Laserfiche WebLink
CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> Aek ACCOUNT TRANSMITTAL <br /> "C (aFly <br /> ACCOUNT NO. DEPT.N REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST AKA FIRST MI TITLE <br /> CENTER AUTO REPAIR it I I I 1= I I I I L <br /> C/O NAME GUARANTOR SSN <br /> HA TRAN <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1587 TURNPIKE RD STOCKTON CA 95206 209-948-0832 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1551 PRAIRIE LN STOCKTON CA 95209 209-948-0832 <br /> PYMT PROB <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT Tppm- ATP <br /> 6890 HAZMAT 3/20/10 <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 /> CHARGE11 DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2010 Hazmat Fee $130.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $13.00 <br /> TOTAL $192.00 <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 /> CENTER AUTO REPAIR 209-948-0832 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1587 TURNPIKE RD STOCKTON CA 952.06 <br /> 64QU89 CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIG NO AUTO LIC NO <br /> I I E <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CENTER AUTO REPAIR 209-948-0832 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1587 TURNPIKE RD STOCKTON CA 95206 <br /> PREPARED B CHECKED BY DATE y/a3Jic COL. 20(3788) <br />