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CPG # T0: OFICE OF REVENUE AND RECOVERY 0 ((''�� <br /> ACCOUNT TRANSMITTAL C O u <br /> ACCOUNT NO. DEPT.NO. REFERRAL y <br /> ATE <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> AGCO PARTS DISTRIBUTION CTR <br /> C/O NAME GUARANTOR SSN <br /> AGCO CORP <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1648 N SHAW RD STOCKTON CA 95215-4019 209-466-4961 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1500 N RADDANT RD BATAVIA IL 60510 630-406-3400 <br /> USER REFERENCE NO. I BILL STAA CYCLE STATUS DATE BMC CBMC INT I MONTHLY PAY AMT Ip,',MA'TF I TERM DATE <br /> 1756 HAZMAT 3115108 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> DOB <br /> SERVICE DATE: DATE OF <br /> FNO <br /> STOP MED REC NO CHARGE <br /> DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 026000.0 2008 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 /> `f , ' <br /> • i <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 /> AGCO PARTS DISTRIBUTION CTR 209-466-4961 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1648 N SHAW RD STOCKTON CA 95215-4019 <br /> 8£eUSB CO-OWNER <br /> LAST FIRST MI TITLEJ SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> AGCO PARTS DISTRIBUTION CTR 209-466-4961 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1648 N SHAW RD STOCKTON CA 95215-4019 <br /> PREPARED B _ CHECKED BY -DATE 3 �� coy. 20 El <br />