Laserfiche WebLink
CPG # TO: ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. DATF <br /> REFERRAL <br /> 026000.0 8/8/03 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> COMPLETE AUTO BODY&PAINT <br /> CIO NAME GUARANTOR SN <br /> DAVID BEARY JR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 335 S 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 STA CYCLE STATUS DATE BMd CBMC INT I MONTHLY PAY AMT <br /> 9174 HAZMAT 111 , 7127103 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> onR <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> COPY <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION <br /> AMOUNT <br /> NO <br /> 230 026000.0 2003 Hmmp Annual Fee $240.00 <br /> 2 Chems @ $15.00 Each $30.00 reVlouls a errs: <br /> 10% Late Charge $27.00 <br /> TOTAL $297.00 <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 S WETMORE ST#5 MANTECA CA 95337-5700 <br /> speusH CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COMPLETE AUTO BODY&PAINT 209-825-7250 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 335 S WETMORE ST#5 MANTECA CA 95337-5700 <br /> PREPARED B CHECKED BYJ '/i DATE <br /> • •lam u� $18103 COL. 20 (3188 <br /> Ll.' G <br />