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CPG # TO: IttJJ��' <br /> ICE OF REVENUE AND RECOVERY • <br /> ACCOUNT TRANSMITTAL COLF <br /> jACCOUNTNO. DEPT. NOREFERRAL V <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> AMESSA AUTOMOTIVE CENTER <br /> C/O NAME GUARANTOR SSN <br /> JOSE PADILLA VILLA <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3943 N WEST LN STOCKTON CA 95204-2435 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> USER REFERENCE NO. BILL TAT CYCLE I STATUS DATE I BMd CBM INT MONTHLY PAY AMT PYMT I PROS <br /> 3686 HAZMAT 1.11/,15/091 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Nin230 026000.0 2009 Hmmp Annual Fee $70.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $11.50 <br /> AG <br /> to <br /> TOTAL $126.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> AMESSA AUTOMOTIVE CENTER <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3943 N WEST LN STOCKTON CA 95204-2435 <br /> SPAU,S& CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> AMESSA AUTOMOTIVE CENTER <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3943 N WEST LN STOCKTON CA 95204-2435 <br /> REPARED BY CHECKED BY JDATE / /�� COL 20 (3188) <br />