6832
REQUIRO SCIENTIA ISC FIFTH THIRD BANK
PALM SOCK PI 3300 639171.670
11/06/14
5
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PAY70 THE
ORDER OF Moo ram Moo Shietd $ '1'2,072.82
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Twin Thnucand Seventy-Twe and 0)I.) 00 NO. I ARS i"
Blue Cross Blue Shield
PO Box 538660 8
Atlanta, GA 30353-8660
CMO
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0'00683 20 1:06 70 9 is 7/ RI: 74338123230
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CREDIT ACCT CC NAMED PAYEE 0005211513537 0
ENDORSEMENT GUARANTEED BY BB&T CHARLOTTE NC
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