7332
Fl H THIRD BANK
REQUIRO SCIENTIA LLC
PALM BEAM Ft 3300 63 9./1/670
11/23/16
6
PAY TONE 1
ORDER OF Blue r roc% flue Shield $ "1.998.59
On* 7h/ult.-Ind Nino Hundred Ninety-Fight and SCl/100"sn*******************"'"*". " ************* COLLARS
Blue Cross Blue Shield
PO Box 538660
cett 8
la CIE
I Atlanta, GA 30353-8660
1OOC:
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CREDIT ACCT OF NAMED PAYE
ENDORSEMENT GUARANTEED BY BUT CHARLOTTE NC
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