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LPG #' TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> nATF <br /> 11 11 , 111 , 11 026000.0 7112102 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA FIRST MI TITLE <br /> COMPLETE AUTO BODY&PAINT <br /> CIO NAME GUARANTOR SSN <br /> DAVID BEAKY JR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 335 S WETMORE ST #5 MANTECA CA 95337-5700 209-825-7250 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-825-7250 <br /> USER REFERENCE NO. BILL STA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> n'1E QATF TERM DATE <br /> 9174 HAZMAT 5129102 <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 CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NO <br /> 230 026000.0 1999-2002 Hmmp Annual Business Owner: <br /> Fees @ 240.00 Per Year $960.00 David Beary r <br /> 2 Chems @ $15.00 Each <br /> Per Year-1999-2002 $120.00 <br /> 1999-2002 10% Late Fee <br /> @ $27.00 Per Year $108.00 <br /> Total 4 Years <br /> TOTAL $1188.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO��j <br /> PREOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COMPLETE AUTO BODY&PAINT 209-825-7250 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 335 S WETMORE ST#5 MANTECA CA 95337-5700 <br /> IgE CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COMPLETE AUTO BODY&PAINT 209-825-7250 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 335 S WETMORE ST#5 MANTECA CA 95337-5700 <br /> PREPARE BY CHECK DATE 7112/02 <br /> COL. 20 (3188 <br />