EFTA01122969.pdf

STATEMENT Thomas J. Ma Telephon Alvin Gra son a AEON by asS GAM fl it iha mewl SY Si tette b M riltanCeeo»PIR a as beRm IluPwanS MAE Ins OSA Re Oslo Scant 6a Cede Mr. Jeff Epstein Date Ao:ount 9 East 71st Street 4/30/2015 10949 New York NY 10021 Remittance WPORTART MEW DETACH UPPER PORTION MD RETURN WM YOUR REMTITMCE TO INSURE CREW TO PROPER ACCOUNT Date Patient Description Charges Credits Balance Previous Balance 0.00 4/6/2015 60.00 60.00 4/6/2015 180.00 240.00 4/6/2015 200.00 440.00 Account Total 440.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete and return the top part of this statement, or call the office at Current 30 Days 60 Days 90 Days 120+ Days 440.00 0.00 0.00 0.00 0.00 Thomas A Magnani Alvin Gmyson M. EFTA01122969  STATEMENT Thomas J. Maanaai Telephon a payee by ANN NAL at I,. ran MI MO 11010 SI to ilia box awl El NA Odom lissisocard Amu Cads &posts Span Sc CTN. Mr. Jeff Epstein Dale Account 9 East 71st Street 6/3/2015 10949 New York NY 10021 Remittance **OMNI • PLEASE DETACH UPPER PORTONNORETURN WTH YOUR RDATTANCE TO INELRE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 4/30/2015 Previous Balance 440.00 5/11/2015 425.00 865.00 5/11/2015 375.00 1,240.00 5/11/2015 325.00 1,565.00 5/13/2015 2,200.00 3,765.00 5/21/2015 440.00 3,325.00 (41, 'N I CI ‘( 1°q Account Total 3,325.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete rt of this statement, or call the office at Current 30 Days 60 Days 90 Days 120+ Days 3,325.00 0.00 0.00 0.00 0.00 Thomas J. Macneill M. Alvin Grayson M. Floor New York NY 100t9 EFTA01122970