EFTA01195207.pdf

2 Account Number id Cornell Pa se 3 Service Date(s) From / Through Statement Date 01/14/15 02/18/15 n c e in fo rm a ti o n o n fi le 7 CHECK/M.O. 6 This is the cu rr e n t in s u ra e rr e c ti o n s o n th e b a c k o f th is fo rm ACCT. BALANCE Please review and mak c o Insurance Name $ V05.22 AMT. ENCLOSED $ 653585A (PC T E R IA N HO S P IT A L NEVVY O R K - P R E S B Y 9 P O B O X 9 3 0 5 , N Y 1 0 0 8 7 - 9 3 0 5 NEW Y O R K 1 1 1 1 1 1 1 1 11 1 1 1 111111 I '1'1'1'11144 EFTA01195207