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UE AND <br /> CPG # _, To: 0ICE <br /> ACCOUNT NTRANSMITTAL <br /> RY • ��J <br /> C O lu( <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> IMPERIAL AUTO SPA IIIIIIIJIIII 1111 1 [ <br /> C/O NAME GUARANTOR SSN <br /> FRANK REYNOSO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1211 S TURNPIKE RD STOCKTON CA 95206 (209)405-6915 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3738 MYKALA DRIVE STOCKTON CA 95212 (209)405-6915 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PYMT PROB <br /> 14173 HAZMAT 1.11/15/09 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $70.00 <br /> 1 Chem @ $15.00 $15.00 <br /> 10% Late Charge $8.50 <br /> TOTAL $93.50 <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 /> IMPERIAL AUTO SPA (209)405-6915 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1211 S TURNPIKE RD STOCKTON CA 95206 <br /> S-POU4& CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO I AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> IMPERIAL AUTO SPA (209)405-6915 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1211 S TURNPIKE R ST K O CA 95206 <br /> REPARED BY CHECKED BY DATE (�, /p COL. 20 131881 <br />