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TOt OFFICE OF THE COLLECT <br /> CPG # <br /> ACCOUNT TRANSMITTAL- <br /> -- . <br /> ACCOUNT NO. DEPT. NO. AT <br /> LAST - GUARANTOR - FIRST MI TITLE <br /> / LAST - AKA - FIRST MI TITLE <br /> ASKLQF BOB <br /> C/O NAME GUARANTOR SSN <br /> EMEVTA G E, <br /> .L CITU ST ZIP CODE AREA PHONE NO. <br /> MAILING STREET <br /> PO BOX 288 LOCKFORD 11 95 7 2 7 5 3 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> I <br /> LODI A 95240 2 9 33 11 31 <br /> _ PVMT PROE <br /> USER REFERENCE NO. <br /> BILLSTA OY STATUS DATE M OE INT MONTHLY PAY AMT WE DATE TERM DATE <br /> CLE <br /> CLEME33 <br /> CHARGES <br /> MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> LAST - RECIPIENT - FIRST DOS <br /> I I I I <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> HARG DESCRIPTION AMOUNT HARG E DEPT NO DESCRIPTION <br /> NO <br /> 1986 UGST FEES 300 1:00 <br /> SUFEME <br /> 9 I I I I I I I I I I I I I I I I I <br /> I I I I1 1 12?41 :D I <br /> I l l l i L- <br /> 1987 UGST FEES I I I I inmI I <br /> 1988 UGST FEES I 1 3001 `Om <br /> 1988 PENALTY 13(001 '0 <br /> I 1 I I 1989 9EULTY 13Q01 I1 1 <br /> I I I I 1 1 1 1 <br /> TOTAL 1 1 724O <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> I I I I I I I I l i l •I I <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I <br /> SPOUSE <br /> LAST FIRST MI TITLE SOC SEC NO. DOB OR LIC NO AUTO LIC NO <br /> • I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> EMPLOYER STREET CITY I ST ZIP CODE <br /> PREPARED BY ~' CHECKED BY DATE <br /> y � ® COL. 2013/8 Sl <br />