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CPG # � - TO: ICE OF REVENUE AND RECOVERY • Copy ACCOUNT TRANSMITTAL ACCOUNT NO. DEPT. NO. ngTp <br /> REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> MASTER AUTO REPAIR <br /> C/O NAME GUARANTOR SSN <br /> CESAR DAVILA <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> MASTER AUTO REPAIR 1803 SHADY FOREST WAY STOCKTON CA 95205-2588 209-464-1935 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3630 GAM BEL OAK LANE STOCKTON CA 95205 209-464-1935 <br /> USER REFERENCE NO. IBILL TAT ICYCLE ISTATUS DATEI Bmcl Csmd INTI MONTHLY PAY AMTPYMT PROB <br /> TrAKAnATF <br /> 13367 HAZMAT 11/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOINARRATIVE <br /> DOB <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2006 - 2009 Hmmp <br /> Annual Fee $280.00 <br /> 3 Chems @ $15.00 <br /> Each Year $180.00 <br /> 10% Late Charge $46.00 <br /> TOTAL $506.00 <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 /> MASTER AUTO REPAIR 209-464-1935 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3091 N WILSON WAY STOCKTON CA 95205 <br /> SPOUSF, 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 /> MASTER AUTO REPAIR 209-464-1935 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 91 N W <br /> ILSON WAY YOGKT CA 95205 <br /> ARE <br /> BY CHECKED BY -- s.- DATE /U COL. 20 (3/88) <br />