT MONTHLY PAY AMT <br /> IF DAT RM DATE <br /> 2876 HAZMAT 4/15/06 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT DOB 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 2006 Hmmp Annual Fee $240.00 <br /> 5 Chems @ $15.00 Each $75.00 <br /> 10% Late Charge $31.50 <br /> State Service Fee $24.00 <br /> Sm Hw Gen <5 Tons/yr $200.00 L <br /> Permit Fee Penalty $200.00 <br /> TOTAL $770.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> TED'S WELDING& REPAIR 209-368-9864 OR <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 8932 E HWY 12 VICTOR CA 95253 <br /> 9ReUM CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> TED'S WELDING&REPAIR 209-368-9864 OR <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 8932 E HWY 12 VICTOR CA 95253 <br /> PREPARED BYI CHECKED BY JDATE � 7 , ( COL. 20 fX88 <br /> i N <br />