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CPG"# TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ` I ACCOUNT NO. DEPT. NO. REFERRAL ❑ <br /> 026000.0 <br /> LAST GUARANTOR FIRST MI TITLE LAST - AKA FIRST MI TITLE <br /> JASON'S WHOLESALE 1 11 1 111 <br /> CIO NAME GUARANTOR SSN <br /> JASON MATECKf <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2540 STATION DR DSTOCKTON CA 95215 2093454371 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2540 STATION DR. SUITE C&D STOCKTON CA 95215 2093454371 <br /> USER REFERENCE NO. SILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT PYN1TIP nAT' PROS <br /> 14198 HAZMAT3120110 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> Rill 1111111 <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE Kin DEPT. NO, DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2010 Hazmat Fee $315.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $31.50 TIT,h <br /> fi <br /> TOTAL $395.50 <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 /> JASON'S WHOLESALE 2093454371 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2540 STATION DR D STOCKTON CA 95215 <br /> S�A�3S� CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO, DOB DR LIC NO AUTO LIC NO <br /> I 1 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JASON'S WHOLESALE 2093454371 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2540 STATION DR STOCKTO CA 95215 <br /> PREPARED BY CHECKED BY DATE COL. 20 (3!881 <br />