Laserfiche WebLink
r <br /> CPG # TO: ICE OF REVENUE AND RECOVERY • <br /> ACCOUNT TRANSMITTAL co <br /> '1 �yfACCOUNT NO. DEPT.NO. REFERRII�UUII�026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> 98 CENTS'N DEALS <br /> C/O NAME GUARANTOR SSN <br /> JASON MATECKI <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 98 CENTS'N DEALS 3401 CONANT AVE MODESTO CA 95356 209-345-4371 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3401 CONANT MODESTO CA 95356 209-345-4371 <br /> USER REFERENCE NO. I BILLI STA CYCLE1 STATUS DATE BM CBMC INT I MONTHLY PAY AMT <br /> 12659 HAZMAT I I I I I I I I I I I I I I I I I I 1 11/6/06 <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 /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NONQ <br /> 230 026000.0 2005-2006 Hmmp <br /> Annual Fee $480.00 <br /> 2 Chems C $15.00 Ask <br /> Each Year $60.00 <br /> 10% Late Charge $54.00 <br /> TOTAL $594.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> 98 CENTS'N DEALS 209-345-4371 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1010 SHAW RD STOCKTON CA 95215 <br /> 9PeUSE CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> 98 CENTS'N DEALS 209-345-4371 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1010 SHAW RD STOCKTON CA 95215 <br /> PREPARED B� ;/ CHECKED BY DATE '^ <br /> 7` COL 20 l&88 <br />