Extracted text (via ocr_local)
850 characters
BLUE CROSS BLUE SHIELD OF ARIZONA, INC 346797
GENERAL ACCOUNT
i} PO Box 13466 * Phoenix, AZ 85002-3466
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i i . Check 416123
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aware # DATE REFERENCE GROSS AMOUNT | DISCOUNT | NET AMOUNT
REPLACEMENT CHIECK - ji/23/17 06/18/20 | ATTACH - 14179AW; 1,500.00 | 0.00| 1,500.00
ss
VENDOR 1D: VENDOR TOTALS
11090 MARICOPA COUNTY 1,500.00 0.00 4,500.00
| fsa) BlueCross
inl (3) BlueShield 416123
Ba. “SZ” of Arizona 91-527
1221
{An Independent Liovnsey of the Blue Cruss und Blue Shicld Awoctation
PO Box 13466 Phoenix, AZ 85002-3466 VENDOR ID: 11090 DATE 07/13/20
Void 6 months from Issue date.
PAY THE SUM OF ONE THOUSAND FIVE HUNDRED DOLLARS AND ZERO CENTS*****
PAY MARICOPA COUNTY grrr 500.00
ong Sheriffs Office
FR 550 W Jackson Street 4th Floor BY
Phoenix,AZ 85003 _
Wells Fargo Bank, NA ; (BOM
“wh kB 2 ai" WhecbOoe Pay BbeS?POLLGOW