F REQUIRO SCIENTIA LLC PALM kli ”..e4 63.9171/670 RLHo rrncc Mom Shield FIFTH THIRD BANK wain:r= 07/20/17 $ —1.040.88 One Th„„„ nd Fnny and Rai Inn.....•••••*****************triVIretr*******4*******•*********************Ipleint 'nun Blue Cross Blue Shield PO Box 538660 Atlanta, GA 30353-8660