Laserfiche WebLink
CPG # TO: O:�CE OF REVENUE AND RECOVERY COPY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CENTURY AUTO COLLISION <br /> C/O NAME GUARANTOR SSN <br /> NORMA CORTES <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3128 E FREMONT ST STOCKTON CA 95205 209-464-7226 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 745 W HARDING WAY STOCKTON CA 95204 209-430-7226 <br /> USER REFERENCE NO. I BILLI STATI CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> DATF TERM DATE <br /> 7700 HAZMAT 4/15/06 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE REDOB CIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NO <br /> 230 026000.0 2006 Hmmp Annual Fee $240.00 <br /> 1 Chem @ $15.00 $15.00 <br /> 10% Late Charge $25.50 <br /> State Service Fee $24.00 <br /> Sm Hw Gen <5 Tons $200.00 <br /> Permit Fee Penalty $200.00 <br /> TOTAL $704.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CENTURY AUTO COLLISION 209-464-7226 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3128 E FREMONT ST STOCKTON CA 95205 <br /> OFeUOB CO—OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. I DOB I DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CENTURY AUTO COLLISION 209-464-7226 <br /> EMPLOYER STREET CITY ST T ZIP CODE <br /> 3128 E FREMONT ST STOCKTON CA 95205 <br /> PREPARED B`� CHECKED BY JDATE 6'12 0 / 1 COL 20 tees <br /> � b <br />