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# TO: OFFICE OF REVENUE AND RECOVERY <br /> Ah ACCOUNT TRANSMITTAL O ACCOUNT NO. DEPT. N REFERRA1py <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> BUTTE THERAPY SYSTEMS (STKN) <br /> C/O NAME GUARANTOR SSN <br /> CURTIS SAXTON <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1050 N UNION ST STOCKTON CA 95205 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 125 MARK LANE SUTTER CREEK CA 95685 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATEI BMd CBMC1 INT MONTHLY PAY AMT PYMT PROB <br /> ,p FAT TPRRA nATr <br /> 14161 HAZMAT 3/20/10 <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 LARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2010 Hazmat Fee $255.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $25.50 <br /> TOTAL $329.50 <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 /> BUTTE THERAPY SYSTEMS (STKN) <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1050 N UNION ST STOCKTON CA 95205 <br /> SPOU99 CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BUTTE THERAPY SYSTEMS (STKN) <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1050 N UNION ST STOCKTO CA 95205 <br /> REPARED BY CHECKED BY -1/DATE 11//-' <br /> �' �Q coy. zo (aieel <br />