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CPG # TO: ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL, D Y7 <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> DATIF <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> TWO RIVERS R.V. PARK <br /> C/O NAME GUARANTOR SSN <br /> GEORGETURKMANY <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 31021 TWO RIVERS RD MANTECA CA 95337-9468 209-825-1079— <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 31021 TWO RIVERS RD. MANTECA CA 95337-9468 209-823-8434 <br /> USER REFERENCE NO. BILL STA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> 12065 Hp,ZMAT 2/23/05 <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. CHARGE <br /> NO DESCRIPTION AMOUNT DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2000 -2005 Hmmp NO <br /> Annual Fee $1440.00 <br /> 1 Chem @ $15.00 <br /> Each Year $90.00 <br /> 10% Late Charge $153.00 <br /> State Service Fee $24.00 <br /> TOTAL $1707.00 <br /> GUARANTOR <br /> DOB �NOAUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> TWO RIVERS R.V. PARK 209-825-1079 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 31021 TWO RIVERS RD MANTECA CA 95337-9468 <br /> SFeBS�' CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> TWO RIVERS R.V.PARK 209-825-1079 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 31021 TWO RIVERS RD MANTECA CA 95337-9468 <br /> REPARED BY CHECKED BY DATE <br /> � � y zy ��' SOL. 20 (y88 <br />