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CPG # TO: Or-TCE OF REVENUE AND RECOVERY <br /> We ACCOUNT TRANSMITTAL y <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 8/8/03 <br /> P <br /> T - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> RANTEE REPAIR SERVICE <br /> C/O NAME IGUARANTOR SSN <br /> BONNIE BERNEISER <br /> MAILING STREET CITY ST ZIP CODEaAREAPH01NIEONO. <br /> 101 COMMERCE ST LODI CA 95240-0845 <br /> RESIDENCE STREET CITY ST ZIP CODE <br /> 12611 E PELTIER RD ACAMPO CA 95220 209-369-8373 <br /> USER REFERENCE NO. IBILL STAI CYCLEI STATUS DATEI BM C8MCj INT MONTHLY PAY AMT <br /> 4649 HAZMAT 7/27/03 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> nQR <br /> SERVICE DATE: DATE OF <br /> START I STOP MED REC NO CHARGE <br /> v/ <br /> CHARGE <br /> NO DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NO <br /> 230 026000.0 2003 Hmmp Annual Fee $240.00 <br /> 5 Chems @ $15.00 Each $75.00 <br /> 10% Late Charge $31.50 <br /> Jw <br /> TOTAL $346.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <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 /> speuss CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <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 /> PREPAR CHECKED BY ,,: ! DATE 8/8/03 <br /> jrn .frLott'� COL. 20 IY88 <br />