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CPG '# TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> WEST VALLEY MALL <br /> C/O NAME GUARANTORSSN <br /> GENERAL GROWTH PROPERTIES <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3200 N NAGLEE RD STE 515TRACY CA 95304 312-960-5000 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 110 N WACKER DR CHICAGO IL 60606 312-960-5000 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMI CBMI INT MONTHLY PAY AMT YM PROB <br /> 9595 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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2010 Hazmat Fee $85.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $8.50 h �' <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 /> WEST VALLEY MALL 312-960-5000 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3200 N NAGLEE RD STE 515 TRACY CA 95304 <br /> SPOUS& 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 /> WEST VALLEY MALL 312-960-5000 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3200 N NAGLEE RD STE 515 TR CY CA 95304 <br /> REPARED BY CHECKED BY DATE y1AA1Lj Coy. 20 (3M) <br />