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CPG # TO: OFF OF REVENGE AND RECOVERY cbpy <br /> �CCOUNT TRANSMITTAL <br /> ACCOUNTNO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> BEAR CREEK HIGH SCHOOL <br /> C/O NAME GUARANTOR SSN <br /> LODI UNIFIED SCHOOL DISTRICT <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> BEAR CREEK HIGH SCHOOL 1305 E VINE ST LODI CA 95240-3148 (209)331-7145 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1305 EAST VINE STREET LODI CA 95240-3148 (209)331-7000 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM [NJ MONTHLY PAY AMT n, FPY nATFPROB <br /> 13491 HAZMAT 1.7/1,5/08 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOINARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> mn 230 026000.0 2006-2008 Hmmp <br /> Annual Fee $720.00 <br /> 3 Chems @ $15.00 'by' 4r_LI <br /> Each Year $135.00 <br /> 10%Late Charge $85.50 <br /> State Surcharge Fee $24.00 <br /> TOTAL $964.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BEAR CREEK HIGH SCHOOL (209)331-7145 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> _j <br /> 10555 THORNTON RD STOCKTON CA 95209 <br /> SpQUrvr CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. I DOB I DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BEAR CREEK HIGH SCHOOL 1 (209)331-7145 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 10555 THORNTON RD STOCKTON I CA 95209 <br /> PREPARED.BY CHECKED BY IDATE / COL. 20 l3Ml <br />