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CPG # TO: --VICE OF REVENUE AND RECOVERY <br /> lo., ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT. NO. REERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> GUARANTEE REPAIR SERVICE <br /> C/O NAME GUARANTOR SSN <br /> BONNIE BERNEISER <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> GUARANTEE REPAIR SERVICE P.O. BOX 246 VICTOR CA 95253-0246 209-339-1100 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONENO. <br /> 12611 E PELTIER RD ACAMPO CA 95220 209-369-8373 <br /> USER REFERENCE NO. IBILL TAT CYCLE STATUS DATEI BMd CBMd INTI MONTHLY PAY AMTYMT 8 <br /> 4649 HAZMAT 3/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> E2330 <br /> DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 4 Chems @ $15.00 Each $60.00 <br /> 10% Late Charge $30.00 <br /> State Service Fee $24.00 <br /> Sm Hz Gen <5 Tonstyr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $780.00 <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 /> GUARANTEE REPAIR SERVICE 209-339-1100 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 101 COMMERCE ST LODI CA 95240-0845 <br /> SPQUST� CO-OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GUARANTEE REPAIR SERVICE 209-339-1100 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 101 COMMERCE ST LODI CA 95240-0845 <br /> PREPARED BY I CHECKED BY 12ATE COL. p r3W) <br />