REQUIRO SCIENTIA LLC FIFTH TKIRD BANK P48m BACK R 33480 63.9171/670 7571 05/09/18 ORDER THE OF Blue Cross Blue Shield - • $ "2,199.52 Two Thousand One Hundred Ninety-Nine and 52/100•"""""""`••""""""""""•""' / DOLLARS i Blue Cross Blue Shield 2:Li 34 • ---. 8 Atlanta, GA 30353-8660 PO Box 538660 I .J.r.lot' BUM': 1 in tae 4. Ar-- MEMO • °. ° • " el • D sow ••• •iiMENZENV•• . 4 IM.- . • 1 EFTA00273121 be, ENDORSEHERE DO NOT WRITE. ST•IIP OR SPIN BELOW MIS LINE __• NESERYLU COO F...a•NCiAl. INSTITU• ION U. • ..— .. . .— .. . . ......... ..... ..... ----- .... q5•3 W 0 9 . 9r lir le 7.111 • ... . y W 0 0. 2- W Ce < .1 < < D Z . .3. . :. LL w U w Q2 a w EFTA00273122