6832 REQUIRO SCIENTIA ISC PALM SOCK PI 3300 PAY70 THE ORDER OF Moo ram Moo Shietd FIFTH THIRD BANK 639171.670 Twin Thnucand Seventy-Twe and 0)I.) 00 Blue Cross Blue Shield PO Box 538660 Atlanta, GA 30353-8660 CMO 11/06/14 5 a $ '1'2,072.82 ***********Illtili******11 *********