Laserfiche WebLink
NMENTAL HE, (DEPARTMENT Report#5021 <br /> ~' <br /> ation as of 2/20/2013 Paget <br /> Make changesicorrections in RED ink. <br /> C' rj INFORMATION CHANGE(date) <br /> - OWNERSHIP CHANGE(date) <br /> .1 is jj; <br /> C7 t„ SSN/Fed Tax ID <br /> New Owner ID <br /> y ♦ ip C F. <br /> i`' • li t.7lG <br /> 4: w C' _ <br /> I.tl z t C <br /> q,h 67 <br /> 1/I 'CC <br /> I•;u C LJlu w[i <br /> :h.v C U7 <br /> IF.Yk 1/I rx 1,7 <br /> I—. <br /> :t 1. <br /> ur u: ce <br /> p J y f::z 1p a(]I.;I— ... <br /> Cn WrWj tti -tD4w.LU <br /> 11 eq LA, <br /> LU <br /> w it <br /> -(RaA2(Lr D !�sFD o v 7f1{zCe6 I <br /> a ZI � All Phone <br /> �t(*) Fax <br /> u`t) EMail: <br /> E z LL. <br /> w <s <br /> E~ <br /> x <br /> a <br /> rel Z ,� o y New Account ID: <br /> F O ¢ wo Mail Invoices to: Owner / Facility / Account <br /> cr, W <br /> 2 (Circle One) <br /> A I.WI.I F� N E (d <br /> N•1 OI x . y (Circle One) <br /> Fir, Q . U N Transfer to Activefinaclve <br /> O W c C me Status New Owner? Delete <br /> oC <br /> ti15 c Y N A I D <br /> 19 F zMIE DE LA ROSA Active <br /> 22 z -al '" o ¢ [IS CACAPIT Active Y N A I D <br /> 22 <br /> 23 Z Z MAT SJC DES Inactive Y N A 1 D <br /> EF <br /> Z MAT SJC OES Inactive Y N A I D <br /> O Inactive Y N A I D <br /> BILI edge that all site,andror project speck,PHSIEHD hourly charges associated with this facility <br /> ora <br /> Fed ormed in accordance with all applicable Ordinance Codes anNor Standards and State andlor <br /> 17 <br /> z <br /> W <br /> AP Date <br /> Pro _..._. _.._ q,zo.uu= Amount Paid Date <br /> Water System to be TRANSFERED: _ Amount Paid Date <br /> Payment Type Check Number Receive <br /> REHS: D/a�tte� �/ / Account out: _ Date <br /> f / <br /> COMMENTS: �����'li"`i_ " —./' ''/"�"`�' (/'I� (�����/7✓~__l <br />