REQUIRO SCIENTIA LLC FIFTH TKIRD BANK P48m BACK R 33480 63.9171/670 7571 05/09/18 ORDER THE OF Blue Cross Blue Shield - • $ "2,199.52 Two Thousand One Hundred Ninety-Nine and 52/100•"""""""`••""""""""""•""' / DOLLARS i Blue Cross Blue Shield 2:Li 34 • ---. 8 Atlanta, GA 30353-8660 PO Box 538660 I .J.r.lot' BUM': Ar-- 1 in tae 4. MEMO • °. ° • " el • D sow ••• •iiMENZENV•• . 4 IM.- . • I , 1 EFTA00273121

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