Laserfiche WebLink
CPG # TO: *CE OF REVENUE AND RECOVERY i <br /> ACCOUNT TRANSMITTAL co-py ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST M1 TITLE <br /> COMPLETE AUTO BODY&PAINT <br /> CIO NAME GUARANTOR SSN <br /> DAVID BEAKY JR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 335 E WETMORE ST #5MANTECA CA 95337-5700 209-825-7250 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-825-7250 <br /> USER REFERENCE NO. BILL STAI CYCLE STATUS DATE 13MO CBMCj INT I MONTHLY PAY AMTPYMT <br /> 9174 HAZMA7 1/24/05 <br /> -LLCHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> DOB <br /> SERVICE DATE: IDATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT NO DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NONO <br /> 230 025000.0 2005 Hmmp Annual Pee $240.00 <br /> 2 Chems ® $15.00 Each $30.00 <br /> 10% Late Charge $27.00 <br /> State Service Fee $24.00 <br /> Sm Hz Gen ¢5 Tons/yr $200.00 <br /> Permit Fee Penalty 1 $200-00 <br /> TOTAL $721.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COMPLETE AUTO BODY&PAINT 209-825-7250 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 335 E WETMORE ST#5 MANTECA CA 95337-5700 <br /> IgE CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIG NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COMPLETE AUTO BODY&PAINT 209-825-7250 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 335 E WETMORE ST#5 MANTECA CA 95337-5700 <br /> PREPARED BY CHECKED B DATE COL 20 W8 <br /> ? �-7 <br />