Laserfiche WebLink
'CPG TO: FICE OF REVENUE AND RECOVERY <br /> W ACCOUNT TRANSMITTAL ccS <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> I I QATF ply <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI 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 /> PYMT <br /> USER REFERENCE NO. BILL STA4 CYCLE STATUS DATE BMd CBMC INT MONTHLY PAY AMT <br /> 9174 HAZMAT 4/15/04 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENTDOB 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 /> NO <br /> 230 026000.0 2004 Hmmp Annual Fee $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 $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 /> &Pebx90 CO-OWNER <br /> LAST FIRST MI TITLE 5OC 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 v CHECKED BY" DATE r71� COL. 2Q (wad <br /> t <br />