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CPG- # TO: BICE OF REVENUE AND RECOVERY ACCOUNT TRANSMITTALCOPY <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> nAT <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> G AND S OF JIMCO <br /> C/O NAME GUARANTOR SSN <br /> SUKHDER SINGH <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> G AND S OF JIMCO 2717 CANYON DR MODESTO CA 95351 209-599-7261 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 15420 W AUGUST AVE DELHI CA 95315 209-599-7261 <br /> USER REFERENCE NO. IBILLI STA CYCLEI STATUS DATEI BMd CBMC INT I MONTHLY PAY AMTYMT PROS 111 IPF QATF TERM DATE <br /> 8802 HAZMAT 2123105 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENTDOB USER REFERENCE NOMARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NONO <br /> 230 026000.0 2005 Hmmp Annual Fee $240.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $27.00 <br /> State Service Fee $24.00 <br /> TOTAL $321.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> G AND S OF JIMCO 209-599-7261 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1022 HIGHWAY 99 FRONTAGE RD RIPON CA 95366 <br /> SPASSH CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> G AND S OF JIMCO 209-599-7261 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1022 HIGHWAY 99 FRONTAGE RD RIPON CA 95366 <br /> PREPARED BYE I CHECKED BY q DATEz y oS COL. 20 1388 <br />