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ount Ending 0-13001 Detail Continued Amount 07/13/12 AMERICAN EXPRESS TVLPHOENI X AZ DELTA AIR LINES INC. From: To: BOZEMAN SALT LAKE CITY ALBUQUERQUE SALT LAKE CITY BOZEMAN Carrier. Class: DL DL DL A DL A $900.20 Ticket Number: 00670760047064 Date of Departure:07/27 Passenger Name: HO
a Physician. The following items are hereby removed from the TERMINATION or CANCELLATION section: the date the Covered Person no longer maintains a Permanent Residence in the 50 United States of America, the District of Columbia, Puerto Rico or the U.S. Virgin Islands; the date We determine that the Covered Person
7/14/12 07/14/12 Amount AMERICAN EXPRESS TVLPHOENIX AZ DELTA AIR LINES INC. $900.20 From: To: Carrier: Class: BOZEMAN SALT LAKE CITY DL ALBUQUERQUE DL SALT LAKE CITY DL A BOZEMAN DL A Ticket Number: 00670760047064 Date of Departure:07/27 Passenger Name: HORNER/JOHN ROBERT Document Type
a Physician. The following items are hereby removed from the TERMINATION or CANCELLATION section: the date the Covered Person no longer maintains a Permanent Residence in the 50 United States of America. the District of Columbia. Puerto Rico or the U.S. Virgin Islands; the date We determine that the Covered Person
W YORK NY 212-546-9220 $1,715.00 07/30/12 COMMON GROUNDS WACO TX 254-757-2957 Description FAST FOOD REST $75.00 07/31/12 APPLE STORE 177 ALBUQUERQUE NM COMPUTER STORE $213.95 07/31/12 SPORTS AUTHORI005017ALBUQUERQUE 8006668143 NM $221.44 07/31/12 THE HOME DEPOT 3501 ALBUQUERQUE NM $320
a Physician. The following items are hereby removed from the TERMINATION a CANCELLATION section: the date the Covered Person no longer maintains a Permanent Residence in the 50 United States of Amenca. the District of Columbia. Puerto Rico or the U.S. Virgin Islands: the date We determine that the Covered Person o
0-12003 Detail Continued Foreign Spend Amount 04/28J I 2 ORBITZ MANKATO MN US AIRWAYS INC. From: To: Carrier Class: PHOENIX SKY HARBOR ALBUQUERQUE US WA YY 00 WA YY 00 WA YY 00 Ticket Number 03770008665640 Date of Departure: 04/30 Passenger Name: MARTIN/CRAIG Document Type: PASSENG
a Physician. The following items are hereby removed from the TERMINATION or CANCELLATION section: the date the Covered Person no longer maintains a Permanent Residence in the 50 United States of America. the District of Columbia. Puerto Rico or the U.S. Virgin Islands. the date We determine that the Covered Person
Date of Departure: 03/25 $1.379.20 03/25/13 AMERICAN EXPRESS 1VLPHOENIX AZ UNITED AIRLINES From: To: N.Y. NEWARK INTL A CHICAGO O'HARE INT ALBUQUERQUE DENVER INTL APT N.Y. NEWARK INTL A Ticket Number 01672160298303 Passenger Name: INDYKE/DARREN Document Type: PASSENGERIKKET Carrier. Class: U
re and supervision. Coverage will be extended for as long as such child is incapacitated, unmarried and dependent.). All Covered Persons must have a Permanent Residence within the 50 United States of America, the District of Columbia, Puerto Rico. or the U.S. Virgin Islands. All other persons are not Covered Person
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