EFTA00272701

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REQUIRO SCIENTIA LLC PALM BEACH. FL 33480 FTFTH THIRD BANK 639171/670 7321 Q== PAYTOTHE 080ER OF Mut' rrncc Ririe Shield 10/28/16 $ -1.998.59 1 1 nne Thnoicanri Nine Hundred NInetv-Raht and 59/100*****************"'"'" fin vs 8 Blue Cross Blue Shield PO Box 538660 Atlanta, GA 30353-8660 -- r4rArt. / 3t7114• 'rap •. EFTA00272701

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