NES, LLC 6100 RED HOOK QUARTER, 83 ST. THOMAS 00802 PAY TO THE ORDER OF The State Insurance Fund •IirraCOMITIVIIPINIS DEUTSCHE BANK TRUST COMPANY AMERICAS NEW NEWYORK 1 154 CM6 6/14/2017 $"197A8 One Hundred Ninety-Seven and 48/100*"'"************"*************"*"*"*************"*".****' DOLLARS The State Insurance Fund Disability Benefits P.O. Box 5239 New York, NY 10008-5239 MEMO ,Poiicy_No. 2674,13-4 (06/02/14) 11'00 L 29 511' I:0 2 LOO LO 331: AU11-1ORIZED SI GNATU 8 a. a 2 FFO O it a r F- 2 Z LL/ /LI LI 0 LL z z OO EFTA01350158