EFTA01122975.pdf

STATEMENT Thomas J. Mae Alvin Grayson payAg by cesSi art est the sawn you we wee h he nivitanc• bra ald Maui belay IAsierraint Vai Amu Cord* EN+ ON* Span Sc Code Mr. Jeff Epstein Dale Account 9 East 71st Street 1/7/2015 10055 New York NY 10021 Remittance IMPORTANT - PLEASE COACH UPPER PORTION MO RETURN WITH YOUR RSUNTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 11/26/2014 Previous Balance 0.00 12/15/2014 40.00 40.00 12/15/2014 180.00 220.00 12/18/2014 425.00 645.00 q. S . A . \ Account Total 646.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards! You may complete and return the art of this statement, or call the office at Current 30 Days 60 Days 90 Days 120+ Days 646.00 0.00 0.00 0.00 0.00 Thomas J. Moroni Alvin Grayson MI. M. EFTA01122975  STATEMENT Thomas J. Ma TelephomIMM Alvin Grayson IIpaying by ail OWL INNM inset yaw on IMMO r h• erittana box aid re eta Sent Phieletainf IAN Mtn Cards Exp OMs Sonata Sig CoSe Mr. Jeff Epstein Date Account 9 East 71st Street 7/1/2015 10055 New York NY 10021 Rernittanco &PORTANT • PLEASE DETACH UPPER PORTIONMO FtETURN WIN YOUR RECNCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 6/3/2015 ce 0.00 6/16/2015 180.00 180.00 6/16/2015 40.00 220.00 6/16/2015 180.00 380.00 6/16/2015 750.00 1,130.00 de a l a -tic_ 061- 42. )1 006669 f(“' -7 f I S (1SP Account Total 1,130.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete art of this statement, or call the office atiliallOr Current 30 Days 60 Days 90 Days 120+ Days 1,130.00 0.00 0.00 0.00 0.00 Thorn's J. MartiniMI. ANIn GraYsonS EFTA01122976  STATEMENT Thomas J. Ma . Spaying by asa cat ever Pe anon) YOU WO PON) In h isMum Goa ad R out WM. MateWO Ws. AMP, Cads Tap Dais Wars Sp Cc* Mr. Jeff Epstein Date Account 9 East 71st Street 3/30/2016 10055 New York NY 10021 RomIttanoo INPORTANT - PLEASE DETACH UPPER PORTION AND RERAN WIN YOUR REACTANCE 70 INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 3/2/2016 Pre • ... ;.....nce 0.00 3/21/2016 40.00 40.00 3/21/2016 180.00 220.00 3/21/2016 450.00 670.00 3/21/2016 160.00 830.00 ‘ ( I ( C ° 6 r Account Total 830.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards) You may complete and return the to • part of this statement, or call the office at Current 30 Days 60 Days 90 Days 120+ Days 830.00 0.00 0.00 0.00 0.00 Thomas J. Magnanl S Min Grayson M. EFTA01122977