EFTA01122961.pdf

STATEMENT Thomas J. Maar Telephone: Alvin Grayson peetho by ctedil MIL erne, the ,mew you ere pow., el OM fellablell Maw' Po ou 001m Itesseard Vaa AREA Card • ENE OS Snneture Sc Code Mr. Jeff Epstein Date Account 9 East 71st Street 1/7/2015 10765 New York NY 10021 RemItbnce IMPORTANT • PLEASE DETACH UPPER PORTION ARO RETURN WITH YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 11/26/2014 Previous Balance 0.00 12/22/2014 2,100.00 2,100.00 ItZ,8O/ Account Total 2,100.00 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 2,100.00 0.00 0.00 0.00 0.00 Thomas J. Magnanl Alvin Grayson=. 212)688.1090 EFTA01122961  HISTORICAL STATEMENT 2/3/2015 to 3/17/2015 Thomas J. Ma Telephone Alvin Grayson Mr. Jeff Epstein Date Account 9 East 71st Street 3/17/2015 10765 I New York NY 10021 Remittance L__ DIPORTANT PLEASE DETACH UPPER PORTKM MD RETURN WTI YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 1/29/2015 Previous Balance 0.00 2/3/2015 325.00 325.00 3/3/2015 375.00 700.00 316/2015 25.00 725.00 3/6/2015 24.00 749.00 Account Total 749.00 Patient Charges 749.00 Patient Payments 0.00 Patient Credits 0.00 Patient Debits 0.00 We accept credit cards! You may complete and return the top part of this statement, or call the office at 212-688-1090. Current 30 Days 60 Days 90 Days 120+ Days 424.00 326.00 0.00 0.00 0.00 Thomas 3. MagnaniM. Alvin Grayson-. EFTA01122962  STATEMENT Thomas J. Ma Telephone: ■psylns by NAM cat AMR RP want )0./ Ns pmts., Tr weidpnos box aid SI mg Dorm hissloncartl Arno* Caen Els OM. Sonserp CPS Mr. Jeff Epstein Date Account 9 East 71st Street 4/30/2015 10765 New York NY 10021 Remittance IMPORTANT • PLEASE DETACHUPPER PORTIONNCRETURN NTH TOUR REMITTANCE TO INSURE CRITOIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 3/26/2015 Previous Balance 0.00 3/27/2015 180.00 180.00 3/27/2015 40.00 220.00 4/10/2015 7,500.00 7,720.00 j41 BS' cf Gol .ii 0 A. , Soot" 2 oc., 'co Account Total 7,720.00 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 a Current 30 Days 60 Days 90 Days 120+ Days 7,720.00 0.00 0.00 0.00 0.00 Thomas J. Magnate= Alvin Grayson M. EFTA01122963  STATEMENT Thomas J. Ma Telephone Alvin Gra so Ir c.Si a ty =it card. ever the crawl yca as pratIn x reancsa be' and ra our treaw. Mau/scam Vsa Amex Card • Erc Dna Warta aa Co* Mr. Jeff Epstein Date Account 9 East 71st Street 3/2/2016 10765 New York NY 10021 Remittance ta.PORTANT P.Caaa DETACH UPPER PORIION AND RETURN witirYoun REM-RANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 1/27/2016 Previous Balance 0.00 2/25/2016 40.00 40.00 2/25/2016 160.00 220.00 2/25/2016 0.00 220.00 Account Total 220.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards! You may complete this statement, or call the office Current 30 Days ! 60 Days 90 Days 120i. Days 220.00 0.00 0.00 0.00 0.00 Thomas J. Magoon'''. Alvin Grayson_. 7 EFTA01122964  STATEMENT Thomas J. Ma nani Telephone Alvin Grayson poVrai by opal cant MIN foe amount yco aro psying M To roma:Ana boo a4 Si OA teCIY. Wavercons via Miss Card el Tip Dite ScnotNe SC CoLo Mr. Jeff Epstein Date Account 9 East 71st Street 4/27/2016 10765 New York NY 10021 Remittance ATPORTNJT • PLEASE OETACIT LAVER PORDON ANO RETURN WIN YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 3/30/2016 lance 0.00 4/6/2016 1,100.00 1,100.00 tf (6 sA (Pk t O° 1 &- kliv „turf el 17;51- Account Total 1,100.00 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 a Current 30 Days 60 Days 90 Days 120+ Days 1,100.00 0.00 0.00 0.00 0.00 Thomas J. Magnani=1. Akin Grayson- EFTA01122965