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C # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL Corry <br /> REFERRAL <br /> ACCOUNT NO. DEPT. Nb. <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> VALLEY TOWING PRODUCTS <br /> C/O NAME GUARANTOR SSN <br /> RMP TOWING <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1300 E VINE ST #3&#4LODI CA 95240 209-368-8881 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2250 THUNDERSTICK DR STE 1203 LEXINGTON KY 40505 859-294-5590 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBMd INT MONTHLY PAY AMT PYMT PROBI <br /> 14403 HAZM AT 3/20/11 <br /> CHARGES <br /> LAST - RECIPIENT FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> QQIa <br /> SERVICE DATE: DATE OF <br /> E380 <br /> STOP MED REC NO CHARGE <br /> DEPT. NO. DESCRIPTION AMOUNT HARGE DE <br /> DESCRIPTION AMOUNT <br /> 042000.0 2011 Hazmat Fee $85.00 LL <br /> 042000.0 State Surcharge Fee $24.00 <br /> 042000.0 Electronic Surcharge $25.00 042000.0 Hazmat Penalty Fee $8.50 1, <br /> 380 042000.0 <br /> 380 042000.0 <br /> 380 042000.0 <br /> TOTAL $142.50 <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 /> VALLEY TOWING PRODUCTS 209-368-8881 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1300 E VINE ST#3& #4 LODI CA 95240 <br /> SPAUSrh- CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I 1 I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> VALLEY TOWING PRODUCTS 209-368-8881 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1300 E VINE ST#3&# LO , CA 1 95240 <br /> REPARED BY CHECKED BY ATE coL. zoQ(3/W) <br />