7321
FTFTH THIRD BANK Q==
REQUIRO SCIENTIA LLC
PALM BEACH. FL 33480 639171/670
10/28/16
1
PAYTOTHE
080ER OF Mut' rrncc Ririe Shield $ -1.998.59
1
nne Thnoicanri Nine Hundred NInetv-Raht and 59/100*****************"'"'" fin vs
Blue Cross Blue Shield
PO Box 538660 r4rArt. 8
Atlanta, GA 30353-8660
/ 3t7114•
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EFTA00272701
CREDIT ACCT OF NAMED PAYEE
,ENDORSEMENT GUARANTEED BY BBST CHARLOTTE NC
EFTA00272702