2019-07-27 16:24:02 ATM Terminal ID: 80012011 Transa CARD: Signerl: ROBERTO GRIJALVA Signer2: CHARLENE NIEVES I $76.50 EFTA00133442 III:l United Sorviceg Automobill Assoc! PO Box 33498, u • Ban Antonio, *PIC 78265 PAT **Seventy-six end 50/100 TO ROBERTO ORIJALVA THE ORDER OP: ULLA lit 4170077