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CPG �1 .--> _ TO: OFFICE OF THE COLLECT( 1 ACCOUNT TRANSMITTAL ACCOUNT NO. DEPT. NO. DATE _ -------- ----- 041000 :�1 1.,7! tI LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE 9A�I-,F PVIMQTIO I I I I I I I I I I I I I I I I I I I I 1 111111111111111111 I I I C/O NAME GUARANTOR SSN I I l l l l l t l I I I MAILING STREET CITY ST ZIP CODE AREA PHONE NO. �oI 9 I I I I I I I STOCKTON I I I I I C 95202: I RESIDENCE STREET /� �/ CITY ST ZIP CODE AREA PHONE NO. Op E NAI I I I I I I I I STOCKTO Z I I I Ipil I 95?Q21I III I I I II CY- CB PVMT PROS USER REFERENCE NO. BILLFTAI STATUS DATE MC INT rAUrrT 11LV 1rAV AfnT TEF CLE M DUE DATE_ TERM DATE _— I I I I I I I I I I I I FACILITY #006215 CHARGES LAST - RECIPIENT - FIRST MI TITLE JV„ USER REFERENCE NO NARRATIVE SERVICE DATE: r.AiF „F START STOP MED REC NO "Arn'E I E DESCRIPTION AMOUNT F ARCE DEPT NO DESCRIPTION dU NO 380 041000I ?0 b0 - , 10aI 1l333-1997-TANK— 1999 "ACT-UlY 1998 STATEF i I I I I I I I I FEE I I Ila :So 11 I I I I I : 1999 STATE SURCHARG , 1 „ 81 : q0 1998 TANK FEE I 1 117q ;OP i i I I I I I , 1998 TANK. PENALTY 11701 0 I i 1 1998 STATE SURCHARGE 8 00 1999 TANK FEE I I 117Q '0 I I I I I TOTAL 2424 ' 511) I I I _ _GUARANTOR DOB OR LIC NO AUTO LIC NO PRIOR STREET CITY ST ZIP CODE I EMPLOYER NAME EMPLOYER PHONE NO I l l l l l l t l l l l l I I I I I I I I I I I I I I I I I I I EMPLOYER STREET CITY ST ZIP CODE I I I I I I I I I I I I I I I I I I I I I I 1 1 1 1 1 1 1 I I I I I I I I I SPOUSE--- L AST POUSE _LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO EMPLOYER NAME EMPLOYER PHONE NO I I I I I I I I I I EMPLOYER STREET — I CITY _ ST ZIP COLE PREPARE',1 ( CHECKED .87 DATE . COL. 20 (3'1 5)