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:UIN COUNTY <br /> MENTAL HEALTH DEPARTS `NT Page 1 <br /> ,-AIN STREET <br /> ATON, CA 95202 <br /> ie: (209)468-3420 <br /> INVOICE Account ID AR0030156 <br /> Facility ID FA0017274 <br /> Date Printed 5/1/2009 <br /> R&J DONDERO RE : R&J DONDERO <br /> 16299 E HWY 26 20120 E COPPEROPOLIS RD <br /> LINDEN, CA 95236 LINDEN, CA 95236 <br /> OWNER : R&J DONDERO <br /> Date Health <br /> Program Description Amount <br /> Invoice# IN0189332---Date of Invoice: 5/1/2009 I IIIIIII IIIIII III VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIIIII VIII IIII IIII <br /> 5/1/2009 2220 SM HW GEN<5 TONSNR $ 213.00 <br /> Total for this Invoice $ 213.00 <br /> Payment Due Date 5/31/2009 <br /> TOTAL DUE this Billing Period $ 213.00 <br /> Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT <br /> Penalties will be added to all Permit Fees For OES/HMMP Fees For all SERVICE FEES <br /> at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10% <br /> 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter <br /> 5254.rpt <br />