en Hundred Thirty-Six and 00/100."'" DOLLARS Insurance Office of Central Ohio 165 W. Main Street 8 PO Box 780 New Albany. OH 43054-0780 c1/417>LAASAA MEMO Policy 0021940015 invoice # 233037 IZED SIONA co CV c9 N v- 90 2 >- I z O I o0 ul 76 ci LL D .J Q I= lZ Z W W O O LL ir. Z z O