EFTA01281880

Extracted Images (2) #

Page 1 #Report

Page 2 #Report

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MUCCrOSS BlueShield              Claims Payment                               IRAS_
Mt
of North Caroltoo'                                                            Cseth                        8.
Vold after Mx Months
issinus     —near •
Potato sono
OtdMat ImPl•Coreins 27702.7201                                                      r12 1 15        15 I
EIGHT HUNDRED FORTY• LYE DOLLARS AND SEVENTY. SEVEN CENTS
PAY
season
TO
THE
ORDER
of
Treanor. Glue Cross siva Clue Shield of North Cnds
Inclopendcal license; of no Oluo Cross end [glue WM Associallon
vhf•MO*Pot NA
SDNY_GM_00036888
CONFIDENTIAL
EFTA_001147501
EFTA01281880
SDNY_Ghl_000361189
CONFIDENTIAL
EFT,00147502
EFTA01281881